Non-aneurysmal subarachnoid haemorrhage in COVID-19

Abstract

Coronavirus disease of 2019 (COVID-19) is associated with hypercoagulopathy, but haemorrhage, including spontaneous intracerebral parenchymal haemorrhage and diffuse petechial cerebral haemorrhage, has also been reported. We present two cases of nonaneurysmal subarachnoid haemorrhage (SAH) in patients with severe COVID-19. Careful review of neuroimaging for haemorrhagic complications of COVID-19 should be undertaken, particularly for those patients receiving enhanced prophylaxis for venous thromboembolism. Although likely to be a marker of severe disease, non-aneurysmal SAH can be associated with favourable outcome.

Keywords: COVID-19; Clinical neurology; Neuroradiology; Subarachnoid haemorrhage.

Fig. 1

Non-aneurysmal SAH co-existent with COVID-19 (MRI). In patient A (a–f), brain MRI results demonstrated multifocal convexity high signal change consistent with acute subarachnoid haemorrhage and small infarcts including in the left precentral gyrus (a and b axial T1, c and d coronal fluid-attenuated inversion recovery, e axial diffusion, f axial susceptibility weighted imaging)

Fig. 2

Non-aneurysmal SAH co-existent with COVID-19 (non-contrast CT). Contemporary non-contrast CT brain imaging for patient B was compared with that acquired 8 years previously and demonstrated multifocal, curvilinear foci of sulcal high density consistent with SAH (non-contrast CT head from 2011 a and c, 2020 b and d with arrows highlighting areas of high density)