Case Report: Cerebral Venous Sinus Thrombosis and COVID-19 Infection

Abstract

Coronavirus disease-2019 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus). Coronavirus disease-2019 (COVID-19) was declared a pandemic in March 2020 and has changed our lives in many ways. This infection induces a hypercoagulable state leading to arterial and venous thrombosis, but the exact pathophysiology of thrombosis is unknown. However, various theories have been postulated including excessive cytokine release, endothelial activation, and disseminated intravascular coagulation (DIC). We present a patient diagnosed with cerebral venous sinus thrombosis (CVST) with COVID-19 infection. A 66-year-old man presented to a hospital for evaluation of persistent headaches. He tested positive for COVID-19, and MRI of the brain and CT venogram revealed CVST. He was started on heparin drip in the hospital and transitioned to oral anticoagulants at the time of discharge. His headaches improved with treatment. Even though headache is the most frequent and initial symptom of cerebral venous thrombosis, it is rarely the only symptom. A high index of suspicion is therefore required to diagnose CVST especially if the patient presents with a simple complaint like a headache. Common complaints can delay the diagnosis leading to disease progression. Considering the high mortality rates in patients diagnosed with CVST, we suggest the importance of knowing the association between COVID-19 infection and CVST, especially in susceptible patients.

Cerebral Venous Sinus Thrombosis (CVST): A Clinically Significant Neurological Condition

“…The patient had elevated cerebrospinal fluid (CSF) pressure, but there were noticeably no characteristic IIH symptoms. Therefore, neither high intracranial pressure associated with other recognized etiologies nor IIH was able to fully explain the patient's situation [15].…”

Lower cranial neuropathy as a presentation of cerebral venous sinus thrombosis secondary to antiphospholipid syndrome: A case report

“…Hereditary prothrombotic conditions include protein S deficiency, protein C deficiency, and antithrombin III deficiency. There have been numerous reports of COVID-19 infections leading to intracranial venous sinus thrombosis recently [11][12][13][14][15]. When COVID-2019 infection results in endothelial dysfunction, platelet adhesion, leukocyte aggregation, complement activation, and cytokine release occur, all of which contribute to microvascular thrombosis [14].…”

“…Most of the pathogenesis of CVST in APS is still unknown. Research indicates that the synthesis of APLS, which target cerebral venous and platelet in APS, is linked to CVST [13][14][15][16][17].…”

Cerebral Venous Sinus Thrombosis Following an mRNA COVID-19 Vaccination and Recent Oral Contraceptive Use

“…Thus, when combined with mRNA vaccines, a hypercoagulable state could potentially lead to obstruction of the cerebral sinuses when a thrombus does not resolve. It is important to consider that the COVID-19 infection has also been demonstrated to cause a hypercoagulable state and is responsible for a number of CVST’s [ 27 , 28 , 29 ]. The risk of a COVID-19 infection itself may be more likely to cause CVST in comparison to the mRNA vaccines [ 30 ].…”