Fatal Aneurysmal Subarachnoid Hemorrhage in a Young Patient with COVID-19 Infection

Abstract

Background and Purpose— World Health Organization (WHO) declared coronavirus disease 2019 (COVID-19)
caused by severe acute respiratory distress syndrome corona virus-2 (SARS-CoV2) as a pandemic in March 2020.
Majority of the affected population experience respiratory symptoms although a variety of neurological manifestations
have been reported in COVID-19 patients.
Case Description— We report a 40-year-old Asian woman, with a known exposure to COVID-19 infection
through her husband, 15 days prior to her hospitalization, presented with coma and subarachnoid hemorrhage (SAH).
SARS-CoV-2 was identified by polymerase chain reaction (PCR) on day 2 of admission. Computerized tomography
(CT) imaging of the head without contrast revealed diffuse subarachnoid hemorrhage throughout the basilar cisterns,
sylvian fissure, and intraventricular extension with mild ventricular dilation. CT angiogram head revealed a 5 mm
aneurysm of the left vertebrobasilar junction with relative diminutive contrast throughout the posterior circulation
and a questionable aneurysm of the anterior communicating artery measuring about 2 mm. The patient died on day 4
of hospitalization when the family opted for palliative care.
Conclusion— To our knowledge, very few cases of COVID-19 with SAH have been reported. Damage to the en
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dothelium and underlying inflammation could be a potential cause of aneurysmal rupture.