Fatal intracranial haemorrhage in a hypertensive patient with atrial fibrillation and coronavirus disease 2019

Neuroradiol J. 2021 Apr;34(2):147-150. doi: 10.1177/1971400920978438. Epub 2020 Dec 14.


We present a case of a fatal cerebral haemorrhage in an 82-year-old male patient with coronavirus disease 2019 (COVID-19), who was taking prophylactic oral anticoagulation because of atrial fibrillation (rivaroxaban 20 mg q.d. for two years). On admission, the patient was deeply comatose, mechanically ventilated, with tachycardia up to 150 bpm, high blood pressure >210/120 mmHg and a body temperature >39°C. A computed tomography scan of the head showed a large intracerebral haemorrhage located in the deep structures of the right hemisphere, with a mass effect and bleeding to the ventricles. Rivaroxaban was discontinued at admission. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but he did not have typical symptoms of pneumonia. In the following days, the patient's neurological condition did not improve, and a fever of up to 40°C and abnormal coagulation parameters remained resistant to pharmacotherapy. The patient developed multi-system organ failure and died on day 8. Here, we review the recent literature and discuss the possible association of SARS-CoV-2-mediated endothelial injury and cardiovascular disorders with cerebrovascular complications. We postulate that anti-inflammatory treatment in COVID-19 and the stabilisation of endothelium functions can be particularly important in patients with pre-existing cardiovascular conditions.

Keywords: COVID-19; SARS-CoV-2; anticoagulants; intracranial haemorrhage.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged, 80 and over
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy*
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / physiopathology
  • Cerebral Hemorrhage / diagnostic imaging
  • Cerebral Hemorrhage / etiology*
  • Cerebral Hemorrhage / therapy
  • Factor Xa Inhibitors / adverse effects*
  • Fatal Outcome
  • Humans
  • Hypertension / complications*
  • Hypotension / etiology
  • Male
  • Multiple Organ Failure / etiology
  • Respiratory Insufficiency / etiology
  • Rivaroxaban / adverse effects*
  • SARS-CoV-2
  • Stroke / etiology
  • Stroke / prevention & control*
  • Tachycardia / etiology


  • Factor Xa Inhibitors
  • Rivaroxaban