Intracranial Hemorrhage in COVID-19 patients: A Case Series

Abbas, Rawad; El Naamani, Kareem; Sweid, Ahmad; Schaefer, Joseph W.; Bekelis, Kimon; Sourour, Nader; Elhorany, Mahmoud; Pandey, Aditya S.; Tjoumakaris, Stavropoula; Gooch, Michael R.; Herial, Nabeel A.; Rosenwasser, Robert H.; Jabbour, Pascal

Background The COVID-19 pandemic is an ongoing public health emergency. While most cases end in asymptomatic or minor illness, there is growing evidence that some COVID-19 infections result in non-conventional dire consequences. Objective To describe the characteristics of intracranial hemorrhage (ICH) patients who were infected with SARS-CoV-2. Also, with the existing literature, we raise the idea of a possible association between SARS-CoV-2 infection and ICH and propose possible pathophysiological mechanisms connecting the two. Methods We retrospectively collected and analyzed intracranial hemorrhage cases who were also positive for SARS-CoV-2 from four tertiary-care cerebrovascular centers. Results We identified a total of nineteen patients consisting of eleven males (58%) and eight females (42%). Mean age was 52.2 with 95% being less than 75 years of age. With respect to COVID-19 illness, 50% had mild-moderate disease, 21% had severe disease, and 20% had critical disease requiring intubation. Of the nineteen cases, twelve patients had intraparenchymal hemorrhage (63%), six had subarachnoid hemorrhage (32%), and one patient had a subdural hematoma (5%). Intracerebral hemorrhage score of 0 – 2 were in 43% and 3 – 6 in 57%. Modified Rankin Scale cores at discharge were 0-2 in 23% and 3-6 in 77%. The mortality rate was 59%. Conclusion Our series shed light on a distinct pattern of intracerebral hemorrhage in COVID-19 positive cases compared to typical non-COVID cases, namely the severity of hemorrhage, high mortality rate, and the young age of patients. Further research is warranted to delineate a potential association between SARS-CoV-2 infection and intracranial hemorrhage.