COVID-19 Related Cerebrovascular Thromboembolic Complications in Three Young Patients

Haroon, Khawaja Hassan; Muhammad, Ahmad; Hussain, Suhail; Patro, Satya

doi:10.1159/000511179

Cited by 9 publications

(11 citation statements)

References 14 publications

(13 reference statements)

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“…Overall, 57 CVT cases were collected from 28 reports (Table 1) [17–44]. Mean age was 53.5 years, with 11 cases presenting CVT at age <50 years and balanced gender distribution (50% female).…”

Section: Resultsmentioning

confidence: 99%

“…Only two studies reported CVT in patients asymptomatic for pulmonary or other systemic SARS‐CoV‐2 symptoms [36,40]. High‐resolution computerized tomography of the chest or chest x‐ray demonstrated abnormalities consistent with pulmonary COVID‐19 in 81% of cases (17/21), with only four patients reported to have normal findings (Table 1) [27,39,41].…”

Section: Resultsmentioning

confidence: 99%

“…x-ray demonstrated abnormalities consistent with pulmonary COVID-19 in 81% of cases (17/21), with only four patients reported to have normal findings (Table 1) [27,39,41].…”

Section: High-resolution Computerized Tomography Of the Chest Or Chestmentioning

confidence: 99%

“…Thrombophilia screening results were available for 12 cases [18,21,[24][25][26][27]29,33,39,41,42], 41.7% of which had pathological findings (three with positive lupus anticoagulant, two with anticardiolipin antibodies; Table S4). Cerebrospinal fluid testing for SARS-CoV-2 by PCR was negative in all cases where it was available (n = 5/5) [21,28,29,32,33].…”

Section: Laboratory Findings and Thrombophilia Screeningmentioning

confidence: 99%

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Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus‐2 infection: A systematic review and meta‐analysis

Baldini

Asioli

Romoli

et al. 2021

Euro J of Neurology

126

122

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Background and purpose Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection predisposes patients to arterial and venous thrombosis. This study aimed to systematically review the available evidence in the literature for cerebral venous thrombosis (CVT) in association with coronavirus disease‐2019 (COVID‐19). Methods We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify cases of COVID‐19–associated CVT. The search period spanned 1 January 2020 to 1 December 2020, and the review protocol (PROSPERO‐CRD42020214327) followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Identified studies were evaluated for bias using the Newcastle‐Ottawa scale. A proportion meta‐analysis was performed to estimate the frequency of CVT among hospitalized COVID‐19 patients. Results We identified 57 cases from 28 reports. Study quality was mostly classified as low. CVT symptoms developed after respiratory disease in 90%, and the mean interval was 13 days. CVT involved multiple sites in 67% of individuals, the deep venous system was affected in 37%, and parenchymal hemorrhage was found in 42%. Predisposing factors for CVT beyond SARS‐CoV‐2 infection were present in 31%. In‐hospital mortality was 40%. Using data from 34,331 patients, the estimated frequency of CVT among patients hospitalized for SARS‐CoV‐2 infection was 0.08% (95% confidence interval [CI]: 0.01–0.5). In an inpatient setting, CVT accounted for 4.2% of cerebrovascular disorders in individuals with COVID‐19 (cohort of 406 patients, 95% CI: 1.47–11.39). Conclusions Cerebral venous thrombosis in the context of SARS‐CoV‐2 infection is a rare, although there seems to be an increased relative risk. High suspicion is necessary, because the diagnosis of this potentially life‐threatening condition in COVID‐19 patients can be challenging. Evidence is still scarce on the pathophysiology and potential prevention of COVID‐19–associated CVT.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…x-ray demonstrated abnormalities consistent with pulmonary COVID-19 in 81% of cases (17/21), with only four patients reported to have normal findings (Table 1) [27,39,41].…”

Section: High-resolution Computerized Tomography Of the Chest Or Chestmentioning

confidence: 99%

Section: Laboratory Findings and Thrombophilia Screeningmentioning

confidence: 99%

See 2 more Smart Citations

Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus‐2 infection: A systematic review and meta‐analysis

Baldini

Asioli

Romoli

et al. 2021

Euro J of Neurology

126

122

View full text Add to dashboard Cite

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“…The underlying mechanisms can be broadly categorized into diseases or procedures involving the thoracoabdominal aorta (aortic surgery, aortic dissection), Intrinsic arterial occlusion resulting from arteriosclerosis, vasculitis, infection, embolic occlusion, thrombosis, hypoperfusion and venous infarction. Our 1 st case had severe COVID-19 disease with likely underlying hypercoagulable state which trigged the thrombosis and acute brain and spinal cord infarctions [26] complicated by severe sepsis and hypoxemia. 2 nd case had neck message which triggered vertebral artery dissection leading to cervical cord infarction.…”

Section: Discussionmentioning

confidence: 81%

Acute spinal cord ischemic stroke; A rare but potentially devastating stroke emergency in young healthy adults

Ali¹,

Muhammad²,

Ahmed³

et al. 2021

J Clin Images Med Case Rep

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Introduction: Acute spinal cord infarction represents 1% of all strokes. The neurological presentation of spinal cord infarction is defined by vascular territory i.e. anterior or posterior spinal arteries. A broad spectrum of diseases can cause spinal cord infarction, most common cause is surgical repair or diseases of the thoracoabdominal aorta. MRI of the spine shows hyperintensities on T2WI, restricted diffusion on DWI and vertebral body infarction adjacent to a cord signal abnormality. Poor prognostic factors for recovery are severe impairment at presentation, female sex, advanced age, and lack of improvement in the first 24 hours. We describe clinical presentation, radiological findings and 3-month outcome of four patients who presented with ischemic spinal cord infarction. Methods: We retrospectively analysed our prospectively collected data and found four cases of spinal cord infarction for the period of May 2020 to April 2021. Total of 1,326 stroke patients (1125 i.e. 85% ischemic and 201 i.e. 15% haemorrhagic) were admitted in Hamad General Hospital. At our centre, spinal cord infarction accounts 0.30% of total stroke and 0.35% of ischemic strokes. We describe four young patients, presented with abrupt onset of focal neurologic deficit. Their MRI of the spine revealed hyperintensity signals in T2WI, restricted diffusion on DWI of spinal cord. Two patients had vertebral artery occlusion or dissection. One patient was discharged home and three patients underwent multidisciplinary rehabilitation program. Discussion: Spinal cord infarction may present with acute paraparesis or quadriparesis with devastating consequences. Blood flow to the spinal cord is influenced by perfusion pressure. The most common cause of spinal cord infarction in this case series was vertebral artery dissection or occlusion. Our case series suggests early recognition of spinal cord stroke, appropriate investigations and early treatment with further rehabilitation could improve patient outcome. Conclusion: Spinal cord infarction, a rare but devastating condition, represents 1% of all strokes but 0.3% of total strokes at our centre. Early recognition of spinal cord ischemia especially when presenting with abrupt onset focal neurological deficit, focus on underlying pathology with appropriate imaging and further investigations, secondary stroke prevention and rehabilitation are vital factors to improve neurological recovery. Future randomized trails are needed to establish the efficacy and safety of drug therapy including rt-PA in spinal cord infarction. Abbreviations: ASA: Anterior spinal artery; PSA: Posterior spinal artery; MRI: Magnetic resonance imaging; MRA: Magnetic resonance arteriogram; DWI: Diffusion weighted imaging; ICP: Intra-cranial pressure.

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Coronavirus disease 19 (COVID‐19) and Cerebral venous sinus thrombosis (CVST): A case series and review of the literature

Kallel

Saidani

Kotti

et al. 2022

Clinical Case Reports

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A large proportion of patients with coronavirus disease 19 (COVID‐19) suffer from excessive coagulation activation and coagulopathy which predisposes them to a wide spectrum of thrombotic events including in situ pulmonary thrombosis, deep‐vein thrombosis, and associated pulmonary embolism, as well as arterial thrombotic events. Cerebral venous sinus thrombosis (CVST) have also been reported but in a very small number of cases. This report aims to increase awareness about CVST as a potential neurological thromboembolic complication in patients with coronavirus disease. We report three COVID ‐ 19 patients presenting with CVTS. We also review all previously described cases and present an overview of their demographic, clinical, and diagnostic data. We describe three patients with concomitant coronavirus disease and CVST among 1000 hospitalized COVID‐19 patients (2 males, 1female, and mean age of 37 years). One patient was previously healthy, while the two others had a history of chronic anemia and ulcerative colitis, respectively. CVST symptoms including seizure in two patients and headache in one patient occurred day to weeks after the onset of COVID‐19 symptoms. Three months of anticoagulant therapy was given for all three patients with favorable outcomes. No neurological sequelae and no recurrence occurred within 6 months after hospital discharge. Our search identified 33 cases of COVID‐19 complicated by CVST. The mean age was 45.3 years, there was a slight male predominance (60%), and more than half of cases were diagnosed in previously healthy individuals. All cases of CVT were clinically symptomatic and were observed in patients with a different spectrum of coronavirus disease severity. Headache was the most common complaint, reported by just less than half of patients. There was a high mortality rate (30.3%). CVT is a very rare, but potentially life‐threatening complication in patients with COVID‐19. It's mainly reported in relatively young individuals with no or little comorbid disease and can occur even in patients who do not display severe respiratory symptoms. Atypical clinical presentations may pose a challenge to the early diagnosis and treatment. High suspicion is necessary as early diagnosis and prompt treatment with anticoagulation in all patients with COVID‐19 and CVT could contain the mortality rate and improve neurological outcomes in these patients.

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COVID-19 Related Cerebrovascular Thromboembolic Complications in Three Young Patients

Cited by 9 publications

References 14 publications

Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus‐2 infection: A systematic review and meta‐analysis

Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus‐2 infection: A systematic review and meta‐analysis

Acute spinal cord ischemic stroke; A rare but potentially devastating stroke emergency in young healthy adults

Coronavirus disease 19 (COVID‐19) and Cerebral venous sinus thrombosis (CVST): A case series and review of the literature

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