CO-OCCURENCE COVID-19 AND INTRACEREBRAL HEMORRHAGE IN CEREBRAL CAVERNOUS MALFORMATION, IS IT COINCIDENCE? A CASE REPORT

Abstract

Covid-19 (Corona Virus Disease 2019) caused by a novel Coronavirus has become worldwide pandemic on March 12, 2020. Clinical manifestations of Covid-19 can vary from asymptomatic to severe disease. Not only after struggling with the Covid-19 infection, now clinician has to deal with post Covid-19 syndrome due to by recurrent.  Covid-19 related neurological complication has been reported is cerebrovascular incidence such as thrombosis, venous thrombo-embolism, hemorrhage while Covid-19 related hemorrhage still on debate. The Suggestive hemorrhage mechanism starts on the ACE-II (Angiotensin-Converting Enzyme II) receptor which is used as viral entry. This rapid down regulation of ACE-II receptor result in vasoconstriction and hypertension.  Cerebral Cavernous Malformation (CCM) is an entangled abnormal brain capillary which wall is built on single epithelium line. This wall will casually tear and give unpredictable bleeding. The risk of bleeding might vary. The Coincidence of Intracerebral Hemorrhage in CCM with Covid-19 is less reported. There are possibility that Covid-19 may induce risk of hemorrhage by increasing blood pressure and inflammation. We report a young male patient present CCM rupture and after Covid-19 infection. This case shows the implication of Covid-19 pandemic which cause diagnostic and treatment postponement.