Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature

Nwajei, Felix; Anand, Pria; Abdalkader, Mohamad; Arasa, Vanessa Carlota Andreu; Aparicio, Hugo J.; Behbahani, Siavash; Curiale, Gioacchino; Daneshmand, Ali; Dasenbrock, Hormuzdiyar H.; Mayo, Thomas Wm.; Mian, Asim; Nguyen, Thanh N.; Ong, Charlene; Romero, José R.; Sakai, Osamu; Takahashi, Courtney; Cervantes‐Arslanian, Anna M.

doi:10.1016/j.jstrokecerebrovasdis.2020.105412

Cited by 45 publications

(59 citation statements)

References 44 publications

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“…As previously discussed, the association of CVT with COVID-19 has attracted interest from neurologists. Table 1 summarizes the clinical characteristics of the CVT cases associated with CVT that have been reported [ [21] , [22] , [23] , [24] , [25] , [26] , [27] , 32 , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] ]. Hughes et al.…”

Section: Resultsmentioning

confidence: 99%

“…[ 73 ] 13 patients – A few days Anticoagulant therapy Six patients discharged with good outcomes and three died Nwajei et al. [ 74 ] 68/F – 18 days Unfractionated heparin Improved 79/F Arterial hypertension Three days Low molecular weight heparin Improved 25/F Steroid/intravenous immunoglobulin refractory idiopathic thrombocytopenic purpura, lupus anticoagulant, von-Willebrand disease and Evans syndrome Four months Unfractionated heparin Improved Hussain et al. [ 75 ] 30/M – Eight days Levetiracetam, low molecular weight heparin and rivaroxaban Stable throughout admission …”

Section: Resultsmentioning

confidence: 99%

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Cerebral venous thrombosis in COVID-19

Ghosh

Roy

Mandal

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cerebral venous thrombosis in COVID-19

Ghosh

Roy

Mandal

et al. 2021

Diabetes & Metabolic Syndrome: Clinical Research & Revi

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“…1 Cerebrovascular complications occur in 0.5 to 5% of acute COVID-19 infections. [2][3][4][5] Acute ischemic stroke comprises the majority of cases, but intracerebral hemorrhage, 6 cerebral venous sinus thrombosis, 7,8 the posterior reversible encephalopathy syndrome (PRES) 9 and two cases of RCVS 14,15 have also been reported. There are several mechanisms by which COVID-19 infection may lead to stroke, including exacerbation of pre-existing underlying vascular risk factors, viral mediated hypercoagulability, hyperinflammatory state, general critical illness, hypoxia, hypotension, direct cardiac effects, but also via activation of the renin-angiotensin system, and direct endothelial invasion leading to endotheliitis.…”

Section: Introductionmentioning

confidence: 99%

Reversible Cerebral Vasoconstriction Syndrome in Patients with Coronavirus Disease: A Multicenter Case Series

Arandela

Samudrala

Abdalkader

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Background and objectives: RCVS (Reversible Cerebral Vasoconstrictive Syndrome) is a condition associated with vasoactive agents that alter endothelial function. There is growing evidence that endothelial inflammation contributes to cerebrovascular disease in patients with coronavirus disease 2019 . In our study, we describe the clinical features, risk factors, and outcomes of RCVS in a multicenter case series of patients with COVID-19. Materials and methods: Multicenter retrospective case series. We collected clinical characteristics, imaging, and outcomes of patients with RCVS and COVID-19 identified at each participating site. Results: Ten patients were identified, 7 women, ages 21 À 62 years. Risk factors included use of vasoconstrictive agents in 7 and history of migraine in 2. Presenting symptoms included thunderclap headache in 5 patients with recurrent headaches in 4. Eight were hypertensive on arrival to the hospital. Symptoms of COVID-19 included fever in 2, respiratory symptoms in 8, and gastrointestinal symptoms in 1. One patient did not have systemic COVID-19 symptoms. MRI showed subarachnoid hemorrhage in 3 cases, intraparenchymal hemorrhage in 2, acute ischemic stroke in 4, FLAIR hyperintensities in 2, and no abnormalities in 1 case. Neurovascular imaging showed focal segment irregularity and narrowing concerning for vasospasm of the left MCA in 4 cases and diffuse, multifocal narrowing of the intracranial vasculature in 6 cases. Outcomes varied, with 2 deaths, 2 remaining in the ICU, and 6

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“…While pulmonary embolism (PE) and deep venous thrombosis (DVT) have been well documented in patients with COVID-19, there is limited information on CVST associated with COVID-19 [ 4 ]. We present a case of CVST due to COVID-19 in a 30-year-old Indian man who presented to the ED with a headache one week after he was diagnosed with COVID-19 pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Venous Sinus Thrombosis as an Unexpected Complication of COVID-19 Pneumonia

Abdulgayoom¹,

Abdelmahmuod²,

Elfaki³

et al. 2021

Cureus

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Coronavirus disease 2019 (COVID-19) is commonly associated with acute respiratory distress syndrome and acute cardiac and renal injuries. However, thromboembolic events are also prevalent in COVID-19. The pathogenesis of COVID-19 hypercoagulability is not well known but may be linked to the cytokine storm induced by a viral infection or endothelial damage that triggers a cascade leading to hypercoagulability. Because vascular endothelium has angiotensin-converting enzyme 2-like lung tissue, COVID-19 targets lung tissue and vascular endothelium, leading to thrombosis. We present a rare case of a young patient with COVID-19 who presented with thrombosis of the cerebral venous system managed with anticoagulation. This case highlights the need for heightened awareness of this atypical but potentially treatable complication of the COVID-19 disease spectrum.

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Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature

Cited by 45 publications

References 44 publications

Cerebral venous thrombosis in COVID-19

Cerebral venous thrombosis in COVID-19

Reversible Cerebral Vasoconstriction Syndrome in Patients with Coronavirus Disease: A Multicenter Case Series

Cerebral Venous Sinus Thrombosis as an Unexpected Complication of COVID-19 Pneumonia

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