Objective:

Background:

Perihematomal edema (PHE) is an indicator of secondary brain injury in patients with spontaneous intracerebral hemorrhage (ICH). The complement cascade plays a central role in PHE development. Thus, since COVID-19 infection is known to activate multiple complement cascade pathways, we hypothesized that COVID-19 infection would increase edema to hematoma volume ratio in patients with ICH relative to ICH patients not infected with COVID-19.

Design/Methods:

Patients at Rush University Medical Center with COVID-19 and spontaneous ICH, both diagnosed at admission from April 2020 to June 2021 were identified (N=12) and compared to randomly selected patients with ICH, but without COVID-19 diagnosis in the same time period (N=12). Patient characteristics, presenting factors, and admission CT imaging were abstracted from the electronic health record. Edema and hematoma measurements were made using semiautomatic segmentation software on admission CT scans for greatest accuracy.

Results:

Average hematoma and perihematomal edema volumes were 18.10 mL and 12.12 mL in the non-COVID ICH patients and 18.56 mL and 15.62 mL in COVID ICH patients, respectively (p=0.477, p=0.264). However, edema volume to hematoma volume ratio was 0.75 and 2.47 in non-COVID and COVID patients, respectively (p<0.05).

Conclusions:

Patients with both ICH and COVID-19 have edema volumes significantly greater in relation to their hematoma size compared to ICH patients without COVID-19. As the COVID-19 pandemic has continued, more data is warranted to corroborate these findings and evaluate therapies that minimize edema expansion and promote positive clinical outcomes.