Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients
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COVID-19
Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients Isaac Cheruiyot 1,2 & Prabjot Sehmi 1 & Beryl Ominde 3 & Paul Bundi 4 & Musa Mislani 1 & Brian Ngure 1 & Beda Olabu 1 & Julius A. Ogeng’o 1 Received: 24 September 2020 / Accepted: 28 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract 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 COVID19 patients was 0.7% (95% CI 0.5–0.9), with low levels of inter-study heterogeneity observed (I2 = 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. Keywords COVID-19 . Intracranial hemorrhage . Hemorrhagic stroke
Introduction Recent reports have highlighted the relationship between coronavirus disease 2019 (COVID-19) and cerebrovascular disease (CVD). Past history of CVD has been associated with poor
* Isaac Cheruiyot [email protected] 1
Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
2
School of Medicine, University of Nairobi, Nairobi, Kenya
3
Department of Human Anatomy, Kenya Methodist University, Meru, Kenya
4
Department of Internal Medicine, Kenya Methodist University, Meru, Kenya
outcomes among COVID-19 patients [1–3]. On the other hand, a subset of these patients develops CVD during the course of hospitalization [4, 5]. Whereas ischemic CVD, which has been attributed to a hypercoagulable state characterized by micro- and macrovascular thrombotic angiopathy [6, 7], is more common and is described in literature [4, 5, 8, 9], reports on hemorrhagic CVD in these patients are fe
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