Intracerebral haemorrhage and COVID-19: Clinical characteristics from a case series

Abstract

1. •

   We demonstrate five consecutive cases of predominantly lobar COVID-19-associated intracerebral haemorrhage (ICH).

2. •

   Patients were typically relatively young with a severe, prolonged inflammatory prodrome.

3. •

   COVID-19-induced endotheliitis/endotheliopathy may underlie associated cerebrovascular events.

4. •

   For the clinician, anticoagulation decisions must balance risk of thrombosis with risk of haemorrhage.

Fig. 1

a Patient 1, Volumetric axial CT brain imaging demonstrates a large acute lobar intraparenchymal haematoma, centred on the left frontoparietal region (arrowed). There is surrounding hypo-attenuation and minimal localised mass effect. b. Patient 2, Volumetric axial CT brain imaging demonstrates an acute right frontoparietal intraparenchymal haematoma (arrowed). There is minimal effacement of the adjacent right lateral ventricle. c. Patient 3, Volumetric axial CT brain imaging demonstrates a subacute intraparenchymal haematoma, centred on the right superior frontal gyrus (arrowed). There is evidence of surrounding clot retraction. d. Patient 4, Axial T2-weighted (left) and volumetric non-contrast T1-weighted (right) MRI sequences of the brain demonstrate a subacute intraparenchymal haematoma, centred on the right posterior capsular region (arrowed). e. Patient 5, Axial FLAIR (left) and volumetric non-contrast T1-weighted (right) MRI sequences of the brain demonstrate a subacute intraparenchymal haematoma in the right perirolandic region (solid arrows). There is a left frontal white matter lesion visible (dashed arrow) on the FLAIR sequence, in keeping with the known history of demyelinating disease.