Cerebral Venous Sinus Thrombosis in COVID-19 Infection: A Case Series and Review of The Literature

• Published in: Journal of stroke and cerebrovascular diseases 2021-01, Vol.30 (1), p.105434-105434, Article 105434
• Main Authors: Dakay, Katarina, Cooper, Jared, Bloomfield, Jessica, Overby, Philip, Mayer, Stephan A., Nuoman, Rolla, Sahni, Ramandeep, Gulko, Edwin, Kaur, Gurmeen, Santarelli, Justin, Gandhi, Chirag D., Al-Mufti, Fawaz
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Case Report; Coronavirus; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 - therapy; Fatal Outcome; Female; Humans; Hypercoaguability; Male; Sinus Thrombosis, Intracranial - diagnostic imaging; Sinus Thrombosis, Intracranial - etiology; Sinus Thrombosis, Intracranial - therapy; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - therapy; Thromboembolism - diagnostic imaging; Thromboembolism - etiology; Thromboembolism - therapy; Treatment Outcome; Venous sinus thrombosis; Venous thromboembolism; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - etiology; Venous Thrombosis - therapy
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2020.105434

SARS-CoV-2, the virus responsible for novel Coronavirus (COVID-19) infection, has recently been associated with a myriad of hematologic derangements; in particular, an unusually high incidence of venous thromboembolism has been reported in patients with COVID-19 infection. It is postulated that either the cytokine storm induced by the viral infection or endothelial damage caused by viral binding to the ACE-2 receptor may activate a cascade leading to a hypercoaguable state. Although pulmonary embolism and deep venous thrombosis have been well described in patients with COVID-19 infection, there is a paucity of literature on cerebral venous sinus thrombosis (cVST) associated with COVID-19 infection. cVST is an uncommon etiology of stroke and has a higher occurrence in women and young people. We report a series of three patients at our institution with confirmed COVID-19 infection and venous sinus thrombosis, two of whom were male and one female. These cases fall outside the typical demographic of patients with cVST, potentially attributable to COVID-19 induced hypercoaguability. This illustrates the importance of maintaining a high index of suspicion for cVST in patients with COVID-19 infection, particularly those with unexplained cerebral hemorrhage, or infarcts with an atypical pattern for arterial occlusive disease.