In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH).

We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria.

The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury.

Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.

Hemorrhagic stroke is one of the leading causes of morbidity and mortality worldwide. Medical management has been the mainstay of treatment for patients with intracerebral hemorrhage (ICH). However, with the advent of advanced imaging and minimally invasive surgery (MIS) techniques for hematoma evacuation, patients with large ICH could potentially benefit from surgical intervention. Herein, we report a case with a large ICH that was evacuated using a novel DTT-guided parafascicular Brain Path/Myriad technique.

Chart review including clinical data and imaging results were performed as well as literature search.

In this case presented, a 55-year-old woman presented with acute onset of left facial droop, dysarthria, and left hemiparesis. Brain MRI showed a large right basal ganglia hematoma which had displaced the ipsilateral corticospinal tract (CST) medially on DTT imaging. A right anterior parafascicular approach was utilized for an MIS evacuation of the hematoma using Brain Path/Myriad. Post-operative CT head showed excellent evacuation of the hematoma and the patient recovered with stable neurological functions.

Surgical evacuation of ICH using DTT-guided Brain parafascicular Path/Myriad is an excellent method to rapidly decrease the hematoma burden in patients with ICH to protect the CST.

Intracranial hemorrhage (ICH) causes often devastating brain injury. Predicting long-term motor prognosis and identifying neurosurgical candidates in cases of ICH has been an imprecise practice. Diffusion tensor tractography (DTT) is an imaging modality that may aid in this challenge. This literature review aimed to investigate DTT applications in patients with spontaneous ICH for either motor function prognosis or surgical intervention.

A PubMed and Ovid literature review was performed to select and evaluate studies utilizing DTT for motor prognostication or analysis/optimization of surgical outcomes in patients with spontaneous hypertensive ICH. Studies investigating ICH due to suspected vascular anomalies were excluded.

Forty-two studies met criteria. Six studies addressed surgical application. Surgery was not associated with increased mortality but was associated with decreased hematoma volume and CST compression and improved motor outcomes. Prognostic studies demonstrated that DTT correlates with motor function at multiple timepoints.

DTT is a relatively new imaging technique that may help predict prognosis of patients’ motor function after spontaneous ICH. Additionally, it could possibly serve as an adjunct for determining which patients would benefit from surgical decompression or even help guide surgical approach to hematomas that displace the CST.