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Review
. 2021 May-Jun;15(3):1039-1045.
doi: 10.1016/j.dsx.2021.04.026. Epub 2021 May 18.

Cerebral venous thrombosis in COVID-19

Ritwik Ghosh  1 , Dipayan Roy  2 , Arpan Mandal  1 , Shyamal Kanti Pal  1 , Bikash Chandra Swaika  1 , Dinabandhu Naga  1 , Alak Pandit  3 , Biman Kanti Ray  3 , Julián Benito-León  4
Affiliations
Review

Cerebral venous thrombosis in COVID-19

Ritwik Ghosh et al. Diabetes Metab Syndr. 2021 May-Jun.

Abstract

Background and aims: Initially, novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) was considered primarily a respiratory pathogen. However, with time it has behaved as a virus with the potential to cause multi-system involvement, including neurological manifestations. Cerebral venous sinus thrombosis (CVT) has increasingly been reported in association with coronavirus infectious disease of 2019 (COVID-19). Here, we have shed light upon CVT and its possible mechanisms in the backdrop of the ongoing COVID-19 pandemic.

Methods: In this review, data were collected from PubMed, EMBASE and Web of Science, until March 30, 2021, using pre-specified searching strategies. The search strategy consisted of a variation of keywords of relevant medical subject headings and keywords, including "COVID-19", "SARS-CoV-2", "coronavirus", and "cerebral venous sinus thrombosis".

Results: COVID-19 has a causal association with a plethora of neurological, neuropsychiatric and psychological effects. CVT has gained particular importance in this regard. The known hypercoagulable state in SARS-CoV-2 infection is thought to be the main mechanism in COVID-19 related CVT. Other plausible mechanisms may include vascular endothelial dysfunction and altered flow dynamics.

Conclusions: Although there are no specific clinical characteristics, insidious or acute onset headache, seizures, stroke-like, or encephalopathy symptoms in a patient with, or who has suffered COVID-19, should prompt the attending physician to investigate for CVT. The treatment of COVID-19 associated CVT does not differ radically from the therapy of CVT without the infection, i.e. urgent initiation of parenteral unfractionated heparin or low molecular weight heparin followed by conventional or mostly newer oral anticoagulants.

Keywords: COVID-19; Cerebral venous thrombosis; Neuro-COVID; SARS-CoV-2.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Possible mechanisms through which SARS-CoV-2 can lead to cerebral venous thrombosis.
See this image and copyright information in PMC

References

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