Journal of Medical Evidence

LETTER TO EDITOR
Year
: 2022  |  Volume : 3  |  Issue : 1  |  Page : 90--91

SARS-CoV-2 associated to aneurysmal subarachnoid haemorrhage: Lessons learnt and recommendations from the pandemic


Daniuska Velasquez-Carralero1, Tariq Janjua2, Hefzi Andrea Montano-Bayona3, Iván David Lozada-Martinez4, Luis Rafael Moscote-Salazar4,  
1 Department of Medicine, University of Medical Sciences of Holguin, Faculty of Medical Sciences “Mariana Grajales Coello,” Holguin, Cuba
2 Department of Critical Care Medicine, Physician Regional Medical Center, Naples, Florida, USA
3 Deparment of Medicine, Universidad Simon Bolivar, Barranquilla, Colombia
4 Colombian Clinical Research Group in Neurocritical Care, Colombia

Correspondence Address:
Dr. Luis Rafael Moscote-Salazar
Colombian Clinical Research Group in Neurocritical Care, Bogota
Colombia




How to cite this article:
Velasquez-Carralero D, Janjua T, Montano-Bayona HA, Lozada-Martinez ID, Moscote-Salazar LR. SARS-CoV-2 associated to aneurysmal subarachnoid haemorrhage: Lessons learnt and recommendations from the pandemic.J Med Evid 2022;3:90-91


How to cite this URL:
Velasquez-Carralero D, Janjua T, Montano-Bayona HA, Lozada-Martinez ID, Moscote-Salazar LR. SARS-CoV-2 associated to aneurysmal subarachnoid haemorrhage: Lessons learnt and recommendations from the pandemic. J Med Evid [serial online] 2022 [cited 2022 Aug 7 ];3:90-91
Available from: http://www.journaljme.org/text.asp?2022/3/1/90/344299


Full Text



The infection associated with novel coronavirus has represented an enormous challenge for global health; for several waves, the pandemic has hit humanity with immense mortality.[1] The high infectious capacity observed in the various variants accompanied by the multi-organ commitment of SARS-CoV-2 has contributed to increasing its dramatic impact on human beings. SARS-CoV-2 has an optimal capacity to invade the nervous system, generating a range of diseases such as seizures, Guillain–Barre syndrome, and encephalitis among others. On the other hand, we have witnessed the development of various neurovascular pathologies mainly of thrombotic origin; the latter appearance is one of the key elements of the pathobiology of the disease. Demonstrated neurovirulence combined with neurotropic and neuroinvasive features may explain the context of the disease both by the direct commitment to the nervous system and by the development of encephalopathic alterations linked to the multi-organ condition caused by SARS-CoV-2 infections.[2],[3],[4]

The element of endothelial involvement usually is not clear. This virus induces thrombosis due to high circulating procoagulation factors, ferritin and high inflammatory markers. The endothelium of brain–blood vessels can be part of this process, leading to damage and eventually bleeding. The impact of this haemorrhage is complex due to primary pulmonary injury-like adult respiratory distress syndrome.[5],[6]

Routine neuroimaging is recommended in an acute presentation of SARS-CoV-2 infection with neurological symptoms. Besides other neurological injuries, subarachnoid haemorrhage is possible and further work-up and management are complex. Patients who are already in the intensive care units with a profound pulmonary injury can have neurological issues. A low threshold for neuroimaging will pick up acute stroke, intracranial haemorrhage and subarachnoid haemorrhage. Patients on extracorporeal circulation with venovenous circuits created a new challenge if there is neurological change.[6],[7],[8]

In conclusion, a subarachnoid haemorrhage in SARS-CoV-2 infection can be due to the direct impact of the virus on brain–blood vessels. Patients with acute pulmonary injury and concurrent subarachnoid haemorrhage are extremely difficult situations and require a complex understanding of intensive care resuscitation. Further education, collaboration and research will help us get a better handle on these patients. This pandemic is here to stay, and we still have to learn more about the complex critical care aspects of our patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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