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

• Published in: Brain hemorrhages Vol. 2; no. 4; pp. 141 - 150
• Main Authors: Daly, Samuel R., Nguyen, Anthony V., Zhang, Yilu, Feng, Dongxia, Huang, Jason H.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2021; International Hemorrhagic Stroke Association. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/); KeAi Communications Co., Ltd
• Subjects: Cerebral Venous Sinus Thrombosis; Cerebral Venous Thrombosis; Covid-19; Hemorrhagic Infarct; Intracranial Hemorrhage; Intraparenchymal Hemorrhage; Review; SARS-CoV-2; Subarachnoid Hemorrhage; SARS-CoV-2; Covid-19; Cerebral Venous Sinus Thrombosis; Subarachnoid Hemorrhage; Intraparenchymal Hemorrhage; Cerebral Venous Thrombosis; Hemorrhagic Infarct; Intracranial Hemorrhage
• ISSN: 2589-238X; 2589-238X
• DOI: 10.1016/j.hest.2021.11.003

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