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Spontaneous Intracerebral Hemorrhage in a COVID 19 Postpartum with a Preeclampsia: A Case Report

Jamielou DJ. Dizon

Coronavirus disease 2019 (COVID 19) is a disease caused by severe acute respiratory syndrome coronavirus (SARS-COV2) that has been associated with severe multiorgan complications. Unexpected development of this global health crisis makes health care practitioners unaware of the pathogenesis of this new disease. Only a few studies were published regarding COVID 19 in pregnancy and its effect on intrapartum as well as postpartum period. The strategies in management are constantly changing thus reports and case series are crucial in expanding our understanding of COVID 19 in pregnancy. Many questions arise such as: 1) are pregnant patients more vulnerable to having COVID 19? 2) Does having COVID 19 predispose pregnant patients to develop hypertensive disorders and cerebrovascular accidents? At this juncture, there is no reported case of a spontaneous intracerebral hemorrhage in a COVID 19 postpartum and also there were limited reported cases of stroke in patients with postpartum preeclampsia. Presented in this paper is a case of COVID 19 patient diagnosed with postpartum preeclampsia which progressed to a spontaneous intracerebral hemorrhage.

Stroke is a clinical condition which is defined as a disruption of cerebral function manifested as focal or global signs and symptoms. This a condition that rarely happens during pregnancy but once it occurs it is associated with gestational hypertension and preeclampsia which can be identified in the patient. Most patient with preeclampsia does not develop spontaneous intracerebral hemorrhage thus the call for further exploration of other possible risk factor.

Acute Cerebrovascular disease is a significant manifestation of systemic COVID 19 with incidence rate of 1-6% in positive patients and this rate equates a large proportion of the COVID 19 population as SARS-CoV-2 affects millions of people worldwide which can be caused by direct endothelial inflammation, systemic inflammation and hypercoagulopathy. They are associated with elevated D-dimer and C-Reactive protein which indicates a highly prothrombotic state.

Treatment of spontaneous intracerebral hemorrhage in pregnancy is multidisciplinary approach involving various services. The patient underwent left frontoparietotemporal decompressive hemicraniectomy and evacuation of hematoma. The patient was treated with low molecular weight heparin, antihypertensives and anticonvulsants.