Spontaneous subdural hematoma in a young COVID-19-confirmed patient without comorbidities: A case report

The majority of acute subdural hematomas are due to trauma, and cases of spontaneous subdural hematoma are rare. This report aims to provide an overview of subdural hematoma associated with COVID-19 virus. We described a case of a 22-year-old female without comorbidities and confirmed COVID-19 with spontaneous subdural hematoma on non-contrast computed tomography scan. This was the first case encountered in our hospital. There is no published cases yet in the Philippines. Mechanisms linking cerebrovascular events to COVID-19 are hypothesized. First, it has been postulated that COVID virus is neurotropic toward angiotensinogen-converting enzyme-2 receptors and it can invade and directly damage cerebral vessels. Second, entry of the virus into the cells results in marked reduction in angiotensinogen-converting enzyme-2 levels which could contribute to the development of intracranial hemorrhage. Third, COVID-19 patients usually develop a systemic hyperinflammatory syndrome characterized by fulminant hypercytokinemia which may mediate vascular remodeling and predispose to intracranial hemorrhage. COVID infection should be considered as one of the differentials in patients presenting with neurological symptom. More research needs to be performed to understand the pathogenic mechanisms behind each of these disorders and better treat such patients with suitable drugs in a timely manner.