De novo intracranial aneurysm formation in SARS-CoV-2 infection: first report of a yet unknown complication

Abstract

Background and Importance

COVID-19 is a viral infection that mainly affects the respiratory tract, but can also cause multiple inflammatory reactions, including neurological and cerebrovascular manifestations. We report the case of a COVID-19 patient who developed ‘de novo’ multiple cerebral aneurysms with no risk factors for aneurysm formation.

Clinical Presentation

A 55-year-old man with SARS-CoV-2 infection came to our attention for left eye blindness accompanied by ptosis, palpebral chemosis and retro-orbital pain. Brain CT and CT-angiography were negative for hemorrhages and for vascular malformations. Repeated intracerebral hemorrhages and neurological deterioration then occurred, and a new CT-angiography showed multiple intracranial aneurysms that were not present before.

Conclusion

Intracranial aneurysm formation as a complication of COVID-19 has not been previously reported. As other viral infections do, COVID-19 may be able to determine a vascular damage that can ultimately lead to development of an aneurysm. It is reasonable to hypothesize an involvement of the renin-angiotensin system as a pathogenic mechanism. A conservative therapy aiming at inflammatory modulation and vascular damage prevention may be warranted in these patients.

Keywords:

• COVID-19
• SARS-CoV-2
• intracranial aneurysm
• cerebrovascular
• central nervous system
• pseudoaneurysm

Disclosure statement

All authors certify that they have no personal or institutional financial interest in drugs, materials or devices described in the present work.

Additional information

Funding

No funding was received for this research.