Invited Commentary on Intracerebral Hemorrhage in COVID-19 Patients with Pulmonary Failure: A Propensity Score-Matched Registry Study

By Brett Cucchiara
First Online: 02 April 2021

Early in the coronavirus disease 2019 (COVID-19) pandemic, reported cases of ischemic stroke and intracranial hemorrhage (ICH) complicating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection caused considerable alarm. As more systematic data emerged, it became apparent that these events were, fortunately, relatively uncommon. For example, at our center in Philadelphia we identified ischemic stroke in 2.4% and ICH in 0.9% of 844 hospitalized patients with COVID-19 admitted from March to May 2020 [1]. The mechanistic linkage between SARS-CoV-2 infection and these events is of great interest. Is there something specific about SARS-CoV-2 infection that increases the risk of these events? Or are we just seeing complications related to the diffuse inflammatory response which might be produced by any infectious disease lacking effective treatment or preexisting immunity? Relatedly, because a majority of patients with stroke in the setting of COVID-19 are critically ill, how much of the association is simply due to severe systemic illness or the complications of the treatments for this illness, such as anticoagulation and extracorporeal membrane oxygenation (ECMO)?

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