Impact of COVID-19 on the Central Nervous System: Are Spontaneous Intracranial Haemorrhage and Aseptic Meningitis Extra-pulmonary Manifestations of COVID-19? A Rare Case Report and Literature Review

Background: The coronavirus pandemic that started in December 2019 is mainly related to respiratory symptoms. Clinical presentations have been reported, but so far, no definitive therapy has been established. Intracranial haemorrhage has been observed in patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but the clinical, imaging, and pathophysiological features of intracranial bleeding during coronavirus disease 2019 (COVID-19) infection remain poorly characterized. The occurrence of spontaneous intracranial haemorrhage complicated with aseptic meningitis secondary to COVID-19 is extremely rare. Case presentation: A 19-month-old with fever, and shortness of breath was admitted to our intensive care unit on an emergency basis. Two weeks later, the patient developed a generalized convulsion with deterioration of consciousness. A computed tomography scan of the brain revealed a bifrontal intracerebral haemorrhage compressing the anterior horns of both lateral ventricles of the brain with a massive intraventricular haemorrhage causing hydrocephalus. Emergency ventriculostomy was performed, and a nasal swab for SARSCoV-2 was positive. Cerebrospinal fluid analysis and culture were negative for microorganisms, and analysis revealed features of aseptic meningitis. Conclusions: The possible occurrence of spontaneous intracranial haemorrhage and aseptic meningitis should be kept in mind by physicians, especially when treating critically ill young children with COVID-19. Early recognition of central nervous system involvement may be key to providing a better prognosis.