tetano
Editor, Senior Moderator
J Stroke Cerebrovasc Dis
. 2020 Dec;29(12):105379.
doi: 10.1016/j.jstrokecerebrovasdis.2020.105379. Epub 2020 Oct 6.
Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review
Tian Ming Tu[SUP] 1 [/SUP], Claire Goh[SUP] 2 [/SUP], Ying Kiat Tan[SUP] 2 [/SUP], Aloysius St Leow[SUP] 3 [/SUP], Yu Zhi Pang[SUP] 1 [/SUP], Jaime Chien[SUP] 1 [/SUP], Humaira Shafi[SUP] 1 [/SUP], Bernard Pl Chan[SUP] 3 [/SUP], Andrew Hui[SUP] 4 [/SUP], Jasmine Koh[SUP] 1 [/SUP], Benjamin Yq Tan[SUP] 5 [/SUP], N Thirugnanam Umapathi[SUP] 1 [/SUP], Leonard Ll Yeo[SUP] 6 [/SUP]
Affiliations
Abstract
Background: 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.
Objective: 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.
Methods: 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.
Results: 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%.
Conclusions: 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.
Keywords: Anticoagulation; Cerebral venous thrombosis; Coronavirus disease 2019; Mortality; Systematic review.
. 2020 Dec;29(12):105379.
doi: 10.1016/j.jstrokecerebrovasdis.2020.105379. Epub 2020 Oct 6.
Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review
Tian Ming Tu[SUP] 1 [/SUP], Claire Goh[SUP] 2 [/SUP], Ying Kiat Tan[SUP] 2 [/SUP], Aloysius St Leow[SUP] 3 [/SUP], Yu Zhi Pang[SUP] 1 [/SUP], Jaime Chien[SUP] 1 [/SUP], Humaira Shafi[SUP] 1 [/SUP], Bernard Pl Chan[SUP] 3 [/SUP], Andrew Hui[SUP] 4 [/SUP], Jasmine Koh[SUP] 1 [/SUP], Benjamin Yq Tan[SUP] 5 [/SUP], N Thirugnanam Umapathi[SUP] 1 [/SUP], Leonard Ll Yeo[SUP] 6 [/SUP]
Affiliations
- PMID: 33254369
- DOI: 10.1016/j.jstrokecerebrovasdis.2020.105379
Abstract
Background: 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.
Objective: 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.
Methods: 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.
Results: 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%.
Conclusions: 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.
Keywords: Anticoagulation; Cerebral venous thrombosis; Coronavirus disease 2019; Mortality; Systematic review.