Cerebral Venous Thrombosis and COVID-19: a Case Report and Review of the Literature

Abstract

Background—Cerebral venous thrombosis (CVT) involves thrombosis of intracranial veins largely
attributed to known hypercoagulable risk factors, including oral contraceptives, pregnancy, and various
hypercoagulable states. Hypercoagulability related to the extreme systemic inflammatory state of coronavi‐
rus disease 2019 (COVID-19) patients has resulted in both systemic and intracranial arterial thrombotic
events. Cerebral venous thrombosis, as a manifestation of the cytokine storm and hypercoagulable state
seen in COVID-19, has not been reported in North American literature till date and is important to recog‐
nize as a potential complication.
Case Description—We describe a 24 year-old woman in puerperium with several days of worsening
headache with subsequent development of left-sided hemiparesis who had extensive CVT involving dural
venous sinuses and cortical veins. She was found to have streaky bibasilar opacities on chest radiography,
and COVID-19 was confirmed based on the polymerase chain reaction. She tested positive for beta-2-gly‐
coprotein 1 IgM positive, but otherwise no abnormalities were identified on hypercoagulable work-up. She
underwent systemic heparinization along with endovascular treatment with direct pharmacologic thrombol‐
ysis and mechanical thrombectomy. She experienced in-hospital resolution of her symptoms and was sub‐
sequently discharged home.
Conclusion—CVT is another sequelae of COVID-19 that requires recognition at time of patient evaluation.