Guendouz Cécile, Quenardelle Véronique, Riou-Comte Nolwenn, Welfringer Pascal, Wolff Valérie, Zuily Stéphane, Jager Lavinia, Humbertjean Selton Lisa, Mione Gioia, Pop Raoul, Gory Benjamin, Richard Sébastien
Department of Neurology, Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERMU1116, Nancy.
Stroke Unit, Strasbourg University Hospital, EA3072, Strasbourg.
Medicine (Baltimore). 2021 Mar 12;100(10):e24708. doi: 10.1097/MD.0000000000024708.
Pathogeny of thrombosis in COVID-19 is related to interaction of SARS-Cov-2 with vascular wall through the angiotensin converting enzyme 2 (ACE2) receptor. This induces 2 pathways with immunothrombosis from activated endothelium (cytokine storm, leukocyte and platelet recruitment, and activation of coagulation extrinsic pathway), and rise of angiotensin II levels promoting inflammation. While thrombosis is widely described in COVID-19 patients admitted in intensive care unit, cerebrovascular diseases remains rare, in particular cerebral venous thrombosis (CVT).
We describe 2 cases of women admitted during the spring of 2020 for intracranial hypertension signs, in stroke units in Great-east, a French area particularly affected by COVID-19 pandemia.
Cerebral imaging revealed extended CVT in both cases. The first case described was more serious due to right supratentorial venous infarction with hemorrhagic transformation leading to herniation. Both patients presented typical pneumonia due to SARS-Cov-2 infection, confirmed by reverse transcription polymerase chain reaction on a nasopharyngeal swab in only one.
The first patient had to undergo decompressive craniectomy, and both patients were treated with anticoagulation therapy.
Favorable outcome was observed for 1 patient. Persistent coma, due to bi thalamic infarction, remained for the other with more serious presentation.
CVT, as a serious complication of COVID-19, has to be searched in all patients with intracranial hypertension syndrome. Data about anticoagulation therapy to prevent such serious thrombosis in SARS-Cov-2 infection are lacking, in particular in patients with mild and moderate COVID-19.
2019年冠状病毒病（COVID-19）中血栓形成的发病机制与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）通过血管紧张素转换酶2（ACE2）受体与血管壁的相互作用有关。这通过激活的内皮细胞引发了两条免疫血栓形成途径（细胞因子风暴、白细胞和血小板募集以及凝血外源性途径的激活），并导致血管紧张素II水平升高，从而促进炎症反应。虽然在入住重症监护病房的COVID-19患者中血栓形成的情况被广泛描述，但脑血管疾病仍然罕见，尤其是脑静脉血栓形成（CVT）。
我们描述了2例于2020年春季因颅内高压症状入住法国大东部地区卒中单元的女性病例，该地区尤其受到COVID-19大流行的影响。
脑部影像学检查显示两例均为广泛性CVT。所描述的第一例病情更严重，因右侧幕上静脉梗死伴出血性转化导致脑疝形成。两名患者均表现为典型的由SARS-CoV-2感染引起的肺炎，仅其中一例通过鼻咽拭子逆转录聚合酶链反应得以确诊。
首例患者不得不接受减压性颅骨切除术，两名患者均接受了抗凝治疗。
1例患者预后良好。另1例病情更严重，因双侧丘脑梗死持续昏迷。
对于所有患有颅内高压综合征的患者，都必须排查CVT这一COVID-19的严重并发症。目前缺乏关于抗凝治疗以预防SARS-CoV-2感染中此类严重血栓形成的数据，尤其是在轻症和中症COVID-19患者中。
