Journal of Medical Evidence

: 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

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
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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.

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Conflicts of interest

There are no conflicts of interest.


1Román GC, Spencer PS, Reis J, Buguet A, Faris ME, Katrak SM, et al. The neurology of COVID-19 revisited: A proposal from the environmental neurology specialty group of the world federation of neurology to implement international neurological registries. J Neurol Sci 2020;414:116884.
2Conde Cardona G, Quintana Pájaro LD, Quintero Marzola ID, Ramos Villegas Y, Moscote Salazar LR. Neurotropism of SARS-CoV 2: Mechanisms and manifestations. J Neurol Sci 2020 May 15;412:116824. doi: 10.1016/j.jns.2020.116824. Epub 2020 Apr 8. PMID: 32299010; PMCID: PMC7141641.
3Dong S, Liu P, Luo Y, Cui Y, Song L, Chen Y. Pathophysiology of SARS-CoV-2 infection in patients with intracerebral hemorrhage. Aging (Albany NY) 2020;12:13791-802
4Huang J, Zheng M, Tang X, Chen Y, Tong A, Zhou L. Potential of SARS-CoV-2 to cause CNS infection: Biologic fundamental and clinical experience. Front Neurol 2020;11:659.
5Vitalakumar D, Sharma A, Kumar A, Flora SJ. Potential neurological effects of severe COVID-19 infection. Neurosci Res 2020;158:1-5.
6Ninan S, Thompson P, Gershon T, Ford N, Mills W, Jewells V, et al. Fatal Pediatric COVID-19 Case With Seizures and Fulminant Cerebral Edema. Child Neurol Open 2021 Jun 14;8:2329048X211022532. doi: 10.1177/2329048X211022532. PMID: 34179214; PMCID: PMC8207268.
7Cezar-Junior AB, Faquini IV, Silva JL, de Carvalho Junior EV, Lemos LE, Freire Filho JB, et al. Subarachnoid hemorrhage and COVID-19: Association or coincidence? Medicine (Baltimore) 2020;99:e23862.
8Yeung R, Ahmad T, Aviv RI, de Tilly LN, Fox AJ, Symons SP. Comparison of CTA to DSA in determining the etiology of spontaneous ICH. Can J Neurol Sci 2009;36:176-80.