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Abstract
Subarachnoid hemorrhage (SAH) has deleterious outcomes for patients, and during the hospital stay, patients are susceptible to vasospasm and delayed cerebral ischemia. Coronavirus disease 2019 (COVID-19) has been shown to worsen hypertension through angiotensin-converting enzyme 2 (ACE2) activity, therefore, predisposing to aneurysm rupture. The classic renin-angiotensin pathway activation also predisposes to vasospasm and subsequent delayed cerebral ischemia. Matrix metalloproteinase 9 upregulation can lead to an inflammatory surge, which worsens outcomes for patients. SAH patients with COVID-19 are more susceptible to ventilator-associated pneumonia, reversible cerebral vasoconstriction syndrome, and respiratory distress. Emerging treatments are warranted to target key components of the anti-inflammatory cascade. The aim of this review is to explore how the COVID-19 virus and the intensive care unit (ICU) treatment of severe COVID can contribute to SAH.
Highlights
In late 2019, coronavirus disease 2019 (COVID-19) began to spread throughout Wuhan, China
The aim of this review is to explore how the COVID-19 virus and the intensive care unit (ICU) treatment of severe COVID can contribute to Subarachnoid hemorrhage (SAH)
By March of 2020, COVID-19 had spread throughout the world leading to government-mandated lockdowns, and the World Health Organization (WHO) implementing various public health measures to mitigate the spread of the virus [1–3]
Summary
In late 2019, coronavirus disease 2019 (COVID-19) began to spread throughout Wuhan, China. Nontraumatic SAH is most often caused by a ruptured aneurysm, called an aneurysmal SAH (aSAH) This condition is associated with high rates of death due to initial blood loss, severe rise in intracranial pressure, the potential for aneurysmal rebleeding, and delayed cerebral ischemia [6, 8, 10]. Patients infected with COVID-19 are displaying diminished alternative RAS pathway and are at an increased risk for developing cerebral atherosclerotic plaques and blood vessel stenosis. This could cause turbulence in the cerebral blood vessels leading to the development of an aneurysm. Elevated MMP-9 and inflammatory cytokines in COVID-19 infection can lead to arterial instability and subsequent aSAH [23, 24]
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