Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
J Stroke Cerebrovasc Dis. 2021 Apr;30(4):105603. doi: 10.1016/j.jstrokecerebrovasdis.2021.105603. Epub 2021 Jan 8.
To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients.
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.
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.
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.
描述 COVID-19 患者急性颅内出血（ICH）的临床、实验室、时间、影像学和结局特征。
回顾性、观察性、连续病例系列，纳入 2020 年 3 月 1 日至 7 月 31 日期间因 ICH 入住 Maimonides 医疗中心且确诊或高度疑似 COVID-19 的患者。分析人口统计学、临床、实验室、影像学和结局数据。比较了 COVID-19 组与 2019 年同期两周时间间隔内所有中风患者的 ICH 发生率。还对收缩压变异性（SBPV）和中性粒细胞与淋巴细胞比值（NLR）与临床结局的相关性进行了分析。
在 324 名出现中风的患者中，65 名（20%）被诊断为非创伤性 ICH：8 名确诊，3 名高度疑似 COVID-19。9 名（82%）有至少一个 ICH 相关的危险因素。3 例 ICH 发生在住院抗凝治疗期间。超过一半（6 例）患者发生深部或小脑出血；仅有 2 例为脑叶出血。8 例重症肺炎患者中，有 2 例存活。在 4 月纽约市 COVID-19 高峰期，ICH 占所有中风的比例最高（40%），然后每周逐渐下降（p=0.02）。SBPV 和 NLR 与出院改良 Rankin 量表评分中度和弱正相关。
COVID-19 相关的 ICH 常与至少一个已知的 ICH 危险因素和重症肺炎相关。在纽约市大流行的第一个高峰期间，所有中风类型中 ICH 的相对比例呈上升趋势。因此，ICH 作为 COVID-19 的一种可能且重要的表现，需要保持警惕。
