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Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review.
Tu, Tian Ming; Goh, Claire; Tan, Ying Kiat; Leow, Aloysius St; Pang, Yu Zhi; Chien, Jaime; Shafi, Humaira; Chan, Bernard Pl; Hui, Andrew; Koh, Jasmine; Tan, Benjamin Yq; Umapathi, N Thirugnanam; Yeo, Leonard Ll.
  • Tu TM; Department of Neurology, National Neuroscience Institute, Singapore.
  • Goh C; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Tan YK; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
  • Leow AS; Division of Neurology, Department of Medicine, National University Health System, Singapore.
  • Pang YZ; Department of Neurology, National Neuroscience Institute, Singapore.
  • Chien J; Department of Neurology, National Neuroscience Institute, Singapore.
  • Shafi H; Department of Neurology, National Neuroscience Institute, Singapore.
  • Chan BP; Division of Neurology, Department of Medicine, National University Health System, Singapore.
  • Hui A; Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore.
  • Koh J; Department of Neurology, National Neuroscience Institute, Singapore.
  • Tan BY; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore.
  • Umapathi NT; Department of Neurology, National Neuroscience Institute, Singapore.
  • Yeo LL; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Health System, Singapore. Electronic address: leonard_ll_yeo@nuhs.edu.sg.
J Stroke Cerebrovasc Dis ; 29(12): 105379, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-816739
ABSTRACT

BACKGROUND:

There 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.

OBJECTIVE:

We 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.

METHODS:

We 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.

RESULTS:

Nine 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%.

CONCLUSIONS:

The 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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Sinus Thrombosis, Intracranial / Venous Thrombosis / COVID-19 Type of study: Case report / Diagnostic study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2020 Document Type: Article Affiliation country: J.jstrokecerebrovasdis.2020.105379

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Sinus Thrombosis, Intracranial / Venous Thrombosis / COVID-19 Type of study: Case report / Diagnostic study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Female / Humans / Male / Middle aged Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2020 Document Type: Article Affiliation country: J.jstrokecerebrovasdis.2020.105379