key: cord-0815574-7p57llbe
authors: Argirò, R.; Cirelli, C.; Sgreccia, A.; Del Sette, B.; Da Ros, V.
title: Cerebral hemorrhage related to vein thrombosis in Covid-19 patients in different Italian hospitals: View point for clinical and imaging implications
date: 2020-07-10
journal: J Neurol Sci
DOI: 10.1016/j.jns.2020.117023
sha: 433fa04f9a9901a31de2f5724e74cb49d95695a5
doc_id: 815574
cord_uid: 7p57llbe

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patients are acute pulmonary embolism (PE), deep-vein thrombosis (DVT), ischemic stroke, myocardial infarction or systemic arterial embolism and cerebral vein thrombosis without hemorrage [4, 5] ; in consideration of these observations the administration of lowmolecular-weight-heparin (LWMH) has been introduced recently as adjuvant therapy [6] .

Moreover, evidence of central and peripheral neurological symptoms have been recently described in Covid-19 patients in Wuhan (30,2-45-5%) with higher prevalence in cases of severe pulmonary infection, with report of two cerebral hemorrhages (1,8%) [7] ; in these series, heparin was not administered as support therapy. (8) In order to optimize patients care, and only in selected cases with pulmonary and neurological impairment, concomitant chest and brain CT scan might be helpful.

These observations can play a pivot role, in particular in mechanically ventilated patients, due to the possible co-existence of acute hidden underlying neurological alteration.

 Knowledge of incidence of cerebral hemorrhage linked to cerebral vein thrombosis matches the evidence of pro-coagulation disorders and DIC as co-factor in Covid-19 patients with corroboration of LWMH as an essential treatment; moreover, patients admitted in intensive care unit having higher thrombotic risk might benefit from LMWH therapy.

In conclusion, brain CT examination can be suggested in selected cases especially in ICU and mechanically ventilated patients without significantly increasing of time and radiation dose. The present protocol could help to avoid waste of resources in this emergency healthcare condition. Evidence described could also play a crucial role in clinical practice to detect rapidly and more accurately patients who require modification of LMVH therapy J o u r n a l P r e -p r o o f Fig.1: A) and B) Unehnanced axial brain CT scan shows hyperdense appearance along the superior sagittal sinus with intracerebral hemorrhagic infarction in the right parietal and frontal lobes. C) CT sagittal reconstruction depicts the extension of sagittal sinus hyperdensity. D) and E) T2 GRE MRI confirms hemorrhagic foci in parietal and frontal lobes; to note the thrombosis of the superior sagittal sinus and right transverse sinus. F) T1-FFE 3D MRI after administration of contrast medium showed extension of thrombosis in sagittal sinus.

J o u r n a l P r e -p r o o f Journal Pre-proof Figure 1 

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1: Patients characteristics, CT findings, neurological symptoms and therapeutical management. (I.U. International Unit)