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Case Reports
. 2020 Dec;29(12):105379.
doi: 10.1016/j.jstrokecerebrovasdis.2020.105379. Epub 2020 Oct 6.

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

Tian Ming Tu  1 , Claire Goh  2 , Ying Kiat Tan  2 , Aloysius St Leow  3 , Yu Zhi Pang  1 , Jaime Chien  1 , Humaira Shafi  1 , Bernard Pl Chan  3 , Andrew Hui  4 , Jasmine Koh  1 , Benjamin Yq Tan  5 , N Thirugnanam Umapathi  1 , Leonard Ll Yeo  6
Affiliations
Case Reports

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

Tian Ming Tu et al. J Stroke Cerebrovasc Dis. 2020 Dec.

Abstract

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.

Keywords: Anticoagulation; Cerebral venous thrombosis; Coronavirus disease 2019; Mortality; Systematic review.

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Conflict of interest statement

Declaration of Competing Interest There are no conflict of interests.

Figures

Fig 1
Fig. 1
CT venogram demonstrating a filling defect in the right sigmoid sinus.
Fig 2
Fig. 2
MR venogram demonstrating the following: A - Filling defect in the left transverse sinus; B - Left transverse and sigmoid sinus CVT.
Fig 3
Fig. 3
CT brain and CT venogram revealed an acute left temporal lobe intraparenchymal hematoma and an underlying thrombosis of the left transverse sinus.
Fig 4
Fig. 4
PRISMA flowchart.
See this image and copyright information in PMC

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