Subarachnoid hemorrhage associated with COVID-19 infection: case series report

Abstract

Background: Subarachnoid hemorrhage is a sudden bleeding in the subarachnoid space, representing 5-10% of all strokes. Several reports of Covid-19 infection and subarachnoid hemorrhage have been published. The objective of the study was to analyze subarachnoid hemorrhage in patients with COVID-19. Material and methods: Retrospective study of all electronic medical records of patients with COVID-19 treated between March 2020 and May 2021. The subarachnoid hemorrhage was identified in 7 patients out of 204. Results: The study sample included 3 men (42.9%) and 4 women (57.1%) with altered mental state, convulsions, severe headache, nausea and focal signs at the presentation. In one patient hemorrhage occurred 4 days after Covid-19 detection; in 5 patients the infection and hemorrhage were confirmed at admission, and 1 patient was diagnosed with SARS – Cov-2 during hospitalization. There was a marked increase in inflammatory markers (leukocytosis, increased ESR), the presence of pulmonary lesions in 8 pts. Angio CT revealed the presence of aneurysms in 5 patients. Most underwent surgery: by clipping – 6 patients, embolization of the anterior communicating artery – 1 patient and one attempt to ligate the left internal carotid artery. Out of 7 patients – 3 died and 4 were discharged. Conclusions: The subarachnoid hemorrhage can occur both at the initial stage of COVID-19 infection and later after the treatment. The association of infection in patients with subarachnoid hemorrhage leads to pulmonary involvement with inflammatory response and worsening of neurological status with poor prognosis.