Cerebral venous sinus thrombosis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Abstract

Introduction/Objective. Coagulopathy induced by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) can be an underlying cause of cerebral venous sinus thrombosis (CVST), a less common type of stroke with a variable clinical presentation and high mortality rate. Objective: to present a series of CVST cases associated with SARS-CoV-2 infection. Methods. This retrospective study evaluated clinical, laboratory and radiological presentation, risk factors, barriers to diagnosis, treatment and outcome of patients with SARS-CoV-2 infection induced CVST. Results. The study comprised 6 patients diagnosed with COVID-19 induced CVST during the 18 months period. Majority (66.7%) had no significant risk factors for developing CVST. Median time from initial COVID-19 diagnosis to onset of neurologic deficit was 7 days (interquartile range 0.5-7 days). Clinical presentation comprised non specific neurological symptoms: headache (83.3%) and decreased consciousness (33.3%), together with elevated levels of D-dimer and inflammatory biomarkers. The transverse (n = 4 or 66.7%), superior sagittal sinuses (n = 3 or 50%) and sigmoid sinus (n = 2 or 33.3%) were most commonly affected. Five patients (83.3%) had minimal to no symptoms at discharge (mRS ? 2). In-hospital mortality in our current series was relatively high (16.7%). Conclusion. The high mortality rate of SARS-CoV-2-associated CVST urges clinicians to suspect CVST in patients with a history of COVID-19 infection presenting with non-specific neurological symptoms in order to provide proper treatment and prevent complications.

Specifics in the diagnosis and treatment of cerebral venous sinus thrombosis associated with Covid 19 infection

“…U praksi, mnogi pacijenti imaju kliničke nalaze povezane sa oba mehanizma, bilo pri prezentaciji ili sa progresijom bolesti 1 . Najčešće kliničko ispoljavanje predstavljeno je: glavoboljom (> 80%), fokalnim neurološkim deficitom (40%), epileptičnim napadima (40%), encefalopatijom (15-20%), edemom papile (20-30%) i paralizom kranijalnih živaca (16%).…”

“…CT venografija ima veoma dobru dijagnostičku tačnost (senzitivnost od 95% i specifičnost od 91%). Može pokazati odsutan protok u tromboziranim venama ili sinusima i delimično obodno pojačanje tromboziranih venskih sinusa ("empty delta sign") 1,6 .…”