Cerebral Venous Thromboses in a Patient With No Reported Risk Factors: A Case Report.

Stroke is a neurologic condition caused either by brain ischemia or brain hemorrhage, where most cases are a result of ischemic brain injury. Stroke more commonly affects the arterial blood supply of the brain, but in rare cases, it is evoked by the occlusion of the venous sinuses that drain blood from the brain. This phenomenon is known as cerebral venous sinus thrombosis (CVST), also referred to as cerebral sinovenous thrombosis. The pathogenesis of CVST is not completely understood, although common risk factors associated with the condition include obesity, hypercoagulable states, oral contraceptive use, intracranial infections, trauma, and, more recently, coronavirus disease 2019 (COVID-19). Immediate medical intervention is required because CVST can result in increased intracranial pressure and diffuse cerebral edema, which can bring about fatal complications that can lead to early death. However, CVST is challenging to diagnose, as its clinical presentation is highly variable. It can range from headaches to signs of elevated intracranial pressure, including nausea, vomiting, and vision problems. In this case report, the patient is a 25-year-old previously healthy African American female who presented with a weeklong headache and acute onset of delirium an hour prior to arrival at the hospital. The patient had prior emergency department (ED) visits from different facilities where head imaging was performed and showed negative results allowing her to return home. The patient was then brought by a friend to our ED due to altered mental status and agitation. Initial computed tomography of the head did not reveal acute abnormalities; however, magnetic resonance angiography and magnetic resonance venography revealed evidence of venous sinus thrombosis and lack of flow requiring urgent attention. The patient was then referred to endovascular neurology, but despite medical intervention, the patient's medical status deteriorated, and she was declared brain dead. Although rare, this case report emphasizes the atypical presentation and the severity of CVST where a young individual with no significant past medical history presented with neurological symptoms that rapidly progressed to complications that caused her early death.

Coagulopathy and risk factors in patients with severe COVID-19

Background. The pandemic of novel coronavirus infection (NCI) COVID-19 is accompanied by a high risk of thrombosis and bleeding. The debate regarding the choice of dose of anticoagulant therapy in severe patients with NCI is ongoing at present. Objective: to assess coagulation parameters and identify risk factors in patients with severe COVID-19. Patients/Methods. Out of 370 patients with NCI COVID-19 treated in Ryazan covid hospitals in 2021, 173 (46.8%) patients with severe coronavirus infection were included in the retrospective study. Risk factors, the frequency of thrombotic complications and bleeding, laboratory parameters of hemostasis and inflammation (general blood analysis, blood biochemistry, coagulogram), dose variants of anticoagulant therapy (preventive, intermediate and therapeutic doses) were accessed. Results. Among 173 patients with severe COVID-19, 98 (56.7%) persons recovered, and 75 (43.3%) patients died. In non-survivors vs. survivors, hypertension was more often observed — in 64 (85.3%) cases (p = 0.043), as well as obesity — in 8 (50.7%) cases (p = 0.024) and type 2 diabetes mellitus — in 34 (45.3%) cases (p = 0.022), therapeutic dosage of anticoagulants was used more often (58.6% of cases). C-reactive protein (CRP) level on admission was significantly higher in non-survivors vs. survivors — 117.3 (185–356) mg/L vs. 90.4 (1.2–301.0) mg/L (p = 0.033) as well as fibrinogen content — 6.3 (1.3–10.0) g/L vs. 3.6 (1.1–12.0) g/L (p = 0.004). In patients with lethal outcome, pulmonary embolism (PE) without a source in the lower extremities was determined more often than in patients with favorable outcome — 10 (13.3%) vs. 0 (0%) cases (p = 0.002). Isolated deep vein thrombosis (DVT) occurred only in patients with favorable outcome. The analysis of hemorrhagic complications revealed that the frequency of major bleeding was higher among non-survivors vs. survivors — 7 (9.3%) vs. 2 (2.04%) cases (p = 0.032). Conclusions. The use of therapeutic doses of anticoagulants did not reduce the mortality rate in severe patients with NCI and was accompanied by PE development with and without a source in the lower extremities in 15 (20%) cases. High levels of CRP, fibrinogen, D-dimer, and low platelet count are predictive laboratory markers of unfavorable outcome in patients with severe NCI. © Kalinin R.E., Suchkov I.A., Agapov A.B., Mzhavanadze N.D., Maksaev D.A., Chobanyan A.A., 2022 © Gemostaz i Reologia LLC, 2022.

Thromboses of major arteries and ChAdOx1 nCov-19 vaccination.

This correspondence discussed on published article on "thromboses of major arteries and ChAdOx1 nCov-19 vaccination".

Thromboses and Hemostasis Disorders Associated with COVID-19: The Possible Causal Role of Cross-Reactivity and Immunological Imprinting.

By examining the issue of the thromboses and hemostasis disorders associated with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) through the lens of cross-reactivity, it was found that 60 pentapeptides are shared by SARS-CoV-2 spike glycoprotein (gp) and human proteins that- when altered, mutated, deficient or, however, improperly functioning- cause vascular diseases, thromboembolic complications, venous thrombosis, thrombocytopenia, coagulopathies, and bleeding, inter alia. The peptide commonality has a relevant immunological potential as almost all of the shared sequences are present in experimentally validated SARS-CoV-2 spike gp-derived epitopes, thus supporting the possibility of cross-reactions between the viral gp and the thromboses-related human proteins. Moreover, many of the shared peptide sequences are also present in pathogens to which individuals have previously been exposed following natural infection or vaccinal routes, and of which the immune system has stored imprint. Such an immunological memory might rapidly trigger anamnestic secondary cross-reactive responses of extreme affinity and avidity, in this way explaining the thromboembolic adverse events that can associate with SARS-CoV-2 infection or active immunization.

[Features of pathological anatomy of COVID-19 according to autopsy results in the Volgograd Region]. / Osobennosti patologicheskoi anatomii COVID-19 po rezul'tatam autopsii v Volgogradskoi oblasti.

In connection with the ongoing pandemic of the novel coronavirus infection, the study of its morphopathology and the analysis of autopsy data are relevant. At the same time, attention should be paid to thromboses that play a significant role in the development of fatal outcomes in COVID-19, even taking into account the prescription of anticoagulant therapy to most patients. OBJECTIVE: To make an assessment of morphological changes and a statistical analysis of the structure of mortality in COVID-19 on the basis of autopsy results in the Volgograd Region in 2020. MATERIAL AND METHODS: The study was based on data from «The system for information on the work of the Volgograd Regional Autopsy Bureau¼ with a search for cases according to U07.1 code (the COVID-19 virus was identified) in January 1, 2020, to December 31, 2020, as well as on the autopsy materials of the Volgograd Regional Autopsy Bureau, and microscopic examination with photo fixation. Statistical processing was performed using the R programming language. RESULTS: During the above period, 1119 deaths were identified with a confirmed diagnosis of COVID-19. Anatomopathological examination of the autopsy material showed that 77.54% of cases had blood clots mainly in the vessels of the pulmonary microvasculature, often only in the single veins during the applied anticoagulant therapy.Analysis of variance indicated that the obtained result statistically significantly differed from the random distribution, and the probability of the presence of blood clots of specified localization was 3.17 times higher (CI 2.3-4.4; p<0.05) than their absence, as evidenced by logistic regression. In addition, perivascular and intra-alveolar diapedesis hemorrhages were noted in most fatal cases. CONCLUSION: Thus, this investigation has revealed that the high frequency of thrombosis detected in the presence of perivascular and intra-alveolar diapedesis hemorrhages in COVID-19 confirms the tendency of patients with a severe course of the disease to manifest hemostatic disorders, significant blood vascular endothelial injury, and obvious vascular impermeability.

Cerebral Venous Sinus Thromboses in Patients with SARS-CoV-2 Infection: Three Cases and a Review of the Literature.

INTRODUCTION: Early studies suggest that acute cerebrovascular events may be common in patients with coronavirus disease 2019 (COVID-19) and may be associated with a high mortality rate. Most cerebrovascular events described have been ischemic strokes, but both intracerebral hemorrhage and rarely cerebral venous sinus thrombosis (CVST) have also been reported. The diagnosis of CVST can be elusive, with wide-ranging and nonspecific presenting symptoms that can include headache or altered sensorium alone. OBJECTIVE: To describe the presentation, barriers to diagnosis, treatment, and outcome of CVST in patients with COVID-19. METHODS: We abstracted data on all patients diagnosed with CVST and COVID-19 from March 1 to August 9, 2020 at Boston Medical Center. Subsequently, we reviewed the literature and extracted all published cases of CVST in patients with COVID-19 from January 1, 2020 through August 9, 2020 and included all studies with case descriptions. RESULTS: We describe the clinical features and management of CVST in 3 women with COVID-19 who developed CVST days to months after initial COVID-19 symptoms. Two patients presented with encephalopathy and without focal neurologic deficits, while one presented with visual symptoms. All patients were treated with intravenous hydration and anticoagulation. None suffered hemorrhagic complications, and all were discharged home. We identified 12 other patients with CVST in the setting of COVID-19 via literature search. There was a female predominance (54.5%), most patients presented with altered sensorium (54.5%), and there was a high mortality rate (36.4%). CONCLUSIONS: During this pandemic, clinicians should maintain a high index of suspicion for CVST in patients with a recent history of COVID-19 presenting with non-specific neurological symptoms such as headache to provide expedient management and prevent complications. The limited data suggests that CVST in COVID-19 is more prevalent in females and may be associated with high mortality.

Coronavirus 2019, Microthromboses, and Platelet Activating Factor.

Recent articles have reported elevated markers of coagulation, endothelial injury, and microthromboses in lungs from deceased patients with coronavirus 2019 (COVID-19). Platelets are critical in the formation of thrombi, and their most potent trigger is platelet activating factor (PAF). PAF is produced by cells involved in host defense, and its biological actions bear similarities with COVID-19 disease manifestations, including pulmonary microthromboses and inflammation, possibly via activation of mast cells. The histamine1 receptor antagonist rupatadine was developed to have anti-PAF activity and inhibits activation of human mast cells in response to PAF. Rupatadine could be repurposed for COVID-19 prophylaxis.

[COVID-19: Pathogenesis of a multi-faceted disease]. / COVID-19 : physiopathologie d'une maladie à plusieurs visages.

SARS-CoV-2 infection, named COVID-19, can lead to a dysregulated immune response and abnormal coagulation responsible for a viral sepsis. In this review, we specify physiopathological mechanisms of each phase of COVID-19 - viral, immune and pro-thrombotic - notably because they involve different treatment. Finally, we specify the physiopathological mechanisms of organ injury.