Post COVID‐19 Cerebral Venous Thrombosis presenting as Acute Dementia

Background Coronavirus disease (COVID‐19) is an infectious disease caused by SARS‐CoV‐2 virus which may lead to various neurological complications as reported in the literature. One important complication is CVT (Cerebral Venous Thrombosis) which classically presents as acute headache, seizures and focal neurological deficits. We report an interesting and rare case presentation of CVT here. Method A 32 year old female presented to ER with history of progressive forgetfulness since 4 days. She had difficulty in remembering recent activities and names of close associates. This was followed by holocranial headache after 2 days. She had history of COVID‐19 infection 20 days before the symptom onset. With the suspicion of acute vascular event, she was subjected to brain imaging. Result MRI brain with MR venogram showed left temporal venous infarct along with left transverse sinus and superior sagittal sinus thrombosis. She was treated with heparin and acenocoumarol subsequently along with supportive care with full relief in her symptoms. Conclusion CVT is now a known complication of COVID‐19 infection. It is generally an acute condition presenting with its classical features. However, it can also rarely present with other manifestations like acute cognitive decline or rapidly progressive dementia. Careful approach towards clinical presentation with appropriate diagnostic testing can quickly identify this condition for proper and timely treatment.

Rapidly progressive dementia in the COVID-19 era

Abstract Background Rapidly progressive dementias(RPD) are conditions that typically cause dementia over weeks or months.1 Due to the current COVID-19 pandemic, it has become difficult for dementia caregivers on the one hand, and relevant detailed examination and management in the hospitals worldwide, on the other. Recent studies shows that ApoE e4 genotype is associated with both dementia and delirium2. Hence further research into the possible genetic link between dementia and COVID-19 is the need of the hour. Method We studied two elderly male patients, aged 66 and 68 years, presenting with memory decline of recent events, untimely and non-sequential Activities of Daily Living and apathetic alongwith way finding difficulty and errors in money transactions. One patient also had forgetfulness of handwashing and face hygiene measures, and of using preventive face masks in public places as advised for public health during COVID-19 outbreak. On examination, vitals were stable and normal fundus examination with no fever, dry cough or tiredness, and no evidence of Increased Intracranial Pressure(ICP). MMSE score was 16/30 and 17/30 respectively, recent memory and visuospatial skills were impaired and slowness of activities were present. Motor examination was normal, with no focal or non-focal neurological deficit or sensory impairment. All routine tests were normal. Neuroimaging with contrast in one patient showed well defined hyperdense mass lesion of size 4.0*3.5*3.0 cms. showing heterogenous contrast enhancement in left parieto-occipital lobes with moderate perilesional edema suggestive of astrocytoma (intermediate type). Result High index of suspicion of Space occupying lesions should be made in the background of RPD even in the absence of focal or non focal neurological deficit or without signs of raised ICP. Conclusion Most of the etiologies causing RPD especially surgical causes, if diagnosed early and promptly are reversible and treatable. The double hit of dementia and COVID-19 pandemic necessitates further research globally. References: 1) Paterson RW, Takada LT, Geschwind MD. Diagnosis and treatment of rapidly progressive dementias. Neurol Clin Pract. 2012;2(3):187?200. 2) Kuo C-L, Pilling LC, Atkins JL, Kuchel GA, Melzer D. ApoE e2 and aging-related outcomes in 379,000 UK Biobank participants. medRxiv [Internet]. 2020: 2020.02.12.20022459.

Young COVID 19 presenting as fatal subarachnoid hemorrhage: Association or chance?

The coronavirus disease due to severe acute respiratory syndrome-Corona virus 2 emerged in Wuhan city, china in December 2019 and rapidly spread more than 200 countries as a global health Pandemic. While its effects on respiratory symptoms are well recognized, neurologic manifestations have been rarer. We report a case of 21-year-old COVID 19 positive female who presented with fatal Sub arachnoid hemorrhage.