COVID-19-Related Intracerebral Hemorrhage

Abstract

Intracerebral hemorrhage (ICH) is a common and severe neurological disorder and is associated with high rates of mortality and morbidity. ICH is associated with old age and underlying conditions such as hypertension and diabetes mellitus. The COVID-19 pandemic is associated with neurological symptoms and complications including ICH. For instance, the mechanisms by which COVID-19 may contribute to hemorrhagic stroke may include both depletion of angiotensin converting enzyme 2 (ACE2) receptor and overactive immune response. In this study, we herein report three patients (0.25%) out of 1200 admissions with COVID-19 to our center between 1 May and August 4, 2020, who developed ICH. In addition, we will briefly discuss the possible pathophysiological mechanisms of COVID-19 infection in patients with ICH.

Keywords: COVID-19; complications; intracerebral hemorrhage; neurological consequences; pathophysiological mechanisms.

FIGURE 1

CT changes of lung and brain in patients with COVID-19 complicated with ICH (A–F). Chest and brain CT examination of patient 1 showing bilateral consolidations and ground-glass opacities of the lungs (A), and hemorrhage in the parietal- occipital region on the left with a breakthrough of blood into the ventricular system (D). Chest and brain CT examination of patient 2, showing diffuse bilateral ground-glass opacities involving both lungs (B) and hemorrhage in the projection of the basal ganglia on the right (E). Chest and brain CT examination of patient 3, demonstrating bilateral ground-glass opacities (C) and hemorrhage in the projection of the basal ganglia on the right with a breakthrough into the ventricular system (F). P = posterior.