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Management and Outcomes of COVID - 19 Associated Cerebral Venous Sinus Thrombosis

Angel Miraclin T1, Dr Sanjith Aaron1, Ajith Sivadasan1

  • 1Professor and Head, Department of Neurosciences, Christian Medical College, Vellore, Tamil Nadu 632004, India.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|January 29, 2022
PubMed

Insights

COVID-19 infection can present solely with cerebral venous thrombosis (CVT) symptoms. Prompt recognition and aggressive management, including decompressive hemicraniectomy, lead to excellent outcomes for COVID-19 associated CVT.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • Systemic hypercoagulability and thrombosis are known complications of COVID-19.
  • Cerebral venous thrombosis (CVT) is an increasingly reported, serious condition associated with COVID-19.
  • The postulated mechanism involves viral activation of the endothelium, triggering coagulation pathways.

Purpose of the Study:

  • To describe the clinical profile, investigations, and outcomes of patients with COVID-19 associated CVT.
  • To compare COVID-19 associated CVT with non-COVID CVT cases.

Main Methods:

  • A single-center prospective observational study was conducted in South India.
  • Included patients aged over 18 years with concomitant COVID-19 infection and CVT.
  • Clinical, laboratory, and imaging characteristics, management, and outcomes were documented and compared.

Main Results:

  • 11% (11/97) of CVT cases were COVID-19 related during the pandemic's first two waves.
  • 90% of COVID-19 CVT patients presented only with CVT symptoms, lacking respiratory signs.
  • Headache (100%) and seizures (90%) were common; transverse sinus involvement (90%) and hemorrhagic venous infarction (90%) were frequent. Elevated inflammatory markers (D-dimer, CRP) were observed.
  • All COVID-19 CVT patients survived, with 30% requiring decompressive hemicraniectomy; 6-month outcomes were excellent (mRS 0-2) and comparable to non-COVID CVT patients.

Conclusions:

  • Cerebral venous thrombosis (CVT) symptoms can be the sole manifestation of COVID-19.
  • Early diagnosis and aggressive management, including decompressive hemicraniectomy, are crucial for favorable outcomes in COVID-19 associated CVT.
Abstract

Keywords:
COVID-19Cerebral venous thrombosisDecompressive hemicraniectomy

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