tetano
Editor, Senior Moderator
J Stroke Cerebrovasc Dis
. 2022 Jan 10;31(4):106306.
doi: 10.1016/j.jstrokecerebrovasdis.2022.106306. Online ahead of print.
Management and Outcomes of COVID - 19 Associated Cerebral Venous Sinus Thrombosis
Angel Miraclin T[SUP] 1 [/SUP], Dr Sanjith Aaron[SUP] 2 [/SUP], Ajith Sivadasan[SUP] 1 [/SUP], Kenneth Benjamin[SUP] 1 [/SUP], Vanjare Harshad[SUP] 3 [/SUP], Shalini Nair[SUP] 4 [/SUP], Kpp Abhilash[SUP] 5 [/SUP], Prabhakar At[SUP] 1 [/SUP], Vivek Mathew[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Systemic hyper-coagulabilty leading to micro and macro thrombosis is a known complication of Coronavirus disease - 2019(COVID -19). The postulated mechanism appears to be the viral activation of endothelium, triggering the coagulation pathways. Thrombosis of the cerebral veins and sinuses (CVT), a potentially serious condition, has been increasingly reported with COVID - 19 infection. In this clinical study we attempt to describe the clinical profile, investigations and outcomes of patients with COVID- 19 associated CVT.
Methods: This is a single center prospective observational study from South India. The study included patients (aged >18 years) with concomitant COVID infection and CVT. The clinical, laboratory, imaging characteristics, management and outcomes were described and compared with COVID negative CVT patients.
Results: Out of 97 cases of CVT treated at our center during the first and second waves of the COVID pandemic 11/97 (11%) were COVID related CVT. Among these 11 patients, 9 (81%) had presented with only CVT related symptoms and signs and were tested positive for COVID - 19 infection during the pre-hospitalization screening. Respiratory symptoms were absent in 90% of the patients. Headache (100%) and seizures (90%) were the common presenting symptoms. The median time to diagnosis was 6 hours, from presentation to the emergency department. Transverse sinus was involved 10/11 (90%) and majority of them (9/11) had Haemorrhagic Venous Infarction (HVI). Acute inflammatory markers were elevated in comparison with non COVID CVT patients, with the mean serum D-dimer being 2462.75 ng/ml and the C-reactive protein was 64.5 mg/dl. Three patients (30%) underwent decompressive hemicraniectomy (DHC) because of large hemispheric HVI. All patients survived in the COVID CVT group while the mortality in the non COVID group was 4%. At 6 months follow up excellent outcome (modified Rankin Scale (mRS) score of 0-2) was noted equally in both groups.
Conclusions: Symptoms and signs of CVT may be the only presentation of COVID-19 infection. Prompt recognition and aggressive medical management including DHC offers excellent outcomes.
Keywords: COVID-19; Cerebral venous thrombosis; Decompressive hemicraniectomy.
. 2022 Jan 10;31(4):106306.
doi: 10.1016/j.jstrokecerebrovasdis.2022.106306. Online ahead of print.
Management and Outcomes of COVID - 19 Associated Cerebral Venous Sinus Thrombosis
Angel Miraclin T[SUP] 1 [/SUP], Dr Sanjith Aaron[SUP] 2 [/SUP], Ajith Sivadasan[SUP] 1 [/SUP], Kenneth Benjamin[SUP] 1 [/SUP], Vanjare Harshad[SUP] 3 [/SUP], Shalini Nair[SUP] 4 [/SUP], Kpp Abhilash[SUP] 5 [/SUP], Prabhakar At[SUP] 1 [/SUP], Vivek Mathew[SUP] 1 [/SUP]
Affiliations
- PMID: 35091267
- DOI: 10.1016/j.jstrokecerebrovasdis.2022.106306
Abstract
Background: Systemic hyper-coagulabilty leading to micro and macro thrombosis is a known complication of Coronavirus disease - 2019(COVID -19). The postulated mechanism appears to be the viral activation of endothelium, triggering the coagulation pathways. Thrombosis of the cerebral veins and sinuses (CVT), a potentially serious condition, has been increasingly reported with COVID - 19 infection. In this clinical study we attempt to describe the clinical profile, investigations and outcomes of patients with COVID- 19 associated CVT.
Methods: This is a single center prospective observational study from South India. The study included patients (aged >18 years) with concomitant COVID infection and CVT. The clinical, laboratory, imaging characteristics, management and outcomes were described and compared with COVID negative CVT patients.
Results: Out of 97 cases of CVT treated at our center during the first and second waves of the COVID pandemic 11/97 (11%) were COVID related CVT. Among these 11 patients, 9 (81%) had presented with only CVT related symptoms and signs and were tested positive for COVID - 19 infection during the pre-hospitalization screening. Respiratory symptoms were absent in 90% of the patients. Headache (100%) and seizures (90%) were the common presenting symptoms. The median time to diagnosis was 6 hours, from presentation to the emergency department. Transverse sinus was involved 10/11 (90%) and majority of them (9/11) had Haemorrhagic Venous Infarction (HVI). Acute inflammatory markers were elevated in comparison with non COVID CVT patients, with the mean serum D-dimer being 2462.75 ng/ml and the C-reactive protein was 64.5 mg/dl. Three patients (30%) underwent decompressive hemicraniectomy (DHC) because of large hemispheric HVI. All patients survived in the COVID CVT group while the mortality in the non COVID group was 4%. At 6 months follow up excellent outcome (modified Rankin Scale (mRS) score of 0-2) was noted equally in both groups.
Conclusions: Symptoms and signs of CVT may be the only presentation of COVID-19 infection. Prompt recognition and aggressive medical management including DHC offers excellent outcomes.
Keywords: COVID-19; Cerebral venous thrombosis; Decompressive hemicraniectomy.