Ahmad Shwan A, Kakamad Fahmi H, Mohamad Hemin S, Salih Bestoon Kh, Mohammed Shvan H, Abdulla Berwn A, Salih Abdulwahid M
Smart Health Tower, Francios Mettarrand Street, Sulaimani, Kurdistan, Iraq.
Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
Ann Med Surg (Lond). 2021 Dec;72:103031. doi: 10.1016/j.amsu.2021.103031. Epub 2021 Nov 10.
Cerebral venous sinus thrombosis (CVST) in the setting of coronavirus disease 2019 (COVID-19) is an uncommon phenomenon with increasing incidence. This study aims to present a rare case of post COVID-19 CVST.
A 58-year-old female presented with headache, nausea, left sided weakness, and slurred speech. She recently recovered from COVID-19 who had severe presentations. On examination, mild left central facial palsy, high grade left sided hemiparesis (Grade 2/5), positive Babinski on left side, left side hypoesthesia, and inability to walk were observed. Laboratory and ultrasound findings were not significant, however magnetic resonance imaging (MRI) revealed CVST. The patient was prescribed Clexane 6000 IU twice daily, and after 14 days, it was changed to warfarin with an INR between 2 and 3. After 3 weeks of treatment, the patient was able to walk, and after 3 months her warfarin medication was discontinued.
COVID-19 has been reported to be linked with CVST, however there is limited information about it. The exact figures regarding the affected groups and incidence rates are highly controversial. The diagnosis of CVST poses a challenge to physicians as their symptoms are highly unspecific, hence MRI is required for definitive diagnosis. Anticoagulant is commonly used in their treatment; however, the ideal anticoagulant of choice and the management duration are yet to be known.
Active or recently resolved COVID-19 can be considered as an independent risk factor for developing CVST and it rises the mortality rate of the disease.
2019冠状病毒病（COVID-19）背景下的脑静脉窦血栓形成（CVST）是一种发病率不断上升的罕见现象。本研究旨在介绍一例COVID-19后CVST的罕见病例。
一名58岁女性出现头痛、恶心、左侧肢体无力和言语含糊不清。她最近从有严重症状的COVID-19中康复。检查发现轻度左侧中枢性面瘫、左侧重度偏瘫（2/5级）、左侧巴宾斯基征阳性、左侧感觉减退以及无法行走。实验室检查和超声检查结果无明显异常，但磁共振成像（MRI）显示存在CVST。患者被处方每日两次皮下注射6000 IU克赛，14天后改为华法林，国际标准化比值（INR）维持在2至3之间。经过3周治疗，患者能够行走，3个月后停用华法林。
据报道，COVID-19与CVST有关，但相关信息有限。关于受影响人群和发病率的确切数据极具争议性。CVST的诊断对医生构成挑战，因为其症状非常不具特异性，因此确诊需要MRI检查。抗凝剂常用于其治疗；然而，理想的抗凝剂选择和治疗持续时间尚不清楚。
活跃期或近期康复的COVID-19可被视为发生CVST的独立危险因素，且会增加该病的死亡率。
