Subarachnoid hemorrhage (SAH) has deleterious outcomes for patients, and during the hospital stay, patients are susceptible to vasospasm and delayed cerebral ischemia. Coronavirus disease 2019 (COVID-19) has been shown to worsen hypertension through angiotensin-converting enzyme 2 (ACE2) activity, therefore, predisposing to aneurysm rupture. The classic renin-angiotensin pathway activation also predisposes to vasospasm and subsequent delayed cerebral ischemia. Matrix metalloproteinase 9 upregulation can lead to an inflammatory surge, which worsens outcomes for patients. SAH patients with COVID-19 are more susceptible to ventilator-associated pneumonia, reversible cerebral vasoconstriction syndrome, and respiratory distress. Emerging treatments are warranted to target key components of the anti-inflammatory cascade. The aim of this review is to explore how the COVID-19 virus and the intensive care unit (ICU) treatment of severe COVID can contribute to SAH.
Keyphrases
- subarachnoid hemorrhage
- cerebral ischemia
- coronavirus disease
- brain injury
- angiotensin converting enzyme
- sars cov
- ejection fraction
- newly diagnosed
- blood brain barrier
- prognostic factors
- angiotensin ii
- blood pressure
- coronary artery
- healthcare
- anti inflammatory
- metabolic syndrome
- type diabetes
- cell proliferation
- emergency department
- adipose tissue
- signaling pathway
- patient reported outcomes
- skeletal muscle
- poor prognosis
- drug induced