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Review
. 2022 Jul 22;12(8):1105.
doi: 10.3390/life12081105.

Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic

Natalia Novaes  1 , Raphaël Sadik  2 , Jean-Claude Sadik  3 , Michaël Obadia  1
Affiliations
Review

Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic

Natalia Novaes et al. Life (Basel). .

Abstract

Cerebral venous thrombosis (CVT) is a rare type of stroke that may cause an intracranial hypertension syndrome as well as focal neurological deficits due to venous infarcts. MRI with venography is the method of choice for diagnosis, and treatment with anticoagulants should be promptly started. CVT incidence has increased in COVID-19-infected patients due to a hypercoagulability state and endothelial inflammation. CVT following COVID-19 vaccination could be related to vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare but severe complication that should be promptly identified because of its high mortality rate. Platelet count, D-dimer and PF4 antibodies should be dosed. Treatment with non-heparin anticoagulants and immunoglobulin could improve recuperation. Development of headache associated with seizures, impaired consciousness or focal signs should raise immediate suspicion of CVT. In patients who received a COVID-19 adenovirus-vector vaccine presenting thromboembolic events, VITT should be suspected and rapidly treated. Nevertheless, vaccination benefits clearly outweigh risks and should be continued.

Keywords: COVID-19; adenovirus vaccine; cerebral venous thrombosis; vaccine-induced immune thrombotic thrombocytopenia (VITT).

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Conflict of interest statement

The authors declare no conflict of interests.

Figures

Figure 1
Figure 1
(a) Venous MRI showing thrombosis of left transverse and sigmoid sinuses. (b) Diffusion-weighted image showing ischemia of left temporal region. (c,d) Fluid-attenuated inversion recovery (FLAIR) showing hypersignal in temporal and parietal regions.
Figure 2
Figure 2
(a) Magnetic Resonance Imaging (T2* weighted image). (b) FLAIR, showing venous hemorrhagic infarct. (c) Venous angiogram showing extended thrombosis of the left transverse and sigmoid sinuses, after craniectomy.
Figure 3
Figure 3
Venous MRI showing thrombosis of left transverse and sigmoid sinuses.
See this image and copyright information in PMC

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