Cerebral Venous Sinus Thrombosis in COVID-19: An Unusual Presentation

Kaur, Ikwinder Preet; Vyas, C. K.; Mughal, Mohsin Sheraz; Gandhi, Haresh; Du, Doantrang

doi:10.7759/cureus.13767

Cited by 11 publications

(16 citation statements)

References 5 publications

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“…The condition has also been linked to a wide range of viral infections, and according to the recent reports, COVID-19 can be considered as an independent risk factor for CVST as 75% of CVST in COVID-19 cases were not associated with any other identifiable risk factor [ 7 , 13 ]. The exact figure regarding the incidence of CVST in COVID-19 cases is yet to be available [ 14 ]. However, studies with different results have been published.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical manifestations of CVST include seizures, decreased consciousness, headache, focal neurological deficits, weakness of extremities, and disorientation, which may be missed during diagnosis in COVID-19 cases as they can also be associated with neurological manifestations [ 14 ]. The current case was oriented and conscious, but she was presented with headache, nausea, and slurred speech.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of CVST poses a challenge to physicians as their symptoms are highly unspecific, hence further investigation is required for definitive diagnosis [ 13 ]. Even though US can be used in the diagnosis of other thrombotic conditions with a sensitivity of 77.8–90%, it is mostly not suitable for the diagnosis of CVST and a more sensitive imaging techniques are required for these cases, such as MRI or magnetic resonance venography imaging modalities [ 13 , 14 ]. Amongst cases of CVST, the superior sagittal sinus is the most regularly observed location for the occurrence of the condition [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Post COVID-19 cerebral venous sinus thrombosis; a case report

Ahmad¹,

Kakamad²,

Mohamad³

et al. 2021

Annals of Medicine and Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Post COVID-19 cerebral venous sinus thrombosis; a case report

Ahmad¹,

Kakamad²,

Mohamad³

et al. 2021

Annals of Medicine and Surgery

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“…Coronavirus may also increase the risk of coagulation through other unknown pathophysiological mechanisms [ 38 , 39 ]. The mechanism of coagulation by COVID-19 is initiated by the binding of spike surface protein of SARS-CoV-2 to human angiotensin-converting enzyme (ACE) 2 receptor, causing direct viral endothelial invasion, endothelial apoptosis, and neuronal damage [ 38 , 40 - 54 ]. Studies have found that infection with SARS-CoV-2 and activation of the coagulation cascade, cytokine storm-related prothrombotic state, and/or increased platelet activity can accelerate the progression of cerebrovascular events including CVST [ 6 , 40 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Coagulation Complications Following COVID-19 Adenoviral Vector Vaccines: A Systematic Review

et al. 2021

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Emergence of the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak identified in late 2019 in Wuhan, China, was declared a pandemic in March 2020. High fatality rate in afflicted patients prompted scientists and physicians to develop various vaccines against the virus. While administration of millions of doses of the adenoviral vector vaccines (e.g., Oxford-AstraZeneca (ChAdOx1 nCoV-19) and Janssen/Johnson & Johnson (Ad26.COV2. S)) has helped control the disease, numerous cases of cerebral venous sinus thrombosis (CVST) with thrombocytopenia have been reported in vaccinated individuals. In this article, we aim to review the cases reported thus far and further discuss the association between the vaccine administration and subsequent cerebral thromboembolic events. Our study was performed and reported based on the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Google Scholar and Norris Medical Library databases were searched using the following terms: coronavirus disease 2019 (COVID-19) vaccines (“AstraZeneca” or “AZD1222 COVID vaccine” or “ChAdOx1 nCoV-19 COVID-19 vaccine” or “Janssen” or “Johnson & Johnson COVID vaccine” or “Ad26.COV2 COVID vaccine”), coagulopathy (“cerebral venous sinus thrombosis (CVST)” and “vaccine-induced immune thrombotic thrombocytopenia (VITT)” or “cerebral venous thrombosis (CVT)”) and thrombocytopenia. All the relevant studies within the English literature up to August 1, 2021, were included. Fourteen most recent articles reporting on 66 patients with CVST and VITT after adenoviral vector vaccination were reviewed by two independent authors. Age of the patients ranged from 18 to 60 years. The majority of cases were women (43 females versus 14 males). Platelet count was between 5 and 127 × 10 9 /L. Above-normal D-dimer was found in 86% of the patients. A total of 68% of the patients had positive platelet factor 4 IgG assay in the absence of prior exposure to heparin. Among CVST cases following COVID vaccination, 44% succumbed to death. Early diagnosis and treatment of CVST plays a fundamental role in decreasing morbidity and mortality. Health care professional should be familiar with this rare complication post vaccination against COVID-19. Given the rarity of CVST after the COVID-19 vaccine, the benefit of vaccination outweighs the potential harm.

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“…The mostly used anticoagulant therapy was the heparins: enoxaparin 36% (13/36), low molecular weight heparin 28% (10/36), heparin 19% (7/36; undifferentiated Hughes et al 16 Garaci et al 63 Klein et al 38 Sugiyama et al 41 Hemasian and Ansari 60…”

Section: Summary Of the Data In Tablementioning

confidence: 99%

Cerebral venous thrombosis and Covid 19: Literature review

Zicarelli¹,

Martins²,

Doni³

et al. 2021

JNSK

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Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

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Cerebral Venous Sinus Thrombosis in COVID-19: An Unusual Presentation

Cited by 11 publications

References 5 publications

Post COVID-19 cerebral venous sinus thrombosis; a case report

Post COVID-19 cerebral venous sinus thrombosis; a case report

Cerebral Coagulation Complications Following COVID-19 Adenoviral Vector Vaccines: A Systematic Review

Cerebral venous thrombosis and Covid 19: Literature review

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