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2.
Neonatology ; 119(2): 268-272, 2022.
Article in English | MEDLINE | ID: covidwho-1714478

ABSTRACT

A possible consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is the development of an exacerbated thrombophilic status, and cerebral venous thrombosis (CVT) is a rare but possible complication of SARS-CoV-2 infection reported both in adults and in children. The present case report describes the clinical course of a term neonate showing extended CVT of unclear origin, whose mother had developed SARS-CoV-2 infection during the third trimester of pregnancy. We speculate that the prothrombotic status induced by maternal SARS-CoV-2 infection may have played a pathophysiological role in the development of such severe neonatal complication. Further investigations are required to confirm such hypothesis.


Subject(s)
COVID-19 , Intracranial Thrombosis , Pregnancy Complications, Infectious , Venous Thrombosis , Adult , COVID-19/complications , Child , Family , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/etiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Outcome , SARS-CoV-2 , Venous Thrombosis/complications
3.
Neurol Sci ; 43(5): 2951-2956, 2022 May.
Article in English | MEDLINE | ID: covidwho-1712255

ABSTRACT

BACKGROUND: The coronavirus pandemic became the hard challenge for the modern global health system. To date, vaccination is the best strategy against Sars-Cov-2-related illness. About 3 billions of people received at least one of the approved vaccines. The related adverse events were reported during the various experimental phases, but newer and less common side effects are emerging post-marketing. Vaccine-induced thrombocytopenia with thrombosis (VITT) is one of these insidious adverse reactions and it is considered responsible of venous thrombosis, in both the splanchnic and the cerebral circulation. Although its mechanism has been presumably established, resembling that observed in heparin-induced thrombocytopenia, some venous thromboses seem not to recognize this etiology and their pathogenesis remains unknown. Here we described a case of cerebral venous thrombosis after administration of the Ad26.COV2.S, presenting without thrombocytopenia, paving the way for possible novel causes of this vaccine-induced pathological condition. CASE PRESENTATION: A 45-year-old woman came to our observation for bilateral periorbital headache associated with retro-orbital pain started 8 days after administration of COVID vaccine Jannsen. Ophthalmologic exam showing a bilateral papilledema raised the suspicion of intracranial hypertension. Cerebral magnetic resonance imaging revealed signal alteration with T1-positive contrast enhancement in the right temporal and insular lobes suggestive of cerebral venous thrombosis. The absence of thrombocytopenia and platelet factor 4 (PF-4) antibodies led the clinicians to rule out VITT. The patient was treated successfully with warfarin. CONCLUSION: Venous thrombosis occurring after COVID-19 vaccination represents an adverse event of special interest. Patients with thrombosis and thrombocytopenia appear to be affected by a general thrombophilic state, sustained by an autoimmune mechanism, and show a higher mortality. Thrombosis without thrombocytopenia's pathogenesis has not yet been clarified, but laboratory data and good response to vitamin K antagonists help clinicians in the differential diagnosis with VITT. Future research will allow us to discover other possible mechanisms and maybe identify a subgroup of patients with a higher risk of developing this medical complication.


Subject(s)
COVID-19 , Intracranial Thrombosis , Thrombocytopenia , Thrombosis , Vaccines , Venous Thrombosis , COVID-19/complications , COVID-19 Vaccines/adverse effects , Female , Headache/complications , Humans , Intracranial Thrombosis/chemically induced , Intracranial Thrombosis/diagnostic imaging , Middle Aged , SARS-CoV-2 , Thrombocytopenia/chemically induced , Thrombocytopenia/diagnosis , Thrombosis/complications , Vaccines/adverse effects , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Venous Thrombosis/etiology
6.
BMJ Case Rep ; 14(6)2021 Jun 15.
Article in English | MEDLINE | ID: covidwho-1270883

ABSTRACT

Isolated cortical vein thrombosis (ICVT) is a rare entity and accounts for only 6.3% of cerebral venous and sinus thrombosis. ICVT is an uncommon cause of seizures in young adults. We present a 27-year-old man with no medical history who presented with dizziness, loss of consciousness and a seizure-like episode. The patient was found to have an elevated D-dimer and brain imaging revealed ICVT. The patient was started on anticoagulation and antiseizure medications. A high index of suspicion for uncommon aetiologies for new-onset seizure, especially in the young, is key to accurate diagnosis of ICVT. Evaluation and work-up should include detailed physical examination, along with appropriate brain imaging and testing for other conditions that predispose venous thrombosis. In the setting of the SARS-CoV-2 pandemic, testing for COVID-19 may also be warranted. Rapid diagnosis and full anticoagulation can help avoid debilitating complications and long-term sequelae.


Subject(s)
COVID-19 , Cerebral Veins , Intracranial Thrombosis , Venous Thrombosis , Adult , COVID-19 Testing , Cerebral Veins/diagnostic imaging , Humans , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/drug therapy , Male , SARS-CoV-2 , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Young Adult
7.
Tidsskr Nor Laegeforen ; 140(18)2020 12 15.
Article in Norwegian | MEDLINE | ID: covidwho-1117720

ABSTRACT

BACKGROUND: There is emerging evidence of an increased risk of venous thromboembolism as well as several reports of cerebral venous thrombosis in COVID-19. CASE PRESENTATION: A previously healthy man in his fifties was admitted due to sudden confusion and reduced consciousness. One month earlier the patient had symptoms with headache, fever, dry cough, vomiting and diarrhoea and reduced sense of taste and smell. He was diagnosed with COVID-19 and the symptoms were mainly resolved within three weeks. On admission the patient was disorientated with aphasia. Brain imaging revealed a haemorrhagic infarction in the left temporal lobe due to thrombosis of the left transverse sinus and low-molecular weight heparin was instituted. On follow-up four months later, there was clinical improvement with only slight problems with short term memory and concentration. INTERPRETATION: This case illustrates the risk of serious neurological complications due to cerebral venous thrombosis in COVID-19.


Subject(s)
COVID-19/complications , Intracranial Thrombosis/virology , Venous Thrombosis/virology , Brain/diagnostic imaging , Humans , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/drug therapy , Male , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy
8.
Am J Case Rep ; 22: e927011, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-1005105

ABSTRACT

BACKGROUND Pandemic coronavirus disease 2019 (COVID-19) originated in Wuhan, China, and is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Severe respiratory symptoms are a hallmark of the disease, which may also include complications related to a hypercoagulable state and central nervous system involvement. These complications can occur during either the acute or the recovery phase. The cerebral involvement typically manifests as intracranial hypertension, intracerebral hemorrhage, diffuse encephalopathy, or cerebral venous thrombosis. The hemorrhagic form of cerebral venous thrombosis can be a diagnostic challenge and is treated by anticoagulation therapy, despite the existence of an intracerebral hemorrhage. This report describes a case of superficial cerebral venous thrombosis and intracerebral hematoma in a 48-year-old man weeks after recovering from the acute phase of SARSCoV-2 infection. CASE REPORT A 48-year-old man with a past medical history of SARS-CoV-2 infection confirmed by SARS-CoV-2 reverse-transcription polymerase chain reaction presented with left upper-limb numbness, weakness, and impaired positional sensorium. After initial stabilization, noncontrast computerized tomography and magnetic resonance imaging confirmed an intracerebral hemorrhage with underlying cerebral venous thrombosis. The patient was successfully treated with enoxaparin anticoagulation therapy, and symptoms improved over the following 12 days. CONCLUSIONS Central nervous system venous thrombosis is an atypical presentation of the hypercoagulable state primarily seen in younger patients, and it can occur in a delayed fashion after recovery from mild forms of COVID-19.


Subject(s)
COVID-19/complications , Cerebral Hemorrhage/diagnostic imaging , Hematoma/diagnostic imaging , Intracranial Thrombosis/diagnostic imaging , Venous Thrombosis/diagnostic imaging , Anticoagulants/therapeutic use , Cerebral Hemorrhage/virology , Enoxaparin/therapeutic use , Hematoma/virology , Humans , Intracranial Thrombosis/drug therapy , Intracranial Thrombosis/virology , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray Computed , Venous Thrombosis/drug therapy , Venous Thrombosis/virology
9.
J Stroke Cerebrovasc Dis ; 29(12): 105353, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-796759

ABSTRACT

Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Neurological manifestations related to COVID-19, including acute ischemic Stroke (AIS), have been reported in recent studies. In most of these, the patients are older, have multiple co-morbidities as risk factors for AIS and have developed a severe respiratory illness. Herein, we report a 36-year-old man with no significant past medical history who recently recovered from a mild COVID-19 infection and presented with unusual pattern of arterial macrothrombosis causing AIS. When the AIS happened, he had no COVID-19 related symptoms, had two negative screening tests for the infection and his chest CT was unremarkable.


Subject(s)
Brain Ischemia/etiology , COVID-19/complications , Carotid Stenosis/etiology , Intracranial Thrombosis/etiology , Stroke/etiology , Adult , Age Factors , Anticoagulants/administration & dosage , Brain Ischemia/diagnostic imaging , Brain Ischemia/therapy , COVID-19/diagnosis , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/therapy , Heparin/administration & dosage , Humans , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/therapy , Male , Stroke/diagnostic imaging , Stroke/therapy , Thrombectomy , Time Factors , Treatment Outcome
13.
Eur J Neurol ; 27(11): 2308-2311, 2020 11.
Article in English | MEDLINE | ID: covidwho-697171

ABSTRACT

BACKGROUND AND PURPOSE: Ischaemic stroke has been described in association with COVID-19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS-CoV-2 infection and underlying atherosclerotic lesions. METHODS: A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS-CoV-2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île-de France area, France. RESULTS: The median age was 52 years, median body mass index was 29.5 kg/m2 . All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID-19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non-stenosing atheroma, after an etiological workup based on angio-computed tomography or magnetic resonance imaging and/or cervical echography. CONCLUSION: Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID-19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.


Subject(s)
Atherosclerosis/complications , COVID-19/complications , Intracranial Thrombosis/etiology , Ischemic Stroke/etiology , Arterial Occlusive Diseases/etiology , Atherosclerosis/diagnostic imaging , COVID-19/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Female , Humans , Intracranial Thrombosis/complications , Intracranial Thrombosis/diagnostic imaging , Ischemic Stroke/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Risk Factors , Tomography, X-Ray Computed
14.
J Clin Neurosci ; 79: 30-32, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-665630

ABSTRACT

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.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Intracranial Thrombosis/etiology , Pneumonia, Viral/complications , Venous Thrombosis/etiology , COVID-19 , Fibrin Fibrinogen Degradation Products/analysis , Heparin/therapeutic use , Humans , Intracranial Thrombosis/diagnostic imaging , Intracranial Thrombosis/drug therapy , Magnetic Resonance Imaging , Male , Middle Aged , Pandemics , Pyridines/therapeutic use , SARS-CoV-2 , Thiazoles/therapeutic use , Tomography, X-Ray Computed , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy
16.
AJNR Am J Neuroradiol ; 41(8): 1377-1379, 2020 08.
Article in English | MEDLINE | ID: covidwho-608375

ABSTRACT

There is growing evidence that Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has a neurotropic and neuroinvasive potential. In particular, neurologic complications associated with the infection by SARS-CoV-2 include strokes that may result from a dysregulated inflammatory response to the infection. We report an atypical deep cerebral vein thrombosis complicated with hemorrhagic venous infarction in a patient positive for SARS-CoV-2 with no risk factors for thrombosis.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Intracranial Hemorrhages/etiology , Intracranial Thrombosis/etiology , Pneumonia, Viral/complications , Venous Thrombosis/etiology , Aged , COVID-19 , Humans , Intracranial Hemorrhages/diagnostic imaging , Intracranial Thrombosis/diagnostic imaging , Magnetic Resonance Imaging , Male , Multimodal Imaging , Pandemics , SARS-CoV-2 , Tomography, X-Ray Computed , Venous Thrombosis/diagnostic imaging
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