Ruptured Cerebral Aneurysms and Dissecting Aneurysms in Patients with COVID-19: A Case Series and Literature Review

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a hypercoagulable state and ischemic stroke. However, aneurysmal subarachnoid hemorrhage (SAH) due to SARS-CoV-2 infection is uncommon. Here, we report a case series of SAH caused by ruptured cerebral aneurysms or dissecting aneurysms (DAs) in patients with coronavirus disease 2019 (COVID-19) and discuss the potential relationships between them.

Case Description Four of the six patients had a history of COVID-19, ranging from 2 to 9 days, one had COVID-19 pneumonia for 1 month, and one had SARS-CoV-2 positivity on admission. Plain head computed tomography revealed diffuse SAH in all cases, while angiography revealed a DA in the right posterior cerebral artery (P2 portion) in patient 1, DA in the right vertebral artery (VA) in patients 2 and 6, anterior communicating artery aneurysm in patient 3, blister aneurysm in the right internal cerebral artery (ICA) (C2 portion) in patient 4, and DAs in the right VA and extracranial portion of the right ICA in patient 5. Treatment comprised internal trapping for patients 1, 2, and 6; neck clipping for patient 3; stent-assisted coiling for patient 4; and internal trapping and flow diversion for patient 5. All the patients' postoperative courses were uneventful.

Conclusion The present cases alone do not provide clear evidence on whether SARS-CoV-2 infection causes ruptured cerebral aneurysms or DAs. Therefore, accumulation of more cases and further studies are needed to clarify the relationship between SARS-CoV-2 infection and these aneurysm conditions.

Keywords

angiography - COVID-19 - intracranial aneurysms - ischemic stroke - SARS-CoV-2 - subarachnoid hemorrhage

 

Ethics Statement and Informed Consent

This study complies with all relevant national regulations and institutional policies and the tenets of the Helsinki Declaration. It has been approved by the institutional review board or equivalent committee of the institution to which the authors are affiliated. Written informed consent was provided by all patients in this study.

Publikationsverlauf

Artikel online veröffentlicht:
21. Dezember 2023

• References

• 1 Abou-Ismail MY, Diamond A, Kapoor S, Arafah Y, Nayak L. The hypercoagulable state in COVID-19: incidence, pathophysiology, and management. Thromb Res 2020; 194: 101-115
• 2 Humayun L, Smith C, Li W. et al. SARS-CoV-2-related vascular injury: mechanisms, imaging and models. Microphysiol Syst 2021; 5: 1
• 3 Wajima D, Hourani S, Dodd W. et al. Interleukin-6 promotes murine estrogen deficiency-associated cerebral aneurysm rupture. Neurosurgery 2020; 86 (04) 583-592
• 4 Sato T, Miura Y, Yasuda R, Toma N, Suzuki H. Vertebral artery dissecting aneurysm rupture under severe COVID-19. Brain Hemorrhages 2022; 3 (04) 210-213
• 5 Bond KM, Krings T, Lanzino G, Brinjikji W. Intracranial dissections: A pictorial review of pathophysiology, imaging features, and natural history. J Neuroradiol 2021; 48 (03) 176-188
• 6 Daly SR, Nguyen AV, Zhang Y, Feng D, Huang JH. The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review. Brain Hemorrhages 2021; 2 (04) 141-150
• 7 Dodd WS, Jabbour PM, Sweid A. et al. Aneurysmal subarachnoid hemorrhage in patients with coronavirus disease 2019 (COVID-19): a case series. World Neurosurg 2021; 153: e259-e264
• 8 Benger M, Williams O, Siddiqui J, Sztriha L. Intracerebral haemorrhage and COVID-19: Clinical characteristics from a case series. Brain Behav Immun 2020; 88: 940-944
• 9 Miyata H, Koseki H, Takizawa K. et al. T cell function is dispensable for intracranial aneurysm formation and progression. PLoS One 2017; 12 (04) e0175421
• 10 Morassi M, Bigni B, Cobelli M, Giudice L, Bnà C, Vogrig A. Bilateral carotid artery dissection in a SARS-CoV-2 infected patient: causality or coincidence?. J Neurol 2020; 267 (10) 2812-2814
• 11 Fiani B, Fowler JB, Figueras RA. et al. Ruptured cerebral aneurysms in COVID-19 patients: a review of literature with case examples. Surg Neurol Int 2021; 12: 187
• 12 Kostyra K, Nowak B, Kostkiewicz B. Clipping of a ruptured middle cerebral artery aneurysm in a patient with coronavirus disease 2019 (COVID-19): a case report. Interdiscip Neurosurg 2020; 22: 100849
• 13 Coomes EA, Haghbayan H. Interleukin-6 in Covid-19: a systematic review and meta-analysis. Rev Med Virol 2020; 30 (06) 1-9
• 14 Fraiman P, Godeiro Junior C, Moro E, Cavallieri F, Zedde M. COVID-19 and cerebrovascular diseases: a systematic review and perspectives for stroke management. Front Neurol 2020; 11: 574694
• 15 Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol 2021; 93 (01) 250-256
• 16 Savić D, Alsheikh TM, Alhaj AK. et al. Ruptured cerebral pseudoaneurysm in an adolescent as an early onset of COVID-19 infection: case report. Acta Neurochir (Wien) 2020; 162 (11) 2725-2729