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J Stroke Cerebrovasc Dis · Dec 2020
Case ReportsCerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review.
- Tian Ming Tu, Claire Goh, Ying Kiat Tan, Aloysius St Leow, Yu Zhi Pang, Jaime Chien, Humaira Shafi, Bernard Pl Chan, Andrew Hui, Jasmine Koh, Benjamin Yq Tan, N Thirugnanam Umapathi, and Leonard Ll Yeo.
- Department of Neurology, National Neuroscience Institute, Singapore.
- J Stroke Cerebrovasc Dis. 2020 Dec 1; 29 (12): 105379.
BackgroundThere 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.ObjectiveWe 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.MethodsWe 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.ResultsNine 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%.ConclusionsThe 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.Copyright © 2020 Elsevier Inc. All rights reserved.
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