ABSTRACT
Background and aims: Anticoagulation regimens are now being considered for COVID-19. Anticoagulation is known to increase the risk for adverse bleeding events, of which intracerebral hemorrhage (ICH). Methods: Case Report. Results: We report a 57-year-old man was admitted to hospital due decreased oxygen saturation, increased blood glucose levels and RT-PCR of oropharyngeal swab confirmed COVID-19. The patient had a previous history of type 2 DM and ischemic stroke. The first 5 days, the patient was receiving a prophylactic dose of low molecular weight heparin, enoxaparin, then continued with unfractionated heparin. The patient also received antiplatelet clopidogrel and convalescent plasma. The laboratory results are leucocyte 18.9 K/μL, ureum 79 mg/dL, creatinine 2.0 mg/dL, D-Dimer 0.22 μg/mL, INR 1.03, NLR 15.82, ALC 547, HbA1C 9.2, blood glucose level 336 mg/dL, CRP 41.2 mg/dL. On day ten of hospitalization, the patient had sudden right-sided hemiplegia and Broca's aphasia. A CT head demonstrated an ICH in the left basal ganglia with a volume approximately 77cc. Three days later the patient's condition had decreased consciousness and a craniotomy was performed. After being intubated for 4 days post craniotomy, because his condition improved, he was extubated. On day nine after surgery, the patient's condition decreased to coma, a repeat chest X-ray showed a worsening of the bilateral infiltrates and pleural effusion. His oxygen requirement was progressively increasing, so he was shifted to mechanical ventilation again. Conclusions: The risk of intracerebral hemorrhage in patients with COVID-19 is of paramount importance to inform the risk-benefit assessment of the use of anticoagulation in this patient.
ABSTRACT
Background and aims: Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a contagious disease that causes the current pandemic. SARS‐CoV‐2 has been postulated to have a neuroinvasive potential. Headache as a very common non-respiratory symptom of COVID-19. The literature review is intended to explain about headache in patients with SARS-COV-2 infection. Methods: The journals used in literature reviews obtained through databases include Google Scholar, PubMed, and Science Direct. The search found 26 articles from Google Scholar, 3 from PubMed, and 6 articles from Science Direct. Of all the articles, the selection was made based on the title and abstract, so that 35 articles were obtained. The literature used is not a thesis, dissertation, thesis, or other literature review. The articles used are only journals in full text. So that the number of articles used is 25 articles. Results: From the 25-literature reviewed, headache in COVID-19 patients appears in the prodromal phase and is followed by anosmia/hyposmia. Headache on COVID-19 patients in general were holocranial, hemicranial, or occipital, pressing, and worsens with physical activity or head movements. Pathogenesis of headache on COVID-19 patients still under debated. The mechanism of headache in SARS-CoV-2 is related to cytokine storm and cytokine release syndrome (CRS). Conclusions: Headache is one of the most common neurological manifestations in patients infected with SARS-CoV-2. The characteristic of headache in patient COVID-19 is typically a headache of moderate to severe intensity with frontal predominance and oppressive quality.