Cerebral venous sinus thrombosis associated with coronavirus disease 2019: Case report and review of the literature

Authors

Kessarin Panichpisal, Advocate Aurora HealthFollow
Ilana Ruff, Advocate Aurora HealthFollow
Maharaj Singh, Advocate Aurora HealthFollow
Massihullah Hamidi, Advocate Aurora HealthFollow
Pedro D. Salinas, Advocate Aurora HealthFollow
Kyle Swanson, Advocate Aurora HealthFollow
Stephen Medlin, Advocate Aurora HealthFollow
Sudeepta Dandapat, Advocate Aurora HealthFollow
Payton Tepp, Advocate Aurora HealthFollow
Genevieve Kuchinsky, Advocate Aurora HealthFollow
Amy Pesch, Advocate Aurora HealthFollow
Thomas Wolfe, Advocate Aurora HealthFollow

Recommended Citation

Panichpisal K, Ruff I, Singh M, et al. Cerebral Venous Sinus Thrombosis Associated With Coronavirus Disease 2019: Case Report and Review of the Literature. Neurologist. 2022;27(5):253-262. Published 2022 Sep 1. doi:10.1097/NRL.0000000000000390

Affiliations

Aurora Neurosciences Innovative Institute, Aurora Cancer Care, Aurora St. Luke's Medical Center, Aurora Critical Care Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Research Institute

Abstract

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with significant risk of acute thrombosis. We present a case report of a patient with cerebral venous sinus thrombosis (CVST) associated with COVID-19 and performed a literature review of CVST associated with COVID-19 cases. CASE REPORT: A 38-year-old woman was admitted with severe headache and acute altered mental status a week after confirmed diagnosis of COVID-19. Magnetic resonance imaging brain showed diffuse venous sinus thrombosis involving the superficial and deep veins, and diffuse edema of bilateral thalami, basal ganglia and hippocampi because of venous infarction. Her neurological exam improved with anticoagulation (AC) and was subsequently discharged home. We identified 43 patients presenting with CVST associated with COVID-19 infection. 56% were male with mean age of 51.8±18.2 years old. The mean time of CVST diagnosis was 15.6±23.7 days after onset of COVID-19 symptoms. Most patients (87%) had thrombosis of multiple dural sinuses and parenchymal changes (79%). Almost 40% had deep cerebral venous system thrombosis. Laboratory findings revealed elevated mean D-dimer level (7.14/mL±12.23 mg/L) and mean fibrinogen level (4.71±1.93 g/L). Less than half of patients had prior thrombotic risk factors. Seventeen patients (52%) had good outcomes (mRS <=2). The mortality rate was 39% (13 patients). CONCLUSION: CVST should be in the differential diagnosis when patients present with acute neurological symptoms in this COVID pandemic. The mortality rate of CVST associated with COVID-19 can be very high, therefore, early diagnosis and prompt treatment are crucial to the outcomes of these patients.

Type

Article

PubMed ID

34855659