Background
SARS-CoV-2 virus infection leads to a severe and dysbalanced inflammatory response with hypercytokinemia and immunodepression. Systemic inflammation due to viral infections can potentially cause vascular damage including disruption of blood-brain barrier (BBB) and alterations in coagulation system that may also lead to cardiovascular and neurovascular events. Here, we report the first case of COVID-19 infection leading to aneurysmal subarachnoid haemorrhage (aSAH).

Case Description
A 61-year-old woman presented with dyspnea, cough and fever. She was over weight with Body mass-index of 34 and history of hypertension. No history of subarachnoid hemorrhage in the family. She was admitted in ICU due to low oxygen saturation (89%). A chest CT showed typical picture of COVID-19 pneumonia. Oropharyngeal swab with a PCR-based testing was COVID-19 positive. She was prescribed with favipiravir and hydroxychloroquine in Addition to oxygen support. On second day she experienced sudden headache and losst conciousness. A computer tomography (CT) with CT-angiography revealed subarachnoid haemorrhage in basal cisterns from a ruptured anterior communicating artery aneurysm. The aneurysm was clipped microsurgically through a standard pterional approach and the patient was admitted again to intensive care unit for further intensive medical treatment. Post-operative the patient showed slight motor dysphasia. No other neurological deficits.

Conclusion
Aneurysmal subarachnoid haemorrhage secondary to COVID-19 infection might be triggered by systemic inflammation. COVID-19 infection could be one of the risk factors leading to instability and rupture of intracranial aneurysm.