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Epidemiology and Management of Cerebral Venous Thrombosis during the COVID-19 Pandemic

Natalia Novaes1, Raphaël Sadik2, Jean-Claude Sadik3

  • 1Hôpital Fondation Adolphe de Rothschild, Stroke Unit, 75019 Paris, France.

Life (Basel, Switzerland)
|July 27, 2022
PubMed

Insights

Cerebral venous thrombosis (CVT), a rare stroke, can occur in COVID-19 patients or after adenovirus-vector vaccination. Prompt diagnosis and treatment are crucial for managing this condition and its severe complications like VITT.

Area of Science:

  • Neurology
  • Hematology
  • Infectious Diseases

Background:

  • Cerebral venous thrombosis (CVT) is a rare stroke type causing intracranial hypertension and neurological deficits.
  • Increased CVT incidence is observed in COVID-19 patients due to hypercoagulability and inflammation.
  • CVT following COVID-19 vaccination may indicate vaccine-induced immune thrombotic thrombocytopenia (VITT), a severe complication.

Purpose of the Study:

  • To review the diagnosis and management of CVT, particularly in the context of COVID-19 infection and vaccination.
  • To highlight the recognition and treatment of VITT, a rare but critical complication of adenovirus-vector vaccines.

Main Methods:

  • Review of current literature on CVT diagnosis and treatment.
  • Emphasis on diagnostic imaging (MRI with venography) and laboratory markers (platelet count, D-dimer, PF4 antibodies).
  • Discussion of therapeutic strategies including anticoagulation and immunomodulatory treatments.

Main Results:

  • MRI with venography is the gold standard for CVT diagnosis.
  • Prompt anticoagulant therapy is essential for CVT management.
  • VITT requires specific treatment with non-heparin anticoagulants and immunoglobulin.

Conclusions:

  • Early suspicion of CVT is vital, especially with symptoms like headache, seizures, or altered consciousness post-vaccination.
  • VITT must be rapidly identified and treated in patients with thromboembolic events after adenovirus-vector COVID-19 vaccination.
  • The benefits of COVID-19 vaccination significantly outweigh the risks, and vaccination should continue.

Keywords:
COVID-19adenovirus vaccinecerebral venous thrombosisvaccine-induced immune thrombotic thrombocytopenia (VITT)

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