Venous and arterial cerebral thrombosis: a COVID-19 dual pathology and single possible etiology—a case report

Abstract

Background Corona virus disease of the year 2019 (COVID-19) is still devastating the world for more than 19 months since its declaration as a pandemic by world health organization. Its manifestations does not stand at respiratory system but involves other body systems including central nervous system and its vasculature. In the following case report, cerebral venous and arterial thrombosis is detected in a case just in convalescence from COVID-19 with still detected positive IgM. Case presentation A 68-year-old female presenting with disturbed conscious level, bilateral convergent squint, single attack of generalized seizures, left sided dense weakness within a short time from catching COVID-19 and while still in quarantine hospital in recovery phase from infection. Magnetic resonance studies revealed bilateral cortical border zone infarcts as well as left lateral dural sinus and deep venous thrombosis. Conclusion Along the forth wave, COVID-19 is still hitting hardly the central nervous system vasculature.

Encephalopathy as the Only Manifestation in Simultaneous Arterial Infarct and Cerebral Venous Sinus Thrombosis in Recent COVID-19 Infection

“…All patients reported by Kananeh et al had moderate to critical COVID-19 symptoms, requiring ICU admission, and significantly elevated D-dimer levels. This is also consistent with the reports of Malentacchi et al and Roushdy et al, who reported impaired coagulation profiles and elevated D-dimer levels in their patients with moderate to critical SARS-CoV-2 infections and concurrent arterial and cerebral venous thromboses [1,6]. However, our patient had no fever, and his inflammatory markers, platelet count, D-dimer level, and coagulation profile were within the normal range.…”

“…Our case is the first reported case of concurrent arterial stroke and cerebral venous thrombosis associated with SARS-CoV-2 infection in Singapore and, as far as we know, the fourth reported case worldwide. [1,5,6], all patients showed significant neurological deficits including coma [1], pyramidal signs such as positive Babinski sign [1], weakness [5], ataxia [5], and seizures [6]. These findings differ from our patient, who had only encephalopathy without other significant neurological symptoms and focal deficits.…”

“…However, the co-occurrence of arterial strokes and cerebral venous thrombosis is rare. To the best of our knowledge, only 3 cases of concurrent arterial infarct and cerebral venous thrombosis have been reported [1,5,6]. Moreover, as the COVID-19 pandemic continues and new variants emerge, it is important to remain vigilant for associated neurological complications, even in recently recovered COVID -19 patients and in patients with subtle, non-specific symptoms, such as encephalopathy without focal neurological deficits, as shown in our case.…”

“…There have been increasing reports of hypercoagulability associated with SARS-CoV-2 infection leading to thromboembolism, such as arterial cerebrovascular infarcts or cerebral venous thrombosis [1][2][3][4][5][6]. However, the co-occurrence of arterial strokes and cerebral venous thrombosis is rare.…”

SARS-CoV-2 and monkeypox: what is common and what is not in a present pandemic versus a potential one—a neuropsychiatric narrative review

“…Neurovascular complications of SARS-CoV-2 whether in the form of ischemic strokes or hemorrhagic ones and whether arterial or venous are very common and are reported with mild, moderate, or severe forms of SARS-CoV-2 [39,40].…”