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Observational Study
. 2021 Jun;30(6):105733.
doi: 10.1016/j.jstrokecerebrovasdis.2021.105733. Epub 2021 Mar 4.

Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature

Mohamad Abdalkader  1 , Shamsh P Shaikh  2 , James E Siegler  3 , Anna M Cervantes-Arslanian  4 , Cristina Tiu  5 , Razvan Alexandru Radu  5 , Vlad Eugen Tiu  5 , Dinesh V Jillella  6 , Ossama Yassin Mansour  7 , Víctor Vera  8 , Ángel Chamorro  8 , Jordi Blasco  8 , Antonio López  8 , Mudassir Farooqui  9 , Lauren Thau  3 , Ainsley Smith  3 , Santiago Ortega Gutierrez  10 , Thanh N Nguyen  11 , Tudor G Jovin  3
Affiliations
Observational Study

Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature

Mohamad Abdalkader et al. J Stroke Cerebrovasc Dis. 2021 Jun.

Abstract

Background: COVID-19 infection has been known to predispose patients to both arterial and venous thromboembolic events such as deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke. A few reports from the literature suggest that Cerebral Venous Sinus Thrombosis (CVSTs) may be a direct complication of COVID-19.

Objective: To review the clinical and radiological presentation of COVID-19 positive patients diagnosed with CVST.

Methods: This was a multicenter, cross-sectional, retrospective study of patients diagnosed with CVST and COVID-19 reviewed from March 1, 2020 to November 8, 2020. We evaluated their clinical presentations, risk factors, clinical management, and outcome. We reviewed all published cases of CVST in patients with COVID-19 infection from January 1, 2020 to November 13, 2020.

Results: There were 8 patients diagnosed with CVST and COVID-19 during the study period at 7 out of 31 participating centers. Patients in our case series were mostly female (7/8, 87.5%). Most patients presented with non-specific symptoms such as headache (50%), fever (50%), and gastrointestinal symptoms (75%). Several patients presented with focal neurologic deficits (2/8, 25%) or decreased consciousness (2/8, 25%). D-dimer and inflammatory biomarkers were significantly elevated relative to reference ranges in patients with available laboratory data. The superior sagittal and transverse sinuses were the most common sites for acute CVST formation (6/8, 75%). Median time to onset of focal neurologic deficit from initial COVID-19 diagnosis was 3 days (interquartile range 0.75-3 days). Median time from onset of COVID-19 symptoms to CVST radiologic diagnosis was 11 days (interquartile range 6-16.75 days). Mortality was low in this cohort (1/8 or 12.5%).

Conclusions: Clinicians should consider the risk of acute CVST in patients positive for COVID-19, especially if neurological symptoms develop.

Keywords: COVID-19; CVST; Cerebral venous sinus thrombosis; SARS-CoV-2; Stroke.

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Figures

Fig 1:
Figure 1
A 68-year-old woman presented with fever, cough, and shortness of breath. A nasopharyngeal swab RT-PCR test resulted positive for SARS-CoV-2. Three weeks later, she returned with generalized weakness, headache, nausea and vomiting.
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