J Clin Med . Clinical and Imaging Characteristics in Patients with SARS-CoV-2 Infection and Acute Intracranial Hemorrhage

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J Clin Med


. 2020 Aug 6;9(8):E2543.
doi: 10.3390/jcm9082543.
Clinical and Imaging Characteristics in Patients with SARS-CoV-2 Infection and Acute Intracranial Hemorrhage


Jawed Nawabi ¹ , Andrea Morotti ² , Moritz Wildgruber ³ , Gregoire Boulouis ⁴ , Hermann Kraehling ⁵ , Frieder Schlunk ⁶ , Elif Can ¹ , Helge Kniep ⁷ , G?tz Thomalla ⁸ , Marios Psychogios ⁹ , Bernd Hamm ¹ , Jens Fiehler ⁷ , Uta Hanning ⁷ , Peter Sporns ^{7 9}



Affiliations

• PMID: 32781623
• DOI: 10.3390/jcm9082543

Abstract

Background and purpose: Intracranial hemorrhage has been observed in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19), but the clinical, imaging, and pathophysiological features of intracranial bleeding during COVID-19 infection remain poorly characterized. This study describes clinical and imaging characteristics of patients with COVID-19 infection who presented with intracranial bleeding in a European multicenter cohort.
Methods: This is a multicenter retrospective, observational case series including 18 consecutive patients with COVID-19 infection and intracranial hemorrhage. Data were collected from February to May 2020 at five designated European special care centers for COVID-19. The diagnosis of COVID-19 was based on laboratory-confirmed diagnosis of SARS-CoV-2. Intracranial bleeding was diagnosed on computed tomography (CT) of the brain within one month of the date of COVID-19 diagnosis. The clinical, laboratory, radiologic, and pathologic findings, therapy and outcomes in COVID-19 patients presenting with intracranial bleeding were analyzed.
Results: Eighteen patients had evidence of acute intracranial bleeding within 11 days (IQR 9-29) of admission. Six patients had parenchymal hemorrhage (33.3%), 11 had subarachnoid hemorrhage (SAH) (61.1%), and one patient had subdural hemorrhage (5.6%). Three patients presented with intraventricular hemorrhage (IVH) (16.7%).
Conclusion: This study represents the largest case series of patients with intracranial hemorrhage diagnosed with COVID-19 based on key European countries with geospatial hotspots of SARS-CoV-2. Isolated SAH along the convexity may be a predominant bleeding manifestation and may occur in a late temporal course of severe COVID-19.

Keywords: COVID-19; SARS-CoV-2; imaging characteristics; intracranial hemorrhage.