Cavernous Sinus Thrombosis Linked to COVID-19 Infection: a Case Report

Abstract

The severity of SARS-CoV-2 virus infection is mainly related to its respiratory complications. However, it can also lead to a large variety of thromboembolic events. Symptoms may include headache, fever, and neurological disorders. Since 2020, the clinical presentation of COVID-19 infection has become increasingly varied, leading in some cases to complex symptom associations, including numerous neurological symptoms. SARS-CoV-2 may lead to neurotropism which could reach the central nervous system and all cranial nerves. Cavernous sinus thrombosis is a rare condition and may occur as a complication of ear, nose, and throat (ENT) or facial infections. A 73-year-old man without personal or family history of thrombosis was referred to the emergency room for a sudden appearance of diplopia and ptosis, 3 days after testing positive for COVID-19 infection. An initial head CT-scan found no signs of stroke. He underwent a cerebral MRI 7 days later, which revealed a thrombosis of his right cavernous sinus. A brain CT scan 7 days later showed regression of the thrombosis with complete recanalization of the cavernous sinus. This was accompanied by a complete regression of diplopia and fever. He was discharged from the hospital 10 days after hospital admission. In this case report, we describe a rare event of cavernous thrombophlebitis following a COVID-19 infection.

Keywords: COVID-19 infection; Cavernous sinus thrombosis; Neurological symptoms.

Fig. 1

Magnetic resonance imaging in sagittal, axial, and coronal reconstructions from 3D FLAIR Fat-Sat (a, b, c) and T1 with gadolinium injection in coronal and axial reconstruction (d, e) showing thrombosis of the right cavernous sinus associated with thrombosis and enlargement of the right ophthalmic vein (white arrows). The cranial CT scan after contrast in axial reconstruction (f) allows us to verify the good repermeabilization of the CST (white arrow)