INTRACEREBRAL HEMORRHAGE IN SARS-CoV-2 INFECTION. CASE REPORT

  • C. TOADER “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
  • A.I. CUCU “Professor Dr. N. Oblu” Clinical Emergency Hospital Iasi
  • Mihaela Dana TURLIUC “Professor Dr. N. Oblu” Clinical Emergency Hospital Iasi
  • A.V. CIUREA “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
Keywords: INTRACEREBRAL HEMORRHAGE, COVID-19, SARS-CoV-2 INFECTION

Abstract

Beyond pulmonary infection, SARS-CoV-2 can cause dysfunction of multiple other organs and system, including neurovascular complications such as intracerebral hemorrhage, about which we have now few information. We report the case of a 36-year young COVID-19 patient with intracerebral hemorrhage. As a particularity of this case, we mention the onset of coronavirus disease through a neurological manifestation, to which was later added the respiratory symptoms characteristic of SARS-CoV-2. In conclusion, we consider it important to be aware that COVID-19 patients may present with these onset findings, without initially pulmonary symptoms. Subsequent studies remain to confirm this presumed causality between intracerebral hemorrhages and COVID-19.

Author Biographies

C. TOADER, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

National Institute of Neurology and Neurovascular Diseases, Bucharest, Romania
Neurosurgery Department

A.I. CUCU, “Professor Dr. N. Oblu” Clinical Emergency Hospital Iasi

Department of Neurosurgery

Mihaela Dana TURLIUC, “Professor Dr. N. Oblu” Clinical Emergency Hospital Iasi

Department of Neurosurgery
“Grigore T. Popa” University of Medicine and Pharmacy Iasi
Faculty of Medicine
Department of Surgery (II)

A.V. CIUREA, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Sanador” Clinical Hospital, Bucharest, Romania
Department of Neurosurgery

References

hu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382(8): 727-733.
2. Zhou P, Yang X-L, Wang X-G, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579(7798): 270-273.
3. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77(6): 683.
4. Klok FA, Kruip MJHA, van der Meer NJM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis Research 2020; 191: 145-147.
5. Markus HS, Brainin M. COVID-19 and stroke-A global World Stroke Organization perspective. Int J Stroke 2020; 15(4): 361-364.
6. Benger M, Williams O, Siddiqui J, Sztriha L. Intracerebral hemorrhage, and COVID-19: clinical characteristics from a case series. Brain Behav Immun 2020; 88: 940-944.
7. Avula A, Nalleballe K, Narula N, et al. COVID-19 presenting as stroke. Brain Behav Immun 2020; 87: 115-119.
8. Morassi M, Bagatto D, Cobelli M, et al. Stroke in patients with SARS-CoV-2 infection: case series. J Neurol 2020; 267(8): 2185-2192.
9. Oxley TJ, Mocco J, Majidi S, et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med 2020; 382(20): e60.
10. Vu D, Ruggiero M, Choi WS, et al. Three unsuspected CT diagnoses of COVID-19. Emerg Radiol 2020; 27(3): 229-232.
11. Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral hemorrhage: causative or coin-cidental? New Microbes and New Infections 2020; 35: 100669.
12. Muhammad S, Petridis A, Cornelius JF, Hänggi D. Severe brain hemorrhage and concomitant COVID-19 Infection: A neurovascular complication of COVID-19. Brain Behav Immun 2020; 87: 150-151.
13. Hansen BM, Nilsson OG, Anderson H, et al. Long term (13 years) prognosis after primary intracere-bral hemorrhage: a prospective population-based study of long-term mortality, prognostic factors and causes of death. J Neurol Neurosurg 2013; 84 (10): 1150-1155.
14. D’Amore C, Paciaroni M, Silvestrelli G, et al. Severity of acute intracerebral hemorrhage, elderly age and atrial fibrillation: Independent predictors of poor outcome at three months. Eur J Intern Med 2013; 24(4): 310-313.
15. Aggarwal G, Lippi G, Michael Henry B. Cerebrovascular disease is associated with an increased disease severity in patients with Coronavirus Disease 2019 (COVID-19): A pooled analysis of pub-lished literature. Int J Stroke 2020; 15(4): 385-389.
16. Khattar NK, Sharma M, McCallum AP, et al. Intracranial hemorrhage in a young COVID-19 patient. Interdisciplinary Neurosurgery 2020; 22: 100878.
17. Altschul DJ, Unda SR, de La Garza Ramos R, et al. Hemorrhagic presentations of COVID-19: Risk factors for mortality. Clin Neurol Neurosurg 2020; 198: 106112.
18. Zhou F, Yu T, Du R, Fan G, Liu Y, et al. Clinical course, and risk factors for mortality of adult inpa-tients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet 2020; 395(10229): 1054-1062.
19. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323(16): 1574.
20. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research 2020l; 191: 9-14.
21. Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol 2020; 267(8): 2179-2184.
22. Li Y, Bai W, Hashikawa T. The neuroinvasive potential of SARS‐CoV2 may play a role in the respir-atory failure of COVID‐19 patients. J Med Virol 2020; 92(6): 552-555.
23. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020; 46 (4): 586-590.
24. Divani AA, Andalib S, Di Napoli M, et al. Coronavirus Disease 2019 and Stroke: Clinical Manifesta-tions and Pathophysiological Insights. J Stroke Cerebrovasc Dis 2020; 12: 104941.
Published
2020-12-23