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Case Report

Diagnostic and Therapeutic Challenges of Cerebral Venous Thrombosis in SARS-CoV-2 Infection: A Case Report and Review of Literature

1
Neurology, College of Osteopathic Medicine, Sam Houston State University, Huntsville, TX 77340, USA
2
Neurology, Houston Medical Clerkship, Sugar Land, TX 77478, USA
3
School of Medicine, Caribbean Medical University, 4797 Willemstad, Curaçao
*
Author to whom correspondence should be addressed.
Clin. Pract. 2021, 11(3), 598-606; https://doi.org/10.3390/clinpract11030075
Received: 17 July 2021 / Revised: 17 August 2021 / Accepted: 27 August 2021 / Published: 7 September 2021
Headache, a common prodromal symptom of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can also be a manifestation of cerebral venous thrombosis (CVT), secondary to COVID-19. CVT management continues to evolve, with direct oral anticoagulants (DOACs) emerging as an alternative to warfarin. A 44-year-old Asian female, with no past medical history, presented to the emergency room (ER) with complaints of nonproductive cough and left-sided headache. She denied a history of COVID-19 vaccination, and SARS-CoV-2 testing (with reverse transcriptase-polymerase chain reaction) was positive. Non-contrast computed tomography (CT) of the head revealed left transverse sinus hyperdensity, consistent with dense vein sign, and magnetic resonance venography (MRV) confirmed the presence of thrombus. The initial treatment included subcutaneous enoxaparin with headache resolution, and she was discharged on apixaban. Five weeks later, a non-contrast head CT showed resolution of the dense vein sign and recanalisation of left transverse sinus was seen on MRV. This report has highlighted the need for increased awareness of coagulopathy and thrombotic events, including cerebral venous thrombosis, in patients infected with SARS-CoV-2. Unremitting headache, in context of SARS-CoV-2 infection, should be evaluated with appropriate neurovascular imaging. Controlled studies are required to compare the safety and efficacy of DOACs with warfarin for management of cerebral venous thrombosis. View Full-Text
Keywords: COVID-19; severe acute respiratory syndrome coronavirus; anticoagulants; case report; cerebral venous thrombosis; brain ischemia COVID-19; severe acute respiratory syndrome coronavirus; anticoagulants; case report; cerebral venous thrombosis; brain ischemia
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MDPI and ACS Style

Khan, F.; Sharma, N.; Ud Din, M.; Chetram, R. Diagnostic and Therapeutic Challenges of Cerebral Venous Thrombosis in SARS-CoV-2 Infection: A Case Report and Review of Literature. Clin. Pract. 2021, 11, 598-606. https://doi.org/10.3390/clinpract11030075

AMA Style

Khan F, Sharma N, Ud Din M, Chetram R. Diagnostic and Therapeutic Challenges of Cerebral Venous Thrombosis in SARS-CoV-2 Infection: A Case Report and Review of Literature. Clinics and Practice. 2021; 11(3):598-606. https://doi.org/10.3390/clinpract11030075

Chicago/Turabian Style

Khan, Faisal, Neha Sharma, Moin Ud Din, and Ryan Chetram. 2021. "Diagnostic and Therapeutic Challenges of Cerebral Venous Thrombosis in SARS-CoV-2 Infection: A Case Report and Review of Literature" Clinics and Practice 11, no. 3: 598-606. https://doi.org/10.3390/clinpract11030075

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