Cerebral venous thrombosis in COVID-19-associated coagulopathy: A case report

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was first reported in Wuhan, China in December 2019, and is ongoing pandemic. While a majority of patients with SARS-CoV-2 infection shows asymptomatic or mild disease, hospitalized patients can develop critical condition, such as pneumonia, sepsis, and respiratory failure. Some cases deteriorate into sever systemic disease and multiorgan failure. Many patients of severe COVID-19 show hypercoagulable state and complicate with venous thromboembolism and atrial thrombosis. We herein reported a case of COVID-19 who developed cerebral venous thrombosis (CVT) co-incidence with pulmonary thromboembolism (PTE). A 56-year-old Japanese man was presented with fever and malaise and diagnosed with COVID-19. He was treated with ciclesonide and azithromycin, but his respiratory condition deteriorated. Thus, systemic corticosteroids and favipiravir were initiated and these treatments resulted in afebrile state, improving malaise and respiratory failure. However, he suddenly developed severe headache and vomiting with increased concentration of D-dimer. Brain CT and MRI showed typical images of CVT in the left transvers sinus and CT pulmonary angiography showed PE. Administration of unfractionated heparin followed by edoxaban treatment reduced the levels of D-dimer and improved his clinical presentation and thrombosis. Monitoring coagulopathy is important in COVID-19 patients and in case of venous thromboembolism, including cerebral venous system, appropriate anticoagulant therapy should be initiated.     

New onset of Susac syndrome after mRNA COVID-19 vaccine: a case report

Journal of Neurology -     

Cerebral venous thrombosis after lumbar puncture and intravenous high dose corticosteroids: A case report of a childhood multiple sclerosis

The association between cerebral venous thrombosis (CVT) and multiple sclerosis (MS) has already been reported in several adult patients with clinically definite MS, in a suspected relation to i.v. corticosteroids or previously performed lumbar puncture (LP). We are reporting a case, which is, to our knowledge, the first one concerning a child patient with a MS, who developed multiple CVT after LP and during high-dose i.v. corticosteroid. Our conclusions are that the sequence LP followed by high dose corticosteroids may be a contributory factor for the development of CVT when associated with other risk factors.     

Massive cerebral venous sinus thrombosis in vaccine-induced immune thrombotic thrombocytopenia after ChAdOx1 nCoV-19 serum: case report of a successful multidisciplinary approach

Neurological Sciences - We report a case of massive cerebral venous sinus thrombosis in the contest of vaccine-induced immune thrombotic thrombocytopenia that required the rapid coordination of...     

Cerebral venous sinus thrombosis in the setting of COVID-19 vaccination: a systematic review and meta-analysis

Journal of Neurology - Cerebral venous sinus thrombosis (CVST) has been reported as a rare adverse event in association with thrombosis-thrombocytopenia syndrome (TTS) following COVID-19...     

Coronavirus disease (COVID-19) complicated by rhino-orbital-cerebral mucormycosis presenting with neurovascular thrombosis: a case report and review of literature

Journal of NeuroVirology - Among the ever-increasing literature of the coronavirus disease 2019 (COVID-19), there have been reports on several complications in association with severe acute...     

Guillain-Barré syndrome following the first dose of Pfizer-BioNTech COVID-19 vaccine: case report and review of reported cases

Neurological Sciences - Since the SARS-CoV-2 pandemic has started in December 2019, millions of people have been infected all over the world. Vaccination is the most efficient tool to end this...     

妊娠合并脑静脉窦广泛血栓形成误诊为妊娠反应一例

患者女,22岁,因停经8周,头痛呕吐10 d,双下肢无力6 d,抽搐3 d于2007年1月22日急诊入院.患者末次月经为2006年11月24日,6周后在妇产科诊断为早期妊娠.     

COVID-19-associated necrotizing encephalopathy presenting without active respiratory symptoms: a case report with histopathology

Journal of NeuroVirology - Acute necrotizing encephalopathy (ANE) is a rare complication of coronavirus disease 2019 (COVID-19) secondary to severe acute respiratory syndrome coronavirus 2...     

Cerebral venous sinus thrombosis complicated with acute development of dural arteriovenous fistula: A case report

Development of dural arteriovenous fistula (dAVF) after cerebral venous sinus thrombosis (CVST) was very uncommon and for all these reported cases, the dAVF was a chronic complication. We present a case of acute development of dAVF after CVST. A 40-year-old female was admitted into our department with 2 day’s headache and vomiting for 9 h. Head computed tomography (CT) scan showed only scattered minor hematomas over the right frontal lobe. Blood test indicated an elevated D-dimer. The patient experienced transient paralysis (Todd’s paralysis) after intermittent focal epilepsy from day 3, which progressed into sustained epilepsy on day 6. Magnetic resonance imaging (MRI) on day 7 confirmed the thrombosis of the superior sagittal sinus and a large area of infarction and edema in the left frontal and parietal lobe. She was then treated with heparin and warfarin. Cerebral angiography on day 9 demonstrated a dAVF which was classified as Borden Type II and fed by the left occipital artery. Subsequently, endovascular occlusion of the fistula was conducted and the patient recovered well with only slight right limbs weakness at 1 year follow up.     

Relapse of obsessive–compulsive disorder after cerebral venous sinus thrombosis: a case report

Obsessive–compulsive disorder (OCD) is characterized by repetitive, persistent and unwanted thoughts and ritualistic, repetitive behaviors. The pathophysiology of OCD involves many distinct cortical and subcortical regions and it has been reported that OCD may occur as a consequence of traumatic brain injury, infections and tumors as well as cerebrovascular insult such as cerebral venous sinus thrombosis (CVST). We here describe the case of a 36-year-old woman who developed OCD at the age of 13 with almost complete remission of the symptoms after a 1 year-long treatment. Interestingly, after suffering CVST at the superior sagittal sinus at the age of 33, she experienced a relapse of OCD. The patient was successfully treated with Sertraline and Clomipramine. Previous studies revealed cases of OCD following different cerebrovascular accidents, i.e. predominantly arterial stroke. However, the present case is the first to describe OCD after venous thrombosis. Based on our clinical experience, the most effective treatment of OCD after CVST represents the combination of the selective serotonin reuptake inhibitor Sertraline and the tricyclic antidepressant Clomipramine.     

颅内静脉窦血栓形成后硬脑膜动静脉瘘(附5例报告)

目的探讨硬脑膜动静脉瘘(DAVF)与静脉窦血栓形成发生的关系,以及其临床表现和治疗方法。方法回顾性分析2005年9月至2009年8月收治的5例继发于或伴发颅内静脉窦血栓形成的DAVF患者的临床资料。结果 5例患者中,3例表现为颅内出血,2例表现为突眼和结膜红肿。3例经开颅手术及1例经血管内介入栓塞治疗,术后均恢复良好;另1例未行外科处理,神经功能障碍呈进行性加重。结论静脉窦血栓形成可继发DAVF,但部分患者先期难以明确静脉窦血栓形成,而表现为DAVF伴静脉窦血栓性闭塞;颅内静脉窦血栓形成后继发的DAVF易发生颅内出血,应积极行血管内栓塞或开颅手术治疗。     

Cerebral venous infarction following thrombosis of the draining vein of a venous angioma (developmental abnormality)

We report two cases of cerebral venous angioma presenting as venous infarction, one in the left parietal lobe, the other in the left frontal lobe. Cerebral imaging demonstrated thrombotic occlusion of the draining vein of the venous angioma associated in the latter case with thrombosis of the anterior part of the superior longitudinal sinus. Both patients were free of coagulopathy. They were treated with anticoagulant therapy. One completely recovered, while the other was left with slight residual disability. Thrombosis of the draining vein has been reported in only 6 previous cases, of whom only 2 received anticoagulant therapy. Discovery of a venous angioma in the diagnostic workup of a patient with recent neurological disorders should raise the question of a possible occlusion of the draining vein and lead to an appropriate therapy.     

Sagittal sinus thrombosis associated with thrombocytopenia: a report of two patients.

Reported are two patients presenting with both thrombocytopenia and sagittal sinus thrombosis. The first patient is a 42-month-old male with no identified thrombophilic risk factors who developed acute neurologic symptoms after an acute infection. The second patient is a 22-month-old female with no history of preceding infection but had a positive lupus anticoagulant test. She also developed deep venous thrombosis and was treated with intravenous heparin. Both patients are currently doing well without neurologic deficits. To the authors' knowledge the second patient is the youngest reported patient with cerebral vein thrombosis associated with thrombocytopenia and lupus anticoagulant. These observations call attention to the need for a thorough investigation of thrombophilic risk factors in pediatric patients with thrombotic complications.     

Sildenafil-related cerebral venous sinus thrombosis and papilledema: a case report of a rare entity

Neurological Sciences - We present a rare case of cerebral venous sinus thrombosis associated with long-term and high-dose use of sildenafil. A 29-year-old man was referred to our...     

Impact of COVID-19 on chronic migraine treated with erenumab: a case report

Neurological Sciences - Headache is a frequent symptom of the novel coronavirus 19 disease (COVID-19). To date, there are limited information on how COVID-19 affects migraine and its treatment. A...