Extensive cerebral venous sinus thrombosis: a potential complication in a patient with COVID-19 disease

A 63-year-old man was admitted with left-sided weakness and subsequent focal seizures following a recent diagnosis of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in a nearby hospital. He developed status epilepticus and became comatose, requiring intensive care unit admission for invasive ventilation. Imaging done at admission confirmed extensive cerebral venous sinus thrombosis (CVST) with bilateral venous cortical infarcts and acute cortical haemorrhage. No known risk factor for CVST could be identified. He improved with anticoagulation and antiepileptic therapy. He was subsequently transferred to an inpatient rehabilitation facility. Although Coronavirus disease 19 (COVID-19) infection has been previously associated with thrombotic complications, these mostly relate to the pulmonary vasculature. We present this case as a potential association between CVST and COVID-19 infection.

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A case report of extensive cerebral venous sinus thrombosis: a sequela of COVID-19?

Acute Medicine Journal ◽

10.52964/amja.0866 ◽

2021 ◽

Vol 20 (3) ◽

pp. 219-222

Author(s):

S Sivalokanathan ◽

◽

MO Syed ◽

A Sharmila ◽

◽

...

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Low Molecular Weight ◽

Diagnostic Challenge ◽

Venous Sinus Thrombosis ◽

Refractory Headache ◽

Thrombotic Complications ◽

Medical Intensive Care ◽

Persistent Headache

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease that is often the trigger for thrombotic complications. Cerebral venous sinus thrombosis (CVST) represents a small percentage of strokes, frequently proving to be a diagnostic challenge. We report a 31-year-old lady presenting with a persistent headache, 18 weeks after a mild COVID-19 illness. On her second visit, CT venography revealed extensive CVST. She was commenced on low-molecular-weight heparin, and was monitored closely in the neuro-medical intensive care unit. She was discharged 2 weeks later, with no residual neurological deficit, and commenced on a direct oral anticoagulant in the community. CVST should be considered in patients presenting with a refractory headache, with greater suspicion if previously infected with SARS-CoV-2.

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Cerebral Venous Sinus Thrombosis Associated with SARS-CoV-2; a Multinational Case Series

10.1101/2020.09.12.20186106 ◽

2020 ◽

Author(s):

Ashkan Mowla ◽

Banafsheh Shakibajahromi ◽

Shima Shahjouei ◽

Afshin Borhani-Haghighi ◽

Nasrin Rahimian ◽

...

Keyword(s):

Risk Factors ◽

Sinus Thrombosis ◽

Case Series ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Control Group ◽

Inclusion Criteria ◽

Venous Sinus Thrombosis ◽

Cortical Vein ◽

Thrombotic Complications

Background: SARS-CoV-2 induced coagulopathy can lead to thrombotic complications such as stroke. Cerebral venous sinus thrombosis (CVST) is a less common type of stroke which might be triggered by COVID-19. We present a series of CVST cases with SARS-CoV-2 infection. Methods: In a multinational retrospective study, we collected all cases of CVST in SARS-CoV-2 infected patients admitted to nine tertiary stroke centers from the beginning of the pandemic to June 30th, 2020. We compared the demographics, clinical and radiological characteristics, risk factors, and outcome of these patients with a control group of non-SARS-CoV-2 infected CVST patients in the same seasonal period of the years 2012-2016 from the country where the majority of cases were recruited. Results: A total of 13 patients fulfilled the inclusion criteria (62% women, mean age 50.9 years). Six patients were discharged with good outcomes (mRS≤2) and three patients died in hospital. Compared to the control group, the SARS-CoV-2 infected patients were significantly older (50.9 versus 36.7 years, p<0.001), had a lower rate of identified CVST risk factors (23.1% versus 84.2%, p<0.001), had more frequent cortical vein involvement (38.5% versus 10.5%, p: 0.025), and a non-significant higher rate of in-hospital mortality (23.1% versus 5.3%, p: 0.073). Conclusion: CVST should be considered as potential comorbidity in SARS-CoV-2 infected patients presenting with neurological symptoms. Our data suggest that compared to non-SARS-CoV-2 infected patients, CVST occurs in older patients, with lower rates of known CVST risk factors and might lead to a poorer outcome in the SARS-CoV-2 infected group.

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Cerebral Venous Sinus Thrombosis (CVST): an emerging complication of SARS CoV-2 infection

10.21203/rs.3.rs-465139/v1 ◽

2021 ◽

Author(s):

Nicola Maggialetti ◽

GUALANO ALESSANDRA ◽

Roberto Russo ◽

Rocco Umberto Accogli ◽

Amato Antonio Stabile Ianora

Keyword(s):

Emergency Department ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Neurological Symptoms ◽

Venous Sinus ◽

Thrombotic Complication ◽

Virus Binding ◽

Case Presentation ◽

Venous Sinus Thrombosis ◽

Thrombotic Complications

Abstract Background: During Coronavirus (COVID-19) pandemic, SARS CoV-2 infection has been documented to be associated with thrombotic complications, especially pulmonary embolism, which are triggered by virus binding to ACE-2 receptors and consequent activation of a cascade leading to a hypercoagulable pathway, however Cerebral Venous Sinus Thrombosis (CVST) is emerging as a further thrombotic complication of COVID-19.Case presentation: We report our experience of a patient affected by SARS CoV-2 infection, who presented to our emergency department with neurological symptoms such as confusion and headache and was diagnosed with CVST at imaging exams.Conclusion: As neurological symptoms such as confusion and headache are aspecific and shared with patients affected by SARS CoV-2 infection in absence of CVST, clinicians should be aware of this emerging hematologic complication in order to recognize it as soon as possible and provide the best patient care.

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