Efraime S. Mercado and Joselito B. Diaz
Introduction: Cerebrovascular events have been reported in patients with COVID-19, with ischemic being more common than hemorrhagic strokes. We present an asymptomatic elderly with spontaneous non-aneurysmal subarachnoid hemorrhage who was subsequently diagnosed with COVID-19 critical pneumonia. Spontaneous non-aneurysmal subarachnoid hemorrhage as an initial manifestation of SARS-CoV-2 infection is yet to be documented.
Objectives: This report presents a 75-year-old female with spontaneous nonaneurysmal subarachnoid hemorrhage as initial finding in a background of SARS-CoV-2 infection. We reviewed related literatures that will give insights on the dilemmas encountered in determining the association of spontaneous subarachnoid hemorrhage as a manifestation of COVID-19.
Case presentation: A 75-year-old female was brought to our institution after a presyncopal attack. Cranial neuroimaging showed non-aneurysmal subarachnoid hemorrhage. While hospitalized, she developed fever and dyspnea, subsequently diagnosed COVID-19, developed critical pneumonia and died of pulmonary complications.
Conclusion: This is a possible case of an undetected SARS-CoV-2 infection in an otherwise asymptomatic patient who initially presented with a spontaneous subarachnoid hemorrhage and later progressed to critical pneumonia leading to demise. Factors outside the context of COVID-19 were reviewed with limited literatures. Further epidemiological and clinical studies are warranted to clearly establish spontaneous subarachnoid hemorrhage as an initial manifestation of COVID-19.