key: cord-1029626-c7wyzz3m
authors: Panagiotis Margos, Nikolaos; Stylianos Meintanopoulos, Andreas; Filioglou, Dimitrios; Ellul, John
title: Intracerebral hemorrhage in COVID-19: A narrative review
date: 2021-05-04
journal: J Clin Neurosci
DOI: 10.1016/j.jocn.2021.05.019
sha: e26b3f402ca8e65ebe76de182c56965446e8e90f
doc_id: 1029626
cord_uid: c7wyzz3m

Coronavirus Disease 19 (COVID-19) pandemic affects the worldwide healthcare system and our understanding of this disease grows rapidly. Although COVID-19 is a mainly respiratory disease, neurological manifestations are not uncommon. The aim of this review is to report on the etiology, clinical profile, location, and outcome of patients with intracerebral hemorrhage (ICH) and COVID-19. This review includes 36 studies examining ICH in the clinical presentation of COVID-19. Overall, 217 cases with intracranial hemorrhage, of which 188 ICHs, were reported. Generally, a low incidence of both primary and secondary ICH was found in 8 studies [106 (0.25%) out of 43137 hospitalized patients with COVID-19]. Available data showed a median age of 58 years (range: 52 - 68) and male sex 64%, regarding 36 and 102 patients respectively. Furthermore, 75% of the patients were on prior anticoagulation treatment, 52% had a history of arterial hypertension, and 61% were admitted in intensive care unit. Location of ICH in deep structures/basal ganglia was ascertained in only 7 cases making arterial hypertension an improbable etiopathogenetic mechanism. Mortality was calculated at 52.7%. Disease related pathophysiologic mechanisms support the hypothesis that SARS-CoV2 can cause ICH, however typical ICH risk factors such as anticoagulation treatment, or admission to ICU should also be considered as probable causes. Physicians should strongly suspect the possibility of ICH in individuals with severe COVID-19 admitted to ICU and treated with anticoagulants. It is not clear whether ICH is related directly to COVID-19 or reflects expected comorbidity and/or complications observed in severely ill patients.

Oxygenation. 

Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU 431 patients with COVID-19: An updated analysis

Thromboprophylaxis in the Era of COVID-19

Thromboprophylaxis in Intensive Care Unit Patients: A Literature Review

Risk factors for intracerebral 439 hemorrhage in patients with COVID-19

Anticoagulant-associated intracerebral hemorrhage

International epidemiology of intracerebral 444 hemorrhage

Pathological observations in hypertensive cerebral hemorrhage

COVID-19 is Associated with an Unusual 448 Pattern of Brain Microbleeds in Critically Ill Patients

Critical illness-associated cerebral 452 microbleeds in COVID-19

Critical illness-associated cerebral microbleeds in