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

Abstract

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.

Cerebral Venous Sinus Thrombosis Associated with COVID-19: A Case Series and Literature Review

“…A cumulative data was defined as an amalgam of the current series and the previously reported cases [6][7][8][9][10][11][12][13][14][15][16][17][18]. A comparison between this cumulative data and some large-volume CVST studies performed before the COVID-19 pandemic [1,3,4,21,22], has been made ( Table 3).…”

“…This study represents a case series of CVST associated with SARS-CoV-2 infection, diagnosed and treated at multiple institutions throughout Iran. We provided a brief overview of all previously reported cases in Table 2 as well [6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Since the evolution of the Coronavirus Disease 2019 (COVID-19) pandemic, non-respiratory manifestations of the disease like neurological manifestations [5] and thrombotic events have been progressively appreciated. Although there are some case reports and one case series [6][7][8][9][10][11][12][13][14][15][16][17][18] showing the association of the CVST and SARS-CoV-2 infection, the data about diagnosis and prognosis in this association is still limited. We investigated the demographic, clinical, radiological, and prognostic characteristics of this association to improve the diagnosis and treatment of patients with CVST and COVID-19.…”

Anti-SARS-CoV-2 Spike Protein and Anti-Platelet Factor 4 Antibody Responses Induced by COVID-19 Disease and ChAdOx1 nCov-19 vaccination

“…4,5 Thromboembolic complications in Covid-19 disease have been reported frequently, including unusual locations such as cerebral venous sinus thrombosis (CVST), even in patients without severe respiratory disease. [6][7][8] Very recently, several cases of unusual thromboses such as CVST and splanchnic vein thrombosis in combination with moderate to severe thrombocytopenia were observed in healthy individuals approximately 5 to 20 days following vaccination with COVID-19 Vaccine AstraZeneca. 9 Known as vaccine-induced thrombotic thrombocytopenia (VITT), we have identi ed immunoglobulin G class platelet-activating antibodies directed against the cationic platelet chemokine, platelet factor 4 (PF4; CXCL4), as the underlying cause.…”

Re: The choice of intravenous thrombolysis for Acute Ischemic Stroke under COVID-19 infection

“…We read with great interest the recent publication by Gao X (2020), where some practical points on management of acute ischemic stroke (AIS) during the coronavirus 2019 (COVID-19) pandemic is discussed [ 1 ]. Several studies have shown that SARS-CoV-2 infection could present with various neurological manifestations including AIS [ [2] , [3] , [4] , [5] , [6] , [7] ] and with the daily increase in the number of the infected symptomatic or asymptomatic individuals worldwide, we might encounter more AIS patients in the future.…”