Sato Takenori, Miura Yoichi, Yasuda Ryuta, Toma Naoki, Suzuki Hidenori
Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
Brain Hemorrhages. 2022 Dec;3(4):210-213. doi: 10.1016/j.hest.2022.08.001. Epub 2022 Aug 12.
We report a rare case of subarachnoid hemorrhage (SAH) caused by a ruptured vertebral artery (VA) dissecting aneurysm (DA) under severe COVID-19 treatment, and discuss the potential relationships.
A 58-year-old woman with COVID-19 fell into severe pneumonia needing mechanical ventilation at 10 days post-onset (day 10). The patient had no risk factors for DA or stroke other than COVID-19 infection. At day 17 when weaning ventilatory management, her systolic blood pressure was transiently elevated, and her consciousness did not recover thereafter. Computed tomography (CT) at day 21 revealed SAH with modified Fisher grade 4, and CT angiography revealed a DA in the right VA just distal to the right posterior inferior cerebellar artery (PICA). The DA was treated emergently with internal trapping by endovascular coiling, while the right PICA was preserved. Postoperative course was uneventful, and 2-time negative SARS-CoV-2 PCR results were obtained at day 45. The patient recovered to 4-month modified Rankin Scale 2.
Although it is not clear from the present case alone whether SARS-CoV-2 infection causes SAH by a ruptured VA DA, the accumulation of more cases and further studies are warranted to clarify the relationships between SARS-CoV-2 infection and ruptured intracranial DAs.
我们报告一例在重症新型冠状病毒肺炎（COVID-19）治疗期间，由椎动脉（VA）夹层动脉瘤（DA）破裂引起蛛网膜下腔出血（SAH）的罕见病例，并探讨其潜在关系。
一名58岁的COVID-19女性患者在发病后10天（第10天）发展为严重肺炎，需要机械通气。除了COVID-19感染外，该患者没有DA或中风的危险因素。在第17天进行撤机通气管理时，她的收缩压短暂升高，此后意识未恢复。第21天的计算机断层扫描（CT）显示为改良Fisher 4级的SAH，CT血管造影显示右VA在右小脑后下动脉（PICA）远端有一个DA。通过血管内栓塞进行紧急内部栓塞治疗DA，同时保留右PICA。术后过程顺利，在第45天获得了2次严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）阴性结果。患者恢复至改良Rankin量表4个月评分为2分。
尽管仅从本病例尚不清楚SARS-CoV-2感染是否通过VA DA破裂导致SAH，但需要积累更多病例并进行进一步研究，以阐明SARS-CoV-2感染与颅内DA破裂之间的关系。
