Intracranial Hypotension after Severe COVID-19: Case Report and Literature ReviewAuthor(s): Humberto Foyaca Sibat*
Background: Despite the lack of published clinical studies, new mutations of COVID-19 are travelling worldwide, and sooner or later, unexpected consequences will be reported. At the middle of October 2020 new variant of SARV-CoV-2 (known as 20H/501.V2, B1.351 or variant β) were identified in South Africa. This variant has multiple mutations in the spike protein, including K417N, E484K, N501Y. Soon after another variant from India was also reported which is the predominant variant now? We did an extensive search of the medical literature, looking for all publications regarding intracranial hypotension, subdural effusions SARS-CoV-2/ COVID-19.
Case presentation: We report a 46-years-old-male with severe COVID-19 admitted in the intensive care unit preceded by gastrointestinal manifestations; all performed investigations confirmed the severity of the infection caused by SARS-CoV-2. PMH refers chronic vascular headache, CSF analysis was normal, and MRI of the brain three months before admission reported no abnormalities. The patient recovered from the respiratory disorder and went back home, but he developed a postural headache two weeks later. We suspect spontaneous intracranial hypotension, and the CSF pressure (5.5 cm of H2 O) confirmed it. In addition, a CT scan of the head showed bilateral frontal subdural effusion.
Conclusion: We did not find a published report related to COVID-19, subdural effusion, and intracranial hypotension. We delivered comments and hypotheses to explain its pathophysiology based on the role of zonulin and the microbiota-gut-brain axis.
Abbreviations: ACE-2: Angio Converting Enzyme; CNS: Central Nervous System; COVID-19: Coronavirus Disease 2019; CSH: Chronic Subdural Hematoma; CT: Computer Tomography; ECGF1 Endothelial Cell Growth Factor 1; HCoV-229E: Human Coronavirus 229E; HCoV-OC43: Human Coronavirus OC43; HCoV-NL63: Human Coronavirus NL63; HCoV-HKU1: Human Coronavirus HKU1; IH: Intracranial Hypertension; INFγ: Interferon-Gamma; MERS-CoV: Mild Encephalitis /Encephalopathy with a Reversible Splenial Lesion and Coronavirus; PMH: Past Medical History; SARS-CoV-2: Severe Acute Respiratory Syndrome; Coronavirus 2; SHg: Subdural Hygroma; SIH: Spontaneous Intracranial Hypotension; TNF-α: Tumor Necrotic Factor Alpha; TYMP: Thymidine Phosphorylase; VEGF-A: Vascular Endothelial Growth Factor-A