Cerebral venous thrombosis in COVID-19

Abstract

Background and aims Initially, novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was considered primarily a respiratory pathogen. However, with time it has behaved as a virus with the potential to cause multi-system involvement, including neurological manifestations. Cerebral venous sinus thrombosis (CVT) has increasingly been reported in association with coronavirus infectious disease of 2019 (COVID-19). Here, we have shed light upon CVT and its possible mechanisms in the backdrop of the ongoing COVID-19 pandemic. Methods In this review, data were collected from PubMed, EMBASE and Web of Science, until March 30, 2021, using pre-specified searching strategies. The search strategy consisted of a variation of keywords of relevant medical subject headings and keywords, including “COVID-19”, “SARS-CoV-2”, “coronavirus”, and “cerebral venous sinus thrombosis”. Results COVID-19 has a causal association with a plethora of neurological, neuropsychiatric and psychological effects. CVT has gained particular importance in this regard. The known hypercoagulable state in SARS-CoV-2 infection is thought to be the main mechanism in COVID-19 related CVT. Other plausible mechanisms may include vascular endothelial dysfunction and altered flow dynamics. Conclusions Although there are no specific clinical characteristics, insidious or acute onset headache, seizures, stroke-like, or encephalopathy symptoms in a patient with, or who has suffered COVID-19, should prompt the attending physician to investigate for CVT. The treatment of COVID-19 associated CVT does not differ radically from the therapy of CVT without the infection, i.e. urgent initiation of parenteral unfractionated heparin or low molecular weight heparin followed by conventional or mostly newer oral anticoagulants.

Brain Dural Arteriovenous Fistulas in the Covid-19 era: a warning and rationale for association

“…For COVID-19 infections, the time frame in our cohort was 60-80 days. Indeed, the time from COVID symptoms to CVT reported by other authors is estimated to be between 1-2 weeks 18, 19 . The occurrence of CVTs would precede the diagnosis of bDAVFs in up to 6 months, which agrees with our ndings.…”

Cerebral venous thrombosis during the COVID-19 Pandemic: A multi-center experience

“…Recent studies have found a significant association between COVID-19 and CVT [11] , [12] , [15] , [16] , [17] . In this study, we reviewed our multi-center experience with CVT during the current COVID-19 pandemic with a primary focus on the patients’ presentation, management, and outcomes.…”

“…Most recently, reports of patients presenting with CVT following COVID-19 vaccination have suggested a potential association between CVT and this preventive practice [11] , [12] , [13] . Although multiple studies have looked at CVT in COVID-19 patients [10] , [11] , [12] , [14] , [15] , [16] , [17] , [18] , [19] , the influence of COVID infection or vaccination in patients presenting with CVT and their potential manifestations is understudied. We aim to describe the clinical and radiographic characteristics, as well as management and outcomes of CVT in patients with a prior COVID infection or vaccination who were treated at our institutions during the COVID pandemic.…”

Thrombosis of Bilateral Profunda Femoris, Anterior Tibial, and Tibioperoneal Arteries in a Patient With COVID-19 Infection

“…In a study of COVID-19 patients requiring ICU stay, it was noted that the rate of thrombotic disorders in these patients was 31% [ 7 ]. Furthermore, images have shown that 27% of such thrombotic disorders are due to venous thromboembolism, 3.7% due to arterial thrombosis, and 81% due to pulmonary embolism [ 7 ].…”