Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

Stroke and Vascular Neurology

article

Luke Dixon¹  Cillian McNamara¹  Pritika Gaur¹  Dermot Mallon¹  Charles Coughlan²  Francesca Tona¹  Wajanat Jan¹  Mark Wilson³  Brynmor Jones¹ 

[1] Department of Neuroradiology , Imperial College Healthcare NHS Trust;Department of Cardiac Intensive Care , Imperial College Healthcare NHS Trust;Department of Neurosurgery , Imperial College Healthcare NHS Trust

关键词: blood flow;    brain;    haemorrhage;    infection;    inflammation;   

DOI  :  10.1136/svn-2020-000652

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background Cerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19. This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage. By comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease, this study aims to propose possible common pathogenic mechanisms.Methods A retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI. The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale, and patients’ baseline characteristics and salient test results were also recorded.Results Cerebral microhaemorrhages were noted to have a predilection for the corpus callosum, the juxtacortical white matter and brainstem. All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation.Discussion This study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia. This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND