Cerebral Venous Sinus Thrombosis in COVID-19 Infection: A Case Series and Review of The Literature

Abstract

SARS-CoV-2, the virus responsible for novel Coronavirus (COVID-19) infection, has recently been associated with a myriad of hematologic derangements; in particular, an unusually high incidence of venous thromboembolism has been reported in patients with COVID-19 infection. It is postulated that either the cytokine storm induced by the viral infection or endothelial damage caused by viral binding to the ACE-2 receptor may activate a cascade leading to a hypercoaguable state. Although pulmonary embolism and deep venous thrombosis have been well described in patients with COVID-19 infection, there is a paucity of literature on cerebral venous sinus thrombosis (cVST) associated with COVID-19 infection. cVST is an uncommon etiology of stroke and has a higher occurrence in women and young people. We report a series of three patients at our institution with confirmed COVID-19 infection and venous sinus thrombosis, two of whom were male and one female. These cases fall outside the typical demographic of patients with cVST, potentially attributable to COVID-19 induced hypercoaguability. This illustrates the importance of maintaining a high index of suspicion for cVST in patients with COVID-19 infection, particularly those with unexplained cerebral hemorrhage, or infarcts with an atypical pattern for arterial occlusive disease.

Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms

“…It happens mainly in the early stages of convalescence [129,130,133], but it can also appear later [129,130,133,134]. On the other hand, an atypical increase in cases of arterial venous sinus thrombosis (TSA) (from 7.7% to 28.0%) was reported in hospitalized patients with pneumonia and associated with COVID-19 [133]. TSA is usually classified as a rare subtype of stroke that affects women and young people, with an incidence of 2 to 5 cases per million people.…”

Neurological manifestations of coronavirus disease 2019: exploring past to understand present

“…They likely present in the second week of infection with no sex predilection, with headache being the most common symptom followed by focal neurological deficit. Neuroimaging shows nonarterial infarct or hemorrhage [28,29,69]. [13,14] • Acute encephalitis [1] • Bickerstaff encephalitis with GBS [15] • Acute necrotizing hemorrhagic encephalitis [16,17] • Viral encephalitis [18][19][20] • Meningoencephalitis [21] • Rhombencephalitis [22] 2.…”

“…• Ischemic stroke [23] • Ischemic stroke [1] • Ischemic stroke with large vessel occlusion [11,24] • Intracerebral hemorrhage, subarachnoid hemorrhage [25,26] • CVST [27][28][29] • PRES [30][31][32][33] • Microvascular occlusive disorder [34] 3. Immunological…”

“…EEG Various electroencephalography (EEG) findings including focal or diffuse delta-theta slowing, symmetrical or asymmetrical sporadic epileptiform discharges, lateralized periodic discharges with overriding fast activity, generalized sharp waves with spikes, triphasic waves, and repetitive focal rhthmic bursts of nonconvulsive status epilepticus have been reported in COVID-19 patients presenting with altered mental status, delirium, or encephalopathy, and continuous EEG monitoring is advisable in these patients to diagnose NCSE [53,75,87]. • Ischemic stroke [1,11,67] • Intracerebral hemorrhage, subarachnoid hemorrhage [24,25] • CVST [27,29,85] • PRES [30][31][32]73] • Loss of gray-white differentiation at occipital and parietal lobes or hypo dense lobar lesion. [58], myasthenic crisis, inflammatory myopathy, and critical illness neuropathy [59,88].…”

Cerebral venous sinus thrombosis associated with thrombocytopenia post-vaccination for COVID-19

“…CVST has been reported in COVID-19 patients associated with thrombocytopenia [4,5]; on March 15, 2021, the Paul Ehrlich Institut (Federal Institute for vaccines and biomedicines) reported CVST in seven patients 20-50 years old after vaccination with COVID-19 vaccine AstraZeneca.…”