Ruptured cerebral pseudoaneurysm in an adolescent as an early onset of COVID-19 infection: case report
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CASE REPORT - VASCULAR NEUROSURGERY - OTHER
Ruptured cerebral pseudoaneurysm in an adolescent as an early onset of COVID-19 infection: case report Dragan Savić 1 & Tarik M. Alsheikh 1 & Ahmad Kh. Alhaj 1 & Lazar Lazovic 2 & Lamya Alsarraf 2 & Petar Bosnjakovic 2 & Waleed Yousef 1 Received: 15 July 2020 / Accepted: 20 July 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection. Keywords Cerebral Pseudoaneurysm . COVID-19 infection . Adolescent
Abbreviations SARS-CoV-2 MCA GCS CT CTA DSA CXR
Severe acute respiratory syndrome coronavirus 2 Middle cerebral artery Glasgow coma score Computed tomography Computed tomography angiography Digital subtraction angiography Chest X-ray
Introduction The coronavirus disease 2019 (COVID-19) pandemic is a viral infection that mainly affects the respiratory tract [24]. It can also cause multiple inflammatory reactions with a wide range of clinical manifestations in different organs [23]. The vascular This article is part of the Topical Collection on Vascular Neurosurgery Other * Dragan Savić [email protected] 1
Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
2
Medical Imaging Department, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait
complications after infection with this virus have been reported, but the possible association with cerebrovascular consequences, particularly intracranial hemorrhages, is still under debate [11, 16]. There are rare case reports of adult patients (the youngest was a 31-year-old male, other patients over 60 years old) with COVID-19 infection and ruptured cerebral aneurysm with subarachnoid hemorrhage [1, 16, 19]. The authors assumed that these conditions could be causally linked. However, preceding information from the severe acute respiratory syndrome (SARS) epidemic in 2003 proposed a higher incidence of stroke [3, 14, 21]. Besides, some other viruses are associated with cerebral aneurysmal arteriopathy, such as human immunodeficiency virus (HIV), varicella zoster virus, cytomegalovirus, hepatitis C virus, and parvovirus B-19 [4, 13]. It is proposed that one-third of all vasculopathy conditions are caused by infectious vasculitis of medium and large intracranial vessels [13]. In this paper, we present an adolescent girl with COVID-19 infection, who developed an intracerebral hemat
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