Intracranial hemorrhage in a young COVID-19 patient

Nicolas K Khattar; Mayur Sharma; Abigail P McCallum; Brent G Oxford; Hassan Zeb; Sally A Suliman; Emily P Sieg; J Mocco; Joseph S Neimat; Ajmal Zemmar

doi:10.1016/j.inat.2020.100878

Intracranial hemorrhage in a young COVID-19 patient

Interdiscip Neurosurg. 2020 Dec:22:100878. doi: 10.1016/j.inat.2020.100878. Epub 2020 Aug 12.

Authors

Nicolas K Khattar^{1

2}, Mayur Sharma², Abigail P McCallum², Brent G Oxford², Hassan Zeb³, Sally A Suliman³, Emily P Sieg², J Mocco⁴, Joseph S Neimat², Ajmal Zemmar^{1

2}

Affiliations

¹ Department of Neurosurgery, Henan Provincial People's Hospital, Henan University People's Hospital, Henan University School of Medicine, Zhengzhou, China.
² Department of Neurological Surgery, University of Louisville School of Medicine, Louisville KY, USA.
³ Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
⁴ Department of Neurological Surgery, Mount Sinai Medical Center, New York, NY USA.

Abstract

COVID-19 patients are increasingly understood to develop multisystem manifestations, including neurologic involvement. We report the case of a 42-year old COVID-19 positive patient with a fatal intracerebral hemorrhage (ICH). The patient presented with fever and dyspnea, requiring intubation due to medical complications. After prolonged sedation and anticoagulation, the patient suddenly developed bilaterally fixed and dilated pupils, caused by a right-sided intracranial hemorrhage with uncal herniation. The course of this case illustrates the delicate balance between hypercoagulability and coagulation factor depletion; especially in the intubated and sedated patient, in whom regular neurological assessments are impeded. As we expand our understanding of the neurological ramifications of COVID-19, clinicians need to be increasingly aware of the precarious coagulation balance.

Keywords: COVID-19; Coagulopathy; Inflammation; Intracerebral hemorrhage.

Publication types

Case Reports