Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature

Main Article Content

Ritwik Ghosh, MD Dipayan Roy, MD Adrija Ray, MBBS Shambaditya Das, MD, DM Amrita Mandal, MBBS Shambaditya Das, MD, DM Shyamal Kanti Pal, MD Julián Benito-León, MD, PhD

Abstract

Background: Hemorrhagic cerebrovascular events, either due to aneurysmal rupture or spontaneous subarachnoid hemorrhage (SAH), are not rare in COVID-19. Several mechanisms such as coagulopathy, cytokine storm, viral endotheliopathy, hypertension, and immune modulation might play a role in the pathogenesis of SAH in COVID-19. This study aimed to report the first case of spontaneous non-aneurysmal SAH associated with SARS-CoV-2 from India. We briefly discussed the possible pathogenetic mechanisms underlying this process and succinctly reviewed the relevant literature.


Case report: We herein report a case of a non-comorbid young woman infected with SARS-CoV-2 presenting with thunderclap headache and eventually non-aneurysmal SAH,  who recovered with conservative management.


Conclusion: Headache, although a very common clinical feature of COVID-19 itself, must be investigated in detail to identify alternate causes that may be life-threatening. This case also incites further enquiry into the possible pathogenic mechanisms of neurovascular complications in COVID-19.

Article Details

How to Cite
GHOSH, Ritwik et al. Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature. Medical Research Archives, [S.l.], v. 10, n. 1, jan. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2673>. Date accessed: 28 nov. 2022. doi: https://doi.org/10.18103/mra.v10i1.2673.
Section
Case Reports

References

1. Roy D, Ghosh R, Dubey S, Dubey MJ, Benito-León J, Kanti Ray B. Neurological and neuropsychiatric impacts of COVID-19 pandemic. Can J Neurol Sci. 2021;48(1):9-24
2. Ghosh R, Lahiri D, Dubey S, Ray BK, Benito-León J. Hallucinatory palinopsia in COVID-19 induced posterior reversible encephalopathy syndrome. J Neuroophthalmol. 2020;40(4):523-526
3. Ghosh R, Roy D, Sengupta S, Benito-León J. Autonomic dysfunction heralding acute motor axonal neuropathy in COVID-19. J Neurovirol. 2020;26(6):964-966
4. Ghosh R, Dubey S, Kanti Ray B, Chatterjee S, Benito-León J. COVID-19 presenting with thalamic hemorrhage unmasking moyamoya angiopathy. Can J Neurol Sci. 2020;47(6):849-851
5. Ghosh R, Roy D, Mandal A, et al. Cerebral venous thrombosis in COVID-19. Diabetes Metab Syndr. 2021;15:1039–1045.
6. Dakay K, Kaur G, Gulko E. Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection. J Stroke Cerebrovasc Dis. 2020;29(9):105011.
7. Ghosh R, Roy D, Roy D, et al. A Rare Case of SARS-CoV-2 infection associated with pituitary apoplexy without comorbidities. J Endocr Soc. 2021;5(3):bvaa203.
8. Dogra S, Jain R, Cao M, et al. Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis. 2020;29(8):104984.
9. Trejo-Gabriel-Galán JM. Stroke as a complication and prognostic factor of COVID-19. Ictus como complicación y como factor pronóstico de COVID-19. Neurologia (Engl Ed). 2020;35(5):318-322.
10. Cezar-Junior AB, Faquini S IV, Silva JLJ, et al. Subarachnoid hemorrhage and COVID-19: Association or coincidence? Medicine (Baltimore). 2020;99(51):e23862.
11. Avci A, Yesiloglu O, Avci BS, et al. Spontaneous subarachnoidal hemorrhage in patients with Covid-19: case report. J Neurovirol. 2020;Oct;26(5):802-804.
12. Iba T, Levi M, Levy JH. Sepsis-induced coagulopathy and disseminated intravascular ioagulation. Semin Thromb Hemost. 2020.46(1):89-95
13. Zulfiqar AA, Lorenzo-Villalba N, Hassler P, Andrès E. Immune Thrombocytopenic purpura in a patient with Covid-19. N Engl J Med. 2020;382(18):e43.
14. Muehlschlegel S. Subarachnoid Hemorrhage. Continuum (Minneap Minn). 2018;24(6):1623-1657.
15. Tonomura Y, Kataoka H, Yata N, Kawahara M, Okuchi K, Ueno S. A successfully treated case of herpes simplex encephalitis complicated by subarachnoid bleeding: a case report. J Med Case Rep. 2010 Sep 22;4:310.
16. Batcik OE, Kanat A, Cankay TU, et al. COVID-19 infection produces subarachnoid hemorrhage; acting now to understand its cause: A short communication. Clin Neurol Neurosurg. 2021;202:106495.
17. Agarwal A, Pinho M, Raj K, et al.. Neurological emergencies associated with COVID-19: stroke and beyond. EmergRadiol. 2020;27(6):747-754.
18. Gogia B, Fang X, Rai P. Intracranial hemorrhage in a patient with COVID-19: possible explanations and considerations. Cureus. 2020;12(8):e10159.
19. Rustemi O, Raneri F, Iannucci G, Volpin L, Segna A. Aneurysmal subarachnoid hemorrhage in a SARS-CoV-2 positive testing: casual or causal? Br J Neurosurg. 2020 July 2:1–2.
20. de Castillo LLC, Diestro JDB, Ignacio KHD, Separa KJNJ, Pasco PMD, Franks MCP. Concurrent acute ischemic stroke and non-aneurysmal subarachnoid hemorrhage in COVID-19. Can J Neurol Sci. 2020;48(4):587-588.
21. Wanjari AK, Dubey A, Chaturvedi S, Kumar S. Young COVID 19 presenting as fatal subarachnoid hemorrhage: Association or chance. Medical Science. 2020;24(104):2712–2715.
22. Fayed I, Pivazyan G, Conte AG, Chang J, Mai JC. Intracranial hemorrhage in critically ill patients hospitalized for COVID-19. J Clin Neurosci. 2020 Nov;81:192-195
23. Ghani MU, Kumar M, Ghani U, Sonia F, Abbas SA. Intracranial hemorrhage complicating anticoagulant prophylactic therapy in three hospitalized COVID-19 patients. J Neurovirol. 2020;26(4):602-604.
24. Melegari G, Rivi V, Zelent G, et al. Mild to Severe Neurological Manifestations of COVID-19: Cases Reports. Int J Environ Res Public Health. 2021;18(7):3673.
25. Sabayan B, Moghadami M, Assarzadegan F, et al. COVID-19 Respiratory illness and subsequent Cerebrovascular events, the initial iranian experience. J Stroke Cerebrovasc Dis. 2021;30(1):105454.
26. Harrogate S, Mortimer A, Burrows L, et al. Non-aneurysmal subarachnoid hemorrhage in COVID-19. Neuroradiology. 2021;63(1):149-152.
27. Mishra S, Choueka M, Wang Q, et al. Intracranial hemorrhage in COVID-19 Patients. J Stroke Cerebrovasc Dis. 2021;30(4):105603.
28. Basirjafari S, Rafiee M, Shahhosseini B, Mohammadi M, Aghayari Sheikh Neshin S, Zarei M. Association of pediatric COVID-19 and subarachnoid hemorrhage. J Med Virol. 2021;93(2):658-660.
29. Haider A, Schmitt C, Greim CA. Multiorgan point-of-care ultrasound in a patient with Coronavirus Disease 2019 pneumonia complicated by subarachnoid hemorrhage and pulmonary embolism. A A Pract. 2020;14(14):e01357.
30. Craen A, Logan G, Ganti L. Novel Coronavirus Disease 2019 and Subarachnoid Hemorrhage: A Case Report. Cureus. 2020;12(4):e7846.
31. Garví López M, Tauler Redondo MDP, Tortajada Soler JJ. Intracranial hemorrhages in critical COVID-19 patients: report of three cases. Med Clin (Barc). 2021;156(1):38-39.
32. Mousa-Ibrahim F, Berg S, Od TPDetola O, Teitcher M, Ruland S. Intracranial hemorrhage in hospitalized SARS-CoV-2 Patients: A case series. J Stroke Cerebrovasc Dis. 2021;30(1):105428.
33. Benger M, Williams O, Siddiqui J, Sztriha L. Intracerebral hemorrhage and COVID-19: Clinical characteristics from a case series. Brain Behav Immun. 2020 Aug;88:940–944.

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