Deep Cerebral Venous Thrombosis Treatment

Yeo, Leonard L.L.; Lye, Priscillia Ps; Yee, Kong Wan; Yang, Chao; Tu, Tian Ming; Ho, Andrew Fu Wah; Sharma, Vijay K.; Chan, Bernard P.L.; Tan, Benjamin Yong-Qiang; Gopinathan, Anil

doi:10.1007/s00062-020-00920-3

Cited by 20 publications

(9 citation statements)

References 80 publications

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“… 22 , 23 One possibility for the poorer outcome in these patients may be due to the location of the occluded sinuses, which showed a higher predilection for the deep venous sinuses to be involved. Thrombus in the internal cerebral veins or straight sinus was seen in 33.3% of the patients and these sites of thrombosis are typically rare and have a higher morbidity and mortality rate 24 Consequently, this may be a contributing factor to the high mortality reported in our series, where 50% of the patients who died had involvement of the deep cerebral veins.…”

Section: Discussionmentioning

confidence: 62%

“…Lastly, thrombectomy is a therapeutic option in patients with severe CVT, not unlike those with concomitant COVID-19. 24 In this study, while the only patient (case 1) who underwent endovascular treatment died, this may be related to the need for a salvage endovascular maneuver in a deteriorating patient despite anticoagulation rather than a reflection of the inability of endovascular treatment in COVID-19 patients with CVT.…”

Section: Discussionmentioning

confidence: 76%

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Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review

Goh

Tan

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

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101

145

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Background There has been increasing reports associating the coronavirus disease 2019 (COVID-19) with thromboembolic phenomenon including ischemic strokes and venous thromboembolism. Cerebral venous thrombosis (CVT) is a rare neurovascular emergency that has been observed in some COVID-19 patients, yet much remains to be learnt of its underlying pathophysiology. Objective We present a case series of local patients with concomitant COVID-19 infection and CVT; and aim to perform a systematic review of known cases in the current literature. Methods We describe two patients with concomitant COVID-19 infection and CVT from a nationwide registry in Singapore. We then conducted a literature search in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 11th June 2020. All studies reporting CVT in COVID-19 patients were included. Results Nine studies and 14 COVID-19 patients with CVT were studied. The median age was 43 years (IQR=36-58) and majority had no significant past medical conditions (60.0%). The time taken from onset of COVID-19 symptoms to CVT diagnosis was a median of 7 days (IQR=6-14). CVT was commonly seen in the transverse (75.0%) and sigmoid sinus (50.0%); 33.3% had involvement of the deep venous sinus system. A significant proportion of patients had raised D-dimer (75.0%) and CRP levels (50.0%). Two patients reported presence of antiphospholipid antibodies. Most patients received anticoagulation (91.7%) while overall mortality rate was 45.5%. Conclusions The high mortality rate of CVT in COVID-19 infection warrants a high index of suspicion from physicians, and early treatment with anticoagulation should be initiated.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 76%

Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review

Goh

Tan

et al. 2020

Journal of Stroke and Cerebrovascular Diseases

Self Cite

101

145

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“…Blockage in the internal cerebral veins or straight sinus was seen in 13% and 23%, respectively of the patients in the systematic review by Zicarelli et al Interestingly, these deep sites of occlusion are generally infrequent and have a higher morbidity and mortality rate. Therefore, this can be a causative component of the increased mortality reported in these series, where almost 50% of the patients who died, had the inclusion of the deep cerebral veins [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Coagulopathy Resulting in Cerebral Venous Thrombosis and Pulmonary Embolism

Abbas¹,

Chaudhary²

2021

Cureus

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Venous stroke is an infrequent complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease. Coronavirus disease 2019 (COVID-19) acts as a causative factor for thromboembolic events such as pulmonary embolism (PE), deep vein thrombosis (DVT), stroke (ischemic or hemorrhagic), and myocardial infarction. We report a case of cerebral venous thrombosis (CVT) following severe COVID-19 infection, with co-incidence of pulmonary thromboembolism. A 39-year-old English lady presented with fever and cough; subsequently, she was diagnosed with COVID-19 and was managed in the high dependency unit (HDU) due to the severity of symptoms; she received dexamethasone and tocilizumab. Her condition improved and she was discharged, but presented again after 15 days due to headache and left-sided weakness. Her neurological examination confirmed nystagmus, past pointing, and dysdiadochokinesia positive on the left side. Initial blood investigations showed D-dimer being raised at 1875 ng/ml. Head CT venogram reported evidence of thrombus in the superior sagittal sinus, left transverse sinus, and inferior sagittal sinus consistent with venous sinus thrombosis. She also underwent CT pulmonary angiogram (CTPA) which revealed lingular acute segmental PE and patchy ground-glass shadowing throughout both lung fields, confirming recent infective COVID-19 changes. She was started on a therapeutic dose of dalteparin (low-molecular-weight heparin). Luckily she made a good recovery from her neurological symptoms. Like this case and many other reported cases, COVID-19 acts as an independent risk factor for increased coagulopathy. Clinicians should maintain a high index of suspicion for CVT to aid in timely diagnosis and prompt treatment to save lives.

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“…Additionally, the 3-month follow-up of 11 patients revealed favorable clinical outcomes and mortalities in 45% and 27% of the subjects, respectively indicating the need for improvement in recanalization strategies regarding this disorder (76). More recently, a meta-analysis emphasized endovascular therapy in patients with initial intracranial hemorrhage predictive of poorer outcomes (80).…”

Section: Jvandcmentioning

confidence: 99%

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Paybast

Aghamiri

2020

J Vessel Circ

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Background and Aim: Cerebral venous thrombosis (CVT) is a relatively common disorder of the cerebral venous system accounting for less than 1% of all strokes with a higher prevalence in Iran. Despite the considerable advances in recent years, the diagnosis and treatment of CVT are still challenging predominantly in the emergency setting. Therefore, the present study sought to provide an update on the diagnosis and treatment of CVT. Materials and Methods: PubMed, Web of Science, Google Scholar, Scopus, Elsevier, and Iranian domestic scientific databases were searched within January 1, 2000, to July 1, 2020. In all the electronic databases, the keywords (in the title/abstract) of "cerebral vein thrombosis" OR "CVT" OR "Cerebral venous sinus thrombosis" OR "CVST" AND "risk factor", "diagnosis", "treatment", and "prognosis" were searched. The unrelated articles, studies not concerning humans or pediatric population, and case reports were excluded from the study. In addition, the articles related to CVT in association with coronavirus disease 2019 infection were excluded from the present review. Results: According to the findings of the present study, the diagnosis of CVT might be delayed due to a wide range of clinical manifestations from a subacute headache with or without the signs of intracranial hypertension to the acute focal neurologic deficit and even loss of consciousness. Although the diagnosis is typically based on brain magnetic resonance imaging and magnetic resonance venography, there has been evidence suggesting that the plain computed tomography markers with an attenuation value of > 60.4 Hounsfield unit (HU) and Hounsfield-hematocrit (H: H) ratio of > 1.42 are specific enough for the diagnosis regardless of confirmatory imaging, such as venography. Additionally, the usefulness of D-dimer is still debatable, and an unacceptable false-negative rate of up to 26% has been illustrated. In terms of therapeutic aspects, although warfarin is still the mainstay of treatment, there has been increasing interest in new oral anticoagulants with promising results in both thrombus recanalization and excellent functional recovery. Balloon angioplasty and mechanical thrombectomy might also be considered in severely progressive cases without response to conventional treatments. It is worth mentioning that even for those achieving favorable outcomes, CVT can remain a disabling condition leading to at least neuropsychiatric complaints. Conclusion: The CVT is a rare and important cause of stroke accounting for less than 5% of all strokes mainly affecting young females. With regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.

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Deep Cerebral Venous Thrombosis Treatment

Cited by 20 publications

References 80 publications

Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review

Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review

COVID-19 Associated Coagulopathy Resulting in Cerebral Venous Thrombosis and Pulmonary Embolism

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

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