Sitanggang Prysta Aderlia, Tini Kumara, Susilawathi Ni Made, Wijayanti Ida Ayu Sri, Dewi Putu Utami, Samatra Dewa Putu Gde Purwa
Departement of Neurology, Udayana University, Sanglah General Hospital, Jalan Kesehatan No.1, Denpasar, Bali Indonesia.
Department of Neurology, Faculty of Medicine, Universitas Udayana, Universitas Udayana Hospital, Jalan Rumah Sakit Universitas Udayana No.1, Jimbaran, South Kuta, Bali Badung, Indonesia.
Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):83. doi: 10.1186/s41983-021-00335-y. Epub 2021 Jun 29.
Coronavirus disease 2019 (COVID-19) pandemic has started in December 2019 and still ongoing. The disease has been expanding rapidly with a high variety of phenotypes from asymptomatic, mild respiratory tract infection, multiple organ system dysfunction, and death. Neurological manifestations also appear in patients with COVID-19, such as headache, seizures, a decrease of consciousness, and paralysis. The hypercoagulable state in patients with COVID-19 is associated with the thromboembolic incident including ischemic strokes, venous thromboembolism, pulmonary artery embolism, and many further. Cerebral sinus venous thrombosis (CSVT) is a rare neurovascular emergency that is often found in critically ill patients. We report two cases of CSVT with different onsets, neurologic manifestations, and prognoses.
Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory, hematology, and coagulation disarrangements, which was triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The first patient, which was presented with a seizure, had hypertension and diabetes mellitus as comorbidities. The latter case had no comorbidity but showed more severe presentations of COVID-19 such as brain and lung thrombosis, although already had several days of intravenous anticoagulant administrations. These two cases also have a different course of disease and outcomes, which were interesting topics to study.
CSVT is one of the neurological complications of the COVID-19 when the brainstem venous drainage is involved. Despite successful alteration to the negative result of SARS-CoV-2 through the rt-PCR test, thrombogenesis and coagulation cascade continuing. Therefore, a high level of neutrophil to lymphocyte ratio (NLR), D-dimer, fibrinogen, and C-reactive protein (CRP) are paramount indicators of poor prognosis.
2019年冠状病毒病（COVID-19）大流行于2019年12月开始，目前仍在持续。该疾病一直在迅速蔓延，具有多种表型，从无症状、轻度呼吸道感染、多器官系统功能障碍到死亡。COVID-19患者也会出现神经学表现，如头痛、癫痫发作、意识减退和瘫痪。COVID-19患者的高凝状态与血栓栓塞事件有关，包括缺血性中风、静脉血栓栓塞、肺动脉栓塞等。脑静脉窦血栓形成（CSVT）是一种罕见的神经血管急症，常见于重症患者。我们报告了两例CSVT病例，其发病、神经学表现和预后各不相同。
报告了两例COVID-19患者的脑静脉窦血栓形成病例，继呼吸、血液学和凝血紊乱之后，由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染引发。首例患者出现癫痫发作，合并高血压和糖尿病。后一例患者无合并症，但表现出更严重的COVID-19症状，如脑和肺血栓形成，尽管已经进行了数天的静脉抗凝治疗。这两例病例的病程和结局也不同，是值得研究的有趣课题。
当脑干静脉引流受累时，CSVT是COVID-19的神经并发症之一。尽管通过逆转录聚合酶链反应（rt-PCR）检测成功转为SARS-CoV-2阴性结果，但血栓形成和凝血级联仍在继续。因此，高比例的中性粒细胞与淋巴细胞比值（NLR）、D-二聚体、纤维蛋白原和C反应蛋白（CRP）是预后不良的关键指标。
