tetano
Editor, Senior Moderator
J Clin Neurosci
. 2020 Nov;81:192-195.
doi: 10.1016/j.jocn.2020.08.026. Epub 2020 Aug 18.
Intracranial hemorrhage in critically ill patients hospitalized for COVID-19
Islam Fayed[SUP] 1 [/SUP], Gnel Pivazyan[SUP] 1 [/SUP], Anthony G Conte[SUP] 1 [/SUP], Jason Chang[SUP] 2 [/SUP], Jeffrey C Mai[SUP] 3 [/SUP]
Affiliations
Abstract
In this study, we report three cases of spontaneous intracranial hemorrhage in patients who were initially hospitalized at our tertiary care center in Washington, DC with symptoms of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all three patients, who were critically ill, requiring intubation and ventilatory support. During their protracted hospitalizations, subsequent imaging disclosed intracranial hemorrhages, including intracerebral and subarachnoid hemorrhages, in the context of anticoagulation and coagulopathy. We believe this is related to the tropism of SARS-CoV-2 to the endothelial lining of the cerebral vasculature via their angiotensin-converting enzyme (ACE) II receptors. Given our findings, we advocate heightened vigilance for intracerebral hemorrhage events, and scanning when practicable, in COVID-19 patients which have prolonged ventilatory support and depressed neurologic examinations.
Keywords: COVID-19; Coagulopathy; Endothelial injury; Intracerebral hemorrhage; Subarachnoid hemorrhage.
. 2020 Nov;81:192-195.
doi: 10.1016/j.jocn.2020.08.026. Epub 2020 Aug 18.
Intracranial hemorrhage in critically ill patients hospitalized for COVID-19
Islam Fayed[SUP] 1 [/SUP], Gnel Pivazyan[SUP] 1 [/SUP], Anthony G Conte[SUP] 1 [/SUP], Jason Chang[SUP] 2 [/SUP], Jeffrey C Mai[SUP] 3 [/SUP]
Affiliations
- PMID: 33222915
- DOI: 10.1016/j.jocn.2020.08.026
Abstract
In this study, we report three cases of spontaneous intracranial hemorrhage in patients who were initially hospitalized at our tertiary care center in Washington, DC with symptoms of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all three patients, who were critically ill, requiring intubation and ventilatory support. During their protracted hospitalizations, subsequent imaging disclosed intracranial hemorrhages, including intracerebral and subarachnoid hemorrhages, in the context of anticoagulation and coagulopathy. We believe this is related to the tropism of SARS-CoV-2 to the endothelial lining of the cerebral vasculature via their angiotensin-converting enzyme (ACE) II receptors. Given our findings, we advocate heightened vigilance for intracerebral hemorrhage events, and scanning when practicable, in COVID-19 patients which have prolonged ventilatory support and depressed neurologic examinations.
Keywords: COVID-19; Coagulopathy; Endothelial injury; Intracerebral hemorrhage; Subarachnoid hemorrhage.