Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients

• Published in: Neurological sciences 2021-01, Vol.42 (1), p.25-33
• Main Authors: Cheruiyot, Isaac, Sehmi, Prabjot, Ominde, Beryl, Bundi, Paul, Mislani, Musa, Ngure, Brian, Olabu, Beda, Ogeng’o, Julius A.
• Format: Article
• Language: English
• Subjects: Cerebrovascular diseases; Coronaviridae; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - mortality; Hemorrhage; Humans; Intracranial Hemorrhages - etiology; Intracranial Hemorrhages - mortality; Ischemia; Medicine; Medicine & Public Health; Mortality; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Psychiatry; Systematic review
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-020-04870-z

Background Emerging evidence suggests that a subset of coronavirus disease 2019 (COVID-19) patients may present with or develop cerebrovascular disease during the course of hospitalization. Whereas ischemic stroke in COVID-19 patients has been well described, data on intracranial hemorrhage (ICH) in these patients is still limited. We, therefore, conducted a rapid systematic review of current scientific literature to identify and consolidate evidence of ICH in COVID-19 patients. Methods A systematic search of literature was conducted between November 1, 2019, and August 14, 2020, on PubMed and China National Knowledge Infrastructure (CNKI) to identify eligible studies. Results A total of 23 studies describing ICH in 148 COVID-19 patients were included. The pooled incidence of ICH in COVID-19 patients was 0.7% (95% CI 0.5–0.9), with low levels of inter-study heterogeneity observed ( I 2 = 33.6%, Cochran’s Q = 12.05, p = 0.149). Most of the patients were elderly male patients (65.8%) with comorbidities, the most common being systemic hypertension (54%). Hemorrhage involving multiple cranial compartments was reported in 9.5% of cases. Single compartments were involved in the rest, with intraparenchymal hemorrhage (IPH) being the most common variety (62.6%) and intraventricular hemorrhage (IVH) the least common (1.4%). Half of these patients were on some form of anticoagulation. Overall, the mortality rate in the COVID-19 patients with ICH was about 48.6%. Conclusion Although relatively uncommon among COVID-19 patients, ICH is associated with a high mortality rate. Early identification of patients at risk of developing ICH, particularly with comorbid conditions and on anticoagulant therapy, may be important to improve outcomes.