SESSION TITLE: Medical Student/Resident Critical Care Posters
SESSION TYPE: Med Student/Res Case Rep Postr
PRESENTED ON: October 18-21, 2020
INTRODUCTION: SARS-CoV-2 is a respiratory virus causing mostly pulmonary manifestations. It has been associated with intracerebral pathology including stroke encephalitis and encephalopathy. Intraventricular hemorrhage may be an unknown fatal extrapulmonary presentation in patients with COVID-19 or a coincidental finding.
CASE PRESENTATION: We report a case of a 32-year-old man with asthma not on any home medications particularly antiplatelet and anti-coagulation medications who presented to the hospital after cardiac arrest at home. He reported blurry vision that morning and collapsed soon after. As per family patient is not on any medications or drug abuse. He was resuscitated and mechanically ventilated in the field and arrived in the emergency department in an irreversible coma. On arrival, his vitals are recorded as tachycardia to 120, and blood pressure is 136/80. Initial labs showed anion gap metabolic acidosis with lactic acidosis and respiratory acidosis, leukocytosis, elevated ferritin, elevated AST, and ALT and in acute kidney injury, urine toxicology is negative. Computed tomographic imaging of the brain revealed diffuse intraventricular hemorrhage with associated hydrocephalus with no obvious parenchymal source of bleeding. Computed tomographic imaging of the chest showed bilateral pneumonia highly suspicious of COVID-19.
DISCUSSION: Recent evidence shows that SARS-CoV-2 (COVID-19) can be complicated by coagulopathy, which may lead to prothrombotic events including venous thromboembolism, pulmonary embolism, and stroke; however, hemorrhagic manifestations are rare in patients with COVID-19. It has been hypothesized that dysfunction of brain ACE II receptors due to COVID-19 could lead to disruption of autoregulation in the cerebral vessel leading to rupture of the arterial wall causing hemorrhage.
CONCLUSIONS: Intracerebral hemorrhage as extrapulmonary manifestations of SARS-CoV-2 is rare and can be fatal. Current literature lacks evidence to support the pathophysiology of hemorrhagic and extrapulmonary manifestations except for entry through the ACE II receptors. More studies should be done in the future to determine possible mechanisms for extrapulmonary manifestations of COVID 19.
Reference #1: Deliwala S, Abdulhamid S, Abusalih MF, Al-Qasmi MM, Bachuwa G. Encephalopathy as the Sentinel Sign of a Cortical Stroke in a Patient Infected With Coronavirus Disease-19 (COVID-19). Cureus. 2020;12(5):e8121. Published 2020 May 14. DOI:10.7759/cureus.8121.
Reference #2: Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19, and intracerebral hemorrhage: causative or coincidental?. New Microbes New Infect. 2020;35:100669. Published 2020 Mar 27. DOI:10.1016/j.nmni.2020.100669.
Reference #3: Kollias A, Kyriakoulis KG, Dimakakos E, Poulakou G, Stergiou GS, Syrigos K. Thromboembolic risk and anticoagulant therapy in COVID-19 patients: emerging evidence and call for action [published online ahead of print, 2020 Apr 18]. Br J Haematol. 2020;10.1111/bjh.16727. DOI:10.1111/bjh.16727
DISCLOSURES: Speaker/Speaker's Bureau relationship with pfizer Please note: $1001 - $5000 Added 06/11/2020 by Yizhak Kupfer, source=Web Response, value=Consulting fee
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