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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0043-1777055
Case Report

Ruptured Cerebral Aneurysms and Dissecting Aneurysms in Patients with COVID-19: A Case Series and Literature Review

Daisuke Wajima  
1   Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
,
Rin Shimozato
1   Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
,
Tomonori Takeshita
1   Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
,
Tomoaki Nagamine
1   Department of Neurosurgery, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center, Okinawa, Japan
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Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a hypercoagulable state and ischemic stroke. However, aneurysmal subarachnoid hemorrhage (SAH) due to SARS-CoV-2 infection is uncommon. Here, we report a case series of SAH caused by ruptured cerebral aneurysms or dissecting aneurysms (DAs) in patients with coronavirus disease 2019 (COVID-19) and discuss the potential relationships between them.

Case Description Four of the six patients had a history of COVID-19, ranging from 2 to 9 days, one had COVID-19 pneumonia for 1 month, and one had SARS-CoV-2 positivity on admission. Plain head computed tomography revealed diffuse SAH in all cases, while angiography revealed a DA in the right posterior cerebral artery (P2 portion) in patient 1, DA in the right vertebral artery (VA) in patients 2 and 6, anterior communicating artery aneurysm in patient 3, blister aneurysm in the right internal cerebral artery (ICA) (C2 portion) in patient 4, and DAs in the right VA and extracranial portion of the right ICA in patient 5. Treatment comprised internal trapping for patients 1, 2, and 6; neck clipping for patient 3; stent-assisted coiling for patient 4; and internal trapping and flow diversion for patient 5. All the patients' postoperative courses were uneventful.

Conclusion The present cases alone do not provide clear evidence on whether SARS-CoV-2 infection causes ruptured cerebral aneurysms or DAs. Therefore, accumulation of more cases and further studies are needed to clarify the relationship between SARS-CoV-2 infection and these aneurysm conditions.

Keywords

angiography - COVID-19 - intracranial aneurysms - ischemic stroke - SARS-CoV-2 - subarachnoid hemorrhage

 


Ethics Statement and Informed Consent

This study complies with all relevant national regulations and institutional policies and the tenets of the Helsinki Declaration. It has been approved by the institutional review board or equivalent committee of the institution to which the authors are affiliated. Written informed consent was provided by all patients in this study.




Publication History

Article published online:
21 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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