Intracranial hemorrhage in critically ill patients hospitalized for COVID-19.

MedStar author(s):
Citation: Journal of Clinical Neuroscience. 81:192-195, 2020 Nov.PMID: 33222915Institution: MedStar Washington Hospital CenterDepartment: Neurosurgery | Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal ArticleSubject headings: *Cerebral Hemorrhage/vi [Virology] | *COVID-19/co [Complications] | Aged | Critical Illness | Female | Hospitalization | Humans | Male | Middle Aged | SARS-CoV-2Year: 2020ISSN:
  • 0967-5868
Name of journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of AustralasiaAbstract: In this study, we report three cases of spontaneous intracranial hemorrhage in patients who were initially hospitalized at our tertiary care center in Washington, DC with symptoms of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all three patients, who were critically ill, requiring intubation and ventilatory support. During their protracted hospitalizations, subsequent imaging disclosed intracranial hemorrhages, including intracerebral and subarachnoid hemorrhages, in the context of anticoagulation and coagulopathy. We believe this is related to the tropism of SARS-CoV-2 to the endothelial lining of the cerebral vasculature via their angiotensin-converting enzyme (ACE) II receptors. Given our findings, we advocate heightened vigilance for intracerebral hemorrhage events, and scanning when practicable, in COVID-19 patients which have prolonged ventilatory support and depressed neurologic examinations. Copyright (c) 2020. Published by Elsevier Ltd.All authors: Chang J, Conte AG, Fayed I, Mai JC, Pivazyan GFiscal year: FY2021Digital Object Identifier: Date added to catalog: 2021-04-01
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Journal Article MedStar Authors Catalog Article 33222915 Available 33222915

In this study, we report three cases of spontaneous intracranial hemorrhage in patients who were initially hospitalized at our tertiary care center in Washington, DC with symptoms of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was diagnosed in all three patients, who were critically ill, requiring intubation and ventilatory support. During their protracted hospitalizations, subsequent imaging disclosed intracranial hemorrhages, including intracerebral and subarachnoid hemorrhages, in the context of anticoagulation and coagulopathy. We believe this is related to the tropism of SARS-CoV-2 to the endothelial lining of the cerebral vasculature via their angiotensin-converting enzyme (ACE) II receptors. Given our findings, we advocate heightened vigilance for intracerebral hemorrhage events, and scanning when practicable, in COVID-19 patients which have prolonged ventilatory support and depressed neurologic examinations. Copyright (c) 2020. Published by Elsevier Ltd.

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