Cerebral venous sinus thrombosis associated with COVID-19: an autopsy case report

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. COVID-19 has been reported to increase the propensity for systemic hypercoagulability and thromboembolism disorders such as cerebral venous sinus thrombosis (CVST). A 66-year-old woman was found dead at her home. She had symptoms of fever, dizziness, and malaise 2 weeks prior to her death. However, her fever declined 3 days before death. Postmortem computed tomography conducted before the autopsy suggested CVST. On autopsy, a massive thrombus was observed from the cortical veins to the superior sagittal sinus and transverse sinus accompanied by a small infarction region in the left parietal region. Although the rapid antigen test was negative, the reverse transcription-quantitative polymerase chain reaction test was positive for SARS-CoV-2, with a cycle threshold (Ct) value of 38.9. The serum C-reactive protein level was 0.532 mg/dL. COVID-19 was the only risk factor for CVST, and no other cause of death was determined. Therefore, the cause of death was determined as acute intracranial hypertension due to CVST associated with COVID-19. The patient died after the symptoms improved, the Ct value of RT-qPCR was 38.9, and the serum C-reactive protein level decreased. Therefore, CVST might have occurred in the convalescent phase of COVID-19 infection.

Keywords: Autopsy; COVID-19; Cerebral venous sinus thrombosis; Forensic; Postmortem CT.

Fig. 1

Postmortem computed tomography images. a Axial image of the head. Low-density area in the enlarged superior sagittal sinus (arrow). b Curved multiplanar reconstruction image of both transverse sinuses. Low-density area in both transverse sinuses are observed, especially in the left transverse sinus (arrow)

Fig. 2

Cross sections of the dural sinuses. Thrombus in the superior sagittal sinus (arrow), left transverse sinus (black arrowhead), and right transverse sinus (white arrowhead) are observed

Fig. 3

Small hemorrhagic infarction in the left cortex (arrow) and thrombus in the veins of the brain convexity (arrowheads)

Fig. 4

Histopathology of the left transverse sinus. a Thrombus in the left transverse sinus (Elastica Masson–Goldner staining, 12.5 ×). b Adhesion of the endothelium of the left transverse sinus and the thrombus (magnification of a). Lymphocytes and plasmacytes can be observed in the endothelium (Elastica Masson–Goldner staining, 100 ×)