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Critical illness-associated cerebral microbleeds: What we learned after the COVID-19 pandemic. A systematic review
Eduardo Mariño1, Carlos Hervás1, Manuel Lorenzo1
1Neurology Department and Stroke Center, Hospital La Paz Institute for Health Research, IdiPAZ (La Paz University Hospital), Universidad Autónoma de Madrid, Madrid, Spain.
Background:
Cerebral microbleeds in critically ill patients have been a reported complication of COVID-19. However, they have also been described in patients with other respiratory infections and conditions requiring intensive care unit (ICU) admission. Here, we aim to describe the clinical characteristics of critical illness-associated cerebral microbleeds and compare COVID-19 cases with those related to other conditions.
Methods:
We performed a systematic literature review in PubMed and Embase for Critical Illness-Associated Cerebral Microbleeds to describe the clinical characteristics of this entity, in both COVID-19 and non-COVID-19 patients.
Results:
Of 157 manuscripts screened, 23 were included, totalling 143 cases (median age 61, interquartile range [IQR] 54-66), 104 (73 %) men. SARS-CoV2-associated pneumonia was found in 105 (73 %) cases. The median ICU stay was 34 (IQR 26-42) days and the median mechanical ventilation time was 24 (IQR 14-35) days. Cerebral microbleeds were more frequently juxtacortical (79 %) or located in the corpus callosum (75 %) and deep white matter (71 %) for both COVID-19 and non-COVID-19 individuals, whilst brainstem location was more frequent in non-COVID-19 patients (37 % vs 13 %; p = 0.02). Non-COVID-19 patients were younger (median age 42, IQR 30-54 years) than COVID-19 patients (median age 62, IQR 57-67 years; p < 0.001), and the median platelet count was significantly higher (200,000; IQR 116,000-284,000 ng/dL) in COVID-19 patients than non-COVID-19 patients (50,000; IQR 39,000-61,000 ng/mL; (p < 0.001).
Conclusions:
In this systematic review, most patients presented respiratory failure with prolonged mechanical ventilation and ICU stay. Juxtacortical white matter and corpus callosum are characteristic locations of critical illness-associated microbleeds.
Insights
Critical illness-associated cerebral microbleeds are common in patients with respiratory failure, particularly those on prolonged mechanical ventilation. These microbleeds most frequently occur in the juxtacortical white matter and corpus callosum.
Area of Science:
- Neurology
- Critical Care Medicine
- Infectious Diseases
Background:
- Cerebral microbleeds are a recognized complication in critically ill patients, including those with COVID-19.
- These microbleeds have also been observed in patients with other respiratory infections and critical conditions requiring intensive care unit (ICU) admission.
Conclusions:
- Critical illness-associated cerebral microbleeds often occur in patients with respiratory failure requiring prolonged mechanical ventilation and ICU stays.
- Characteristic locations for these microbleeds include the juxtacortical white matter and corpus callosum.
