SARS-CoV-2, the virus responsible for novel Coronavirus (COVID-19) infection, has recently been associated with a myriad of hematologic derangements; in particular, an unusually high incidence of venous thromboembolism has been reported in patients with COVID-19 infection. It is postulated that either the cytokine storm induced by the viral infection or endothelial damage caused by viral binding to the ACE-2 receptor may activate a cascade leading to a hypercoaguable state. Although pulmonary embolism and deep venous thrombosis have been well described in patients with COVID-19 infection, there is a paucity of literature on cerebral venous sinus thrombosis (cVST) associated with COVID-19 infection. cVST is an uncommon etiology of stroke and has a higher occurrence in women and young people. We report a series of three patients at our institution with confirmed COVID-19 infection and venous sinus thrombosis, two of whom were male and one female. These cases fall outside the typical demographic of patients with cVST, potentially attributable to COVID-19 induced hypercoaguability. This illustrates the importance of maintaining a high index of suspicion for cVST in patients with COVID-19 infection, particularly those with unexplained cerebral hemorrhage, or infarcts with an atypical pattern for arterial occlusive disease.
BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area. MATERIALS AND METHODS:We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020. RESULTS: Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36-62 years; range, 17-95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%. CONCLUSIONS:Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection. ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; CVST ¼ cerebral venous sinus thrombosis; CVT ¼ cerebral venous thrombosis; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 C oronavirus disease 2019 (COVID-19) is predominantly an acute respiratory disease caused by a single-stranded RNA virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China. 1 The virus possesses a spike protein that binds to angiotensin-converting enzyme receptors, expressed on respiratory epithelium, facilitating entry into the host cell. [2][3][4] Susceptibility of organ systems to this virus may depend on the extent of expression of angiotensin-converting enzyme receptors on cell surfaces. These receptors are expressed on endothelial cells, pericytes, macrophages, glial cells, and cardiac myocytes. [2][3][4] Viral entry into these cells can lead to diverse manifestations such as acute respiratory distress syndrome, acute kidney injury, transaminitis, cardiac injury, and neurologic complications. [3][4][5][6] Neurologic symptoms include headache, confusion, hypogeusia, hyposmia, myalgias, and delirium, while neurologic complications include acute ischemic stroke, encephalitis, and Guillain-Barre syndrome. 3,[6][7][8] Postmortem data have revealed cerebral edema and partial neuronal degeneration in some patients as well. 9 Early evidence suggests an inc...
BACKGROUND AND PURPOSE: Recently, numerous investigational studies, case series, and case reports have been published describing various MR imaging brain findings in patients with COVID-19. The purpose of this literature review was to compile and analyze brain MR imaging findings in patients with COVID-19-related illness.MATERIALS AND METHODS: Literature searches of PubMed, publicly available Internet search engines, and medical journal Web sites were performed to identify articles published before May 30, 2020 that described MR imaging brain findings in patients with COVID-19.RESULTS: Twenty-two articles were included in the analysis: 5 investigational studies, 6 case series, and 11 case reports, encompassing MR imaging of the brain in 126 patients. The articles originated from 7 different countries and were published in 14 medical journals. MR imaging brain findings included specific diagnoses (such as acute infarct, posterior reversible encephalopathy syndrome) or specific imaging features (such as cortical FLAIR signal abnormality, microhemorrhages). CONCLUSIONS:The most frequent diagnoses made on brain MR imaging in patients with COVID-19 were acute and subacute infarcts. Other common findings included a constellation of leukoencephalopathy and microhemorrhages, leptomeningeal contrast enhancement, and cortical FLAIR signal abnormality.ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; PRES ¼ posterior reversible encephalopathy syndrome; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2 G rowing evidence suggests that coronavirus disease 2019 (COVID-19), secondary to infection with Severe Acute Respiratory Syndrome coronavirus 2 can manifest with a multitude of neurologic conditions including ataxia, seizure, acute stroke, and impaired consciousness. 1,2 Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on March 11, 2020, 3 the medical literature describing COVID-19 mechanisms, manifestations, and treatments has expanded with extraordinary speed. In concordance with the World Health Organization's efforts for rapid
Herein, we report the findings of intracranial arterial wall enhancement, consistent with focal cerebral arteriopathyinflammatory type, in a child presenting with acute infarct in the setting of coronavirus disease 2019 (COVID-19) infection. To our knowledge, this report provides the first description of vessel wall imaging findings in COVID-19-associated acute stroke. ABBREVIATIONS: COVID-19 ¼ coronavirus disease 2019; FCA ¼ focal cerebral arteriopathy; SARS-CoV-2 ¼ Severe Acute Respiratory Syndrome coronavirus 2; VWI ¼ vessel wall imaging S evere Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has resulted in the worldwide pandemic of coronavirus disease 2019 (COVID-19) illnesses, including Severe Acute Respiratory Syndrome and a multitude of neurologic manifestations. 1 There is emerging evidence for the role of the cerebrovascular system in neurologic manifestations of COVID-19 infection, and patients with COVID-19 infection may be at greater risk for thromboembolic disease. 2 Recent studies have demonstrated that patients can develop intracranial hemorrhages, acute strokes, 3 and large-vessel arterial occlusions. 4 The pathomechanisms that underlie COVID-19-associated cerebrovascular disease remain unclear. While growing numbers of case reports and studies have highlighted COVID-19-associated neurologic disease in adults, there are few reports of COVID-19associated neurologic disease in children. A recent case report demonstrated stenosis of the left middle cerebral artery, which was attributed to focal cerebral arteriopathy (FCA), in a pediatric patient with COVID-19 and acute stroke. 5 Herein, we describe the second documented case of COVID-19-associated FCA and acute stroke in a pediatric patient. Additionally, we provide the presumptive first description of MR imaging vessel wall imaging (VWI) findings in a patient with COVID-19-related stroke. A 13-year-old right-handed girl presented with fluctuatingbut-persistent headache, speech difficulty, and right upper and
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