# Fatal Spontaneous Rebleeding of Subdural Haematoma Following COVID-19 Infection: A Case Report

## TL;DR

An elderly woman with a subdural haematoma experienced fatal rebleeding after contracting COVID-19, suggesting a possible link between the infection and neurological complications.

## Contribution

This case report highlights a rare and fatal association between COVID-19 infection and spontaneous rebleeding of a pre-existing subdural haematoma.

## Key findings

- The patient's neurological condition rapidly deteriorated within 24 hours of testing positive for COVID-19.
- Imaging confirmed acute rebleeding and increased midline shift despite no trauma or anticoagulation.
- The patient's death suggests a possible role of vascular injury, neuroinflammation, and coagulopathy in the rebleeding.

## Abstract

COVID-19 is associated with various neurological complications, including intracranial haemorrhage. However, spontaneous rebleeding of pre-existing subdural haematomas triggered by COVID-19 infection remains exceptionally rare. We report an 88-year-old woman with rheumatoid arthritis who presented with acute-on-chronic subdural haematoma following a fall. Conservative management was pursued, given her advanced age and comorbidities. After seven days of clinical stability, she contracted COVID-19 via PCR screening. Within 24 hours, she experienced catastrophic neurological deterioration (Glasgow Coma Scale declining from 15 to 3) without trauma or anticoagulation. Imaging confirmed worsening subdural haemorrhage with increased midline shift (12 mm) and acute rebleeding. Despite supportive care, she died 10 days later. This case demonstrates a temporal association between COVID-19 infection and fatal subdural haematoma rebleeding, possibly mediated through vascular injury, neuroinflammation, and coagulopathy. Patients with pre-existing intracranial haemorrhage who develop COVID-19 may require heightened neurological surveillance.