Concurrent intracranial infarct and intraventricular hemorrhage with spontaneous nontraumatic extradural hemorrhage in follow-up: An enigma of COVID-19-associated intracranial vasculopathy

BACKGROUND: Several neurological manifestations have been described in the literature, in patients affected with COVID-19 infection. Some common forms include ischemic stroke, cardioembolic stroke, intraparenchymal hemorrhage, and multicompartmental hemorrhage. Concurrent brain infarct and intraventricular hemorrhage (IVH) have not been described in the literature previously. CASE DESCRIPTION: A 35-year hypertensive and COVID-19-positive patient developed sudden-onset spontaneous IVH with concurrent infarct in the left internal capsule. In spite of undergoing an initial CSF drainage procedure, he had persistent worsening sensorium and increasing midline shift on CT imaging, so he underwent a left-sided decompressive craniectomy. One month after discharge, he developed spontaneous extradural hemorrhage at the operative site. In view of impending cerebral herniation, emergency hematoma evacuation was done, which restored his neurological status. CONCLUSION: This is the first reported detailed case of concurrent intracranial infarct and IVH in a patient affected with COVID-19 infection. We also report a rare phenomenon of nontraumatic noncoagulopathic extradural hemorrhage on the decompressive craniectomy site, in this patient 1 month after surgery.