Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA.
Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA.
J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105412. doi: 10.1016/j.jstrokecerebrovasdis.2020.105412. Epub 2020 Oct 19.
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.
To describe the presentation, barriers to diagnosis, treatment, and outcome of CVST in patients with COVID-19.
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.
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%).
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.
早期研究表明，2019 年冠状病毒病（COVID-19）患者可能会发生急性脑血管事件，且死亡率较高。大多数描述的脑血管事件为缺血性脑卒中，但也有报道同时发生颅内出血和罕见的脑静脉窦血栓形成（CVST）。CVST 的诊断可能难以捉摸，其临床表现广泛且无特异性，仅表现为头痛或意识改变。
描述 COVID-19 患者 CVST 的表现、诊断障碍、治疗和结局。
我们从 2020 年 3 月 1 日至 8 月 9 日在波士顿医疗中心提取所有诊断为 CVST 和 COVID-19 的患者的数据。随后，我们回顾了文献，并从 2020 年 1 月 1 日至 8 月 9 日提取了 COVID-19 患者中所有发表的 CVST 病例，并纳入了所有有病例描述的研究。
我们描述了 3 例 COVID-19 女性患者的 CVST 临床特征和治疗方法，这 3 例患者在 COVID-19 初始症状出现后数天至数月出现 CVST。2 例患者表现为脑病且无局灶性神经功能缺损，1 例患者表现为视觉症状。所有患者均接受静脉补液和抗凝治疗。无出血性并发症，所有患者均出院回家。通过文献检索，我们共发现了 12 例 COVID-19 合并 CVST 的患者。女性占主导地位（54.5%），大多数患者表现为意识改变（54.5%），死亡率较高（36.4%）。
在此次大流行期间，对于有近期 COVID-19 病史、表现为头痛等非特异性神经系统症状的患者，临床医生应保持对 CVST 的高度警惕，以便及时进行治疗并预防并发症。有限的数据表明，COVID-19 合并 CVST 在女性中更为常见，且可能与高死亡率相关。
