Department of Medicine, Aga Khan University, Karachi, Pakistan.
Department of Neurology, Ziauddin University Hospital, Karachi, Pakistan.
Cerebrovasc Dis Extra. 2021;11(2):55-60. doi: 10.1159/000516641. Epub 2021 May 11.
Coronavirus disease 2019 (CO-VID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients.
This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged >18 years) with symptomatic CVT and recent COVID-19 infection.
Twenty patients (70% men) were included. Their mean age was 42.4 years, with a male-to-female ratio of 2.3:1. Headache (85%) and seizures (65%) were the common presenting symptoms, with a mean admission Glasgow Coma Scale (GCS) score of 13. CVT was the presenting feature in 13 cases (65%), while 7 patients (35%) developed CVT while being treated for COVID-19 infection. Respiratory symptoms were absent in 45% of the patients. The most common imaging finding was infarction (65%), followed by hemorrhage (20%). The superior sagittal sinus (65%) was the most common site of thrombosis. Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels. Homocysteine was elevated in half of the tested cases. The mortality rate was 20% (4 patients). A good functional outcome was seen in the surviving patients, with a mean modified Rankin Scale score at discharge of 1.3. Nine patients (45%) had a modified Rankin Scale score of 0-1 at discharge.
COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19-related CVT cases. CVT should be suspected in COVID-19 patients presenting with headache or seizures. Mortality is high, but functional neurological outcome is good among survivors.
2019 年冠状病毒病（COVID-19）具有增加的全身性高凝倾向和血栓栓塞倾向。在这些患者中，已报道与脑血管疾病，特别是脑静脉血栓形成（CVT）有关。本研究的目的是确定 COVID-19 患者中 CVT 的危险因素及其表现和结局。
这是一项多中心和多国家的观察性研究。来自 4 个国家（巴基斯坦、埃及、新加坡和阿拉伯联合酋长国）的 10 个中心参与了这项研究。该研究纳入了有症状性 CVT 和近期 COVID-19 感染的患者（年龄>18 岁）。
共纳入 20 例患者（70%为男性）。他们的平均年龄为 42.4 岁，男女比例为 2.3:1。头痛（85%）和癫痫发作（65%）是常见的首发症状，入院格拉斯哥昏迷量表（GCS）评分平均为 13 分。CVT 是 13 例（65%）患者的首发表现，而 7 例（35%）患者在 COVID-19 感染治疗过程中发生 CVT。45%的患者无呼吸系统症状。最常见的影像学表现为梗死（65%），其次是出血（20%）。最常见的血栓形成部位是上矢状窦（65%）。急性炎症标志物升高，包括血清 D-二聚体升高（87.5%）、红细胞沉降率升高（69%）和 C 反应蛋白升高（47%）。一半的检测病例中同型半胱氨酸升高。死亡率为 20%（4 例）。存活患者的功能结局良好，出院时平均改良 Rankin 量表评分为 1.3。出院时 9 例（45%）患者改良 Rankin 量表评分为 0-1。
与先前报道的非 COVID-19 相关 CVT 病例相比，COVID-19 相关 CVT 更常见于年龄较大的男性。COVID-19 患者出现头痛或癫痫发作时应怀疑 CVT。死亡率高，但幸存者的神经功能结局良好。
