COVID-19-associated spontaneous subacute subdural hematoma; report of two cases

Tabibkhooei, Alireza; Hatam, Jaber; Mokhtari, Mahisa; Abolmaali, Meysam

Since March 2020, the pandemic of Coronavirus Disease 2019 (COVID-19) has become a threat for global health. Thereafter, several kinds of Coronavirus-associated disorders, including vascular involvements with neurologic symptoms, have been reported worldwide. Here, we describe two cases of COVID-19 with no history of traumatic brain injury nor vascular injuries who developed spontaneous subdural hematoma (SDH) in a subacute process. Both cases became lethargic and unresponsive during admission in intensive care unit. Both cases have undergone emergent craniotomy with acceptable outcome. The first patient improved significantly and was discharged a week after surgery. However, the second case had no improvement on her consciousness and died three days after surgery. Hemorrhagic events, including SDH, can happen during COVID-19 infection with several possible mechanisms. Brain imaging and further neurologic evaluation must be performed in any COVID-19 patients with signs of alteration in the state of consciousness.