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The authors of this review summarize current literature regarding cerebral venous thrombosis (CVT) in patients with acute SARS-CoV-2 infection. They identified 14 patients with CVT with a median age of 43 years. Of these, 8 had no significant past medical history, and 2 had no respiratory symptoms. CVT was found in mild, moderate, and severe SARS-CoV-2 infection. Only 2 patients had evidence of a prothrombotic state; 33% of the cohort had thrombosis of the deep venous sinus, including the internal cerebral vein or straight sinus. The mortality rate in this case series was 45.5%.
Acute SARS-CoV-2 infection can be associated with CVT even in patients who do not display respiratory symptoms. The authors suggest that patients presenting with CVT be screened for COVID-19 even in the absence of respiratory symptoms as patients may benefit from early anticoagulation.
– Kyle Binder, MD
This abstract is available on the publisher's site.
There has been increasing reports associating the coronavirus disease 2019 (COVID-19) with thromboembolic phenomenon including ischemic strokes and venous thromboembolism. Cerebral venous thrombosis (CVT) is a rare neurovascular emergency that has been observed in some COVID-19 patients, yet much remains to be learnt of its underlying pathophysiology.
We present a case series of local patients with concomitant COVID-19 infection and CVT; and aim to perform a systematic review of known cases in the current literature.
We describe two patients with concomitant COVID-19 infection and CVT from a nationwide registry in Singapore. We then conducted a literature search in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 11th June 2020. All studies reporting CVT in COVID-19 patients were included.
Nine studies and 14 COVID-19 patients with CVT were studied. The median age was 43 years (IQR=36-58) and majority had no significant past medical conditions (60.0%). The time taken from onset of COVID-19 symptoms to CVT diagnosis was a median of 7 days (IQR=6-14). CVT was commonly seen in the transverse (75.0%) and sigmoid sinus (50.0%); 33.3% had involvement of the deep venous sinus system. A significant proportion of patients had raised D-dimer (75.0%) and CRP levels (50.0%). Two patients reported presence of antiphospholipid antibodies. Most patients received anticoagulation (91.7%) while overall mortality rate was 45.5%.
The high mortality rate of CVT in COVID-19 infection warrants a high index of suspicion from physicians, and early treatment with anticoagulation should be initiated.