Cerebral Venous Sinus Thrombosis as a Presentation of COVID-19

Abstract

Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the case of a 59-year-old man who presented with headache, hypertension and a single episode of fever with no other symptoms. He subsequently developed unilateral weakness. Computer tomography identified a cerebral venous sinus thrombosis (CVST). A subsequent test for COVID-19 was positive. This is the first report of CVST as a presenting symptom of COVID-19 infection.

Learning points: Thrombotic events may be the initial presenting symptom of COVID-19.These thrombotic events include stroke, venous thromboembolism, pulmonary embolism and cardiac complications.Clinicians should carefully consider the risk of thrombosis in patients positive for COVID-19, including prophylaxis and treatment beyond discharge.

Keywords: COVID-19; anticoagulation; cerebral venous sinus thrombosis; stroke.

Figure 1

CT venogram (sagittal reconstruction – 4 mm maximum intensity projection). Contrast in the sagittal sinus should extend inferiorly to meet the straight sinus at the torcula/confluence of the sinuses. In this image, the thrombus fills the lower part of the sagittal sinus, making it similar in density to the brain (black arrow). Note that the sinuses are irregular and variable, and a similar appearance would be seen if part of the sinus were out of the plane of the image

Figure 2

CT venogram (4 mm MIP axial image, bone windows). The dominant sinus is the right one – asymmetry of the sinuses is normal. Contrast is seen in the smaller left sinus (blue arrow), but not where the thrombus fills most of the right transverse sinus (red arrow)