Cerebral Venous Sinus Thrombosis in the COVID-19 Pandemic

Abstract

Background: Recent studies have noted concern for increased thromboembolic events in the setting of Coronavirus Disease 2019 (COVID-19). Cerebral venous sinus thrombosis (CVST) is a form of thromboembolism that has been observed as a neuro-ophthalmologic complication of COVID-19. Methods: Review of the scientific literature. Results: In this article, we report an overview of CVST epidemiology, clinical presentation, diagnostics, disease pathophysiology, and management in the setting of COVID-19. Conclusion: CVST is an uncommon thromboembolic event with variable phenotypes and multiple etiologies. Neurologic complications can be severe, including significant visual deficits and death. Current observations suggest that the risk of CVST may be profoundly impacted by this novel COVID-19 pandemic, thus prompting increased attention to disease presentation, pathogenesis, and management.

Thrombosis after covid-19 vaccination

“…Subsequently, the focus of attention narrowed from thrombosis in general to cerebral venous sinus thrombosis (CVST), a rare condition with a background incidence of about 15 cases per million people each year according to recent studies from Australia and the Netherlands 5. CVST is a rare cause of stroke that generally affects younger adults and women more than men.…”

“…CVST is a rare cause of stroke that generally affects younger adults and women more than men. Important risk factors are pregnancy and hormonal contraception 5…”

Neurological manifestations of coronavirus disease 2019: exploring past to understand present

“…Clusters of microhemorrhages, restricted diffusion and peripheral rim enhancement • Brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamen, and thalamic nuclei • Multifocal confluent lesions in internal and external capsules, splenium and deep white batter of cerebral hemispheres with multiple microhemorrhages and extensive prominent medullary veins. • Components of brachial and lumbosacral plexus showed increased signal and enhancement Cerebrovascular system • Ischemic stroke [ 1 , 11 , 67 ] • Intracerebral hemorrhage, subarachnoid hemorrhage [ 24 , 25 ] • CVST [ 27 , 29 , 85 ] • PRES [ 30 – 32 , 73 ] • Loss of gray-white differentiation at occipital and parietal lobes or hypo dense lobar lesion. • Hyper dense appearance of MCA vessel • SAH centered in the posterior fossa, including the fourth ventricle leading to hydrocephalus • CT angiogram showed right-sided ruptured dissecting posterior-inferior cerebellar artery aneurysm • New bilateral confluent hypodensities in occipital/parieto-occipital/white matter • Patchy lucencies in the bilateral frontoparietal white matter and posterior limb of the left internal capsule • CT angiogram showed a filling defect in the right transverse sinus and jugular bulb suggestive of venous sinus thrombosis • Cortical microhemorrhages • Absence of normal flow void in right transverse sinus • Occlusion of proximal MCA • Left temporoparietal hemorrhagic venous infarction with left transverse and sigmoid sinus thrombosis • Confluent T2 hyperintensity in the same regions without diffusion restriction or susceptibility hypointensity.…”

“…EEG Various electroencephalography (EEG) findings including focal or diffuse delta-theta slowing, symmetrical or asymmetrical sporadic epileptiform discharges, lateralized periodic discharges with overriding fast activity, generalized sharp waves with spikes, triphasic waves, and repetitive focal rhthmic bursts of nonconvulsive status epilepticus have been reported in COVID-19 patients presenting with altered mental status, delirium, or encephalopathy, and continuous EEG monitoring is advisable in these patients to diagnose NCSE [53,75,87]. • Ischemic stroke [1,11,67] • Intracerebral hemorrhage, subarachnoid hemorrhage [24,25] • CVST [27,29,85] • PRES [30][31][32]73] • Loss of gray-white differentiation at occipital and parietal lobes or hypo dense lobar lesion. [58], myasthenic crisis, inflammatory myopathy, and critical illness neuropathy [59,88].…”

Cerebral venous thrombosis and its hemorrhagic complications

“…У пациентов с геморрагическими проявлениями ЦВТ чаще, чем у больных без таковых, встречаются гематологические заболевания (тромбоцитоз, тяжелая анемия, истинная полицитемия, тромбоцитопения) -14% vs 5%, в остальном этиологическая структура похожа [8]. Публикации последних месяцев заставляют предполагать, что ЦВТ ассоциирован с COVID-19 [9][10][11].…”