Cerebral venous sinus thrombosis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Abstract

Introduction/Objective. Coagulopathy induced by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2) can be an underlying cause of cerebral venous sinus thrombosis (CVST), a less common type of stroke with a variable clinical presentation and high mortality rate. The objective of the paper is to present a series of CVST cases associated with SARS-CoV-2 infection. Methods. This retrospective study evaluated clinical, laboratory and radiological presentations, risk factors, barriers to diagnosis, treatment and outcome of patients with SARS-CoV-2 infection-induced CVST. Results. The study comprised six patients diagnosed with COVID-19-induced CVST during an 18-month period. The majority (66.7%) had no significant risk factors for developing CVST. The median time from the initial COVID-19 diagnosis to the onset of neurologic deficit was seven days (interquartile range 0.5–7 days). Clinical presentation comprised non specific neurological symptoms: headache (83.3%) and decreased consciousness (33.3%), together with elevated levels of D-dimer and inflammatory biomarkers. The transverse (n = 4, or 66.7%), superior sagittal sinuses (n = 3, or 50%) and sigmoid sinus (n = 2, or 33.3%) were most commonly affected. Five patients (83.3%) had minimal to no symptoms at discharge (mRS ≤ 2). In-hospital mortality in our current series was relatively high (16.7%). Conclusion. The high mortality rate of SARS-CoV-2-associated CVST urges clinicians to suspect CVST in patients with a history of COVID-19 infection presenting with non-specific neurological symptoms in order to provide proper treatment and prevent complications.

Keywords

• covid-19 coagulopathy
• anticoagulation
• stroke