Objective

To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients.

Methods

Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed.

Results

Of 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively.

Conclusions

COVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.

中文翻译：

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COVID-19 患者的颅内出血

客观的

描述 COVID-19 患者急性颅内出血 (ICH) 的临床、实验室、时间、影像学和结果特征。

方法

2020 年 3 月 1 日至 7 月 31 日期间因 ICH 入院的迈蒙尼德医疗中心确诊或高度疑似 COVID-19 患者的回顾性、观察性连续病例系列。分析了人口统计学、临床、实验室、影像学和结果数据。以两周的时间间隔将所有中风的 ICH 发生率与 2019 年同期进行比较。进行了收缩压变异性 (SBPV) 和中性粒细胞与淋巴细胞比率 (NLR) 与临床结果的相关性。

结果

在 324 名中风患者中，65 名 (20%) 被诊断为非创伤性 ICH：8 名确诊，3 名高度怀疑 COVID-19。九名 (82%) 至少有一个 ICH 相关危险因素。三例 ICH 发生在住院抗凝期间。超过一半（6 人）患有深部出血或小脑出血；只有 2 例是脑叶出血。8名重症肺炎患者中有2人幸存。在 4 月份的纽约市 COVID-19 高峰期，ICH 在所有中风中所占比例最高 (40%)，然后逐周稳步下降 ( p  = 0.02)。SBPV 和 NLR 分别与出院改良 Rankin 量表呈中度和弱正相关。

结论

COVID-19 相关 ICH 通常与至少一种已知的 ICH 危险因素和严重肺炎有关。在纽约市大流行的第一个高峰期间，所有中风类型的 ICH 都出现了提示性的相对激增。重要的是要警惕 ICH 作为 COVID-19 的可能和重要表现。