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Review
. 2021 Dec;2(4):141-150.
doi: 10.1016/j.hest.2021.11.003. Epub 2021 Nov 11.

The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review

Samuel R Daly  1 , Anthony V Nguyen  1 , Yilu Zhang  1 , Dongxia Feng  1 , Jason H Huang  1
Affiliations
Review

The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review

Samuel R Daly et al. Brain Hemorrhages. 2021 Dec.

Abstract

Introduction: In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH).

Methods: We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria.

Results: The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury.

Conclusion: Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.

Keywords: Cerebral Venous Sinus Thrombosis; Cerebral Venous Thrombosis; Covid-19; Hemorrhagic Infarct; Intracranial Hemorrhage; Intraparenchymal Hemorrhage; SARS-CoV-2; Subarachnoid Hemorrhage.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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