Characteristics of subarachnoid hemorrhage associated with COVID-19 infection: A systematic review and descriptive analysis

Mervyn Jun Rui Lim; Jonathan Yeo; Khi Yung Fong; Sean Wai-Onn Eng; Shuning Fu; Benjamin Yong-Qiang Tan; Leonard Leong Litt Yeo; Vincent Diong Weng Nga; Tseng Tsai Yeo

doi:10.1016/j.jstrokecerebrovasdis.2022.106904

Characteristics of subarachnoid hemorrhage associated with COVID-19 infection: A systematic review and descriptive analysis

J Stroke Cerebrovasc Dis. 2023 Feb;32(2):106904. doi: 10.1016/j.jstrokecerebrovasdis.2022.106904. Epub 2022 Nov 22.

Authors

Mervyn Jun Rui Lim¹, Jonathan Yeo², Khi Yung Fong³, Sean Wai-Onn Eng³, Shuning Fu³, Benjamin Yong-Qiang Tan⁴, Leonard Leong Litt Yeo⁴, Vincent Diong Weng Nga⁵, Tseng Tsai Yeo⁵

Affiliations

¹ Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: mervynlim@u.nus.edu.
² Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Electronic address: jonathan.yeo@u.nus.edu.
³ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁴ Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
⁵ Division of Neurosurgery, University Surgical Centre, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

PMID: 36442281
PMCID: PMC9678815
DOI: 10.1016/j.jstrokecerebrovasdis.2022.106904

Abstract

Objective: Subarachnoid hemorrhage (SAH) has been reported as a neurological manifestation in 0.1% of COVID-19 patients. This systematic review investigated the outcomes and predictive factors of SAH in patients with COVID-19.

Materials and methods: An electronic literature search was conducted on PubMed, Embase, and Scopus from inception to 10^th September 2021. Studies reporting SAH in COVID-19 patients were included. Demographic characteristics, risk factors for disease, severity of COVID-19, and mortality of SAH in COVID-19 patients were analyzed. Subgroup analyses stratified by COVID-19 severity and mortality were conducted.

Results: 17 case reports, 11 case series, and 2 retrospective cohort studies, with a total of 345 cases of SAH in COVID-19 patients, were included for analysis. Most published cases were reported in the US. Mean age was 55±18.4 years, and 162 patients (48.5%) were female. 242 patients (73.8%) had severe-to-critical COVID-19, 56.7% had aneurysmal SAH, 71.4% were on anticoagulation, and 10.8% underwent surgical treatment. 136 out of 333 patients (40.8%) died. Among patients with severe-to-critical COVID-19, 11 out of 18 (61.1%) died, and 8 out of 8 (100.0%) were non-aneurysmal SAH.

Conclusions: SAH is a rare but morbid occurrence in COVID-19. The mortality rate of COVID-SAH patients was 40.8%, with a higher prevalence of severe-to-critical COVID-19 (100% versus 53.8%) and non-aneurysmal SAH (85.7% versus 44.6%) among COVID-SAH deaths. Given the changing landscape of COVID-19 variants, further studies investigating the association between COVID-19 and SAH may be warranted to identify the long-term effects of COVID-19.

Keywords: COVID-19; Neurosurgery; Subarachnoid hemorrhage; Systematic review.

Publication types

Systematic Review

MeSH terms

Adult
Aged
COVID-19* / complications
COVID-19* / diagnosis
Female
Humans
Male
Middle Aged
Retrospective Studies
SARS-CoV-2
Subarachnoid Hemorrhage* / diagnostic imaging
Subarachnoid Hemorrhage* / epidemiology
Subarachnoid Hemorrhage* / therapy
Treatment Outcome

Supplementary concepts

SARS-CoV-2 variants