• Auricelio Batista Cezar-Junior, Igor Vilela Faquini, José Laercio Junior Silva, Eduardo Vieira de Carvalho Junior, Luiz Euripedes Almondes Santana Lemos, João Batista Monte Freire Filho, Hetevaldo Tavares de Lira Filho, Erton Cesar de Albuquerque Pontes, Nivaldo Sena Almeida, and Hildo Rocha Cirne Azevedo-Filho.
• Hospital da Restauração, Department of Neurosurgery, Recife, Av. Gov. Agamenon Magalhães, s/n - Derby, Recife - PE, 52171-011, Brazil.
• Medicine (Baltimore). 2020 Dec 18; 99 (51): e23862e23862.

AbstractSome evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center.We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records.Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 μg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2).This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

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