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Abdalkader M, Shaikh SP, Siegler JE, Cervantes-Arslanian AM, Tiu C, Radu RA, Tiu VE, Jillella DV, Mansour OY, Vera V, Chamorro Á, Blasco J, López A, Farooqui M, Thau L, Smith A, Gutierrez SO, Nguyen TN, Jovin TG. Cerebral Venous Sinus Thrombosis in COVID-19 Patients: A Multicenter Study and Review of Literature. J Stroke Cerebrovasc Dis 2021; 30:105733. [PMID: 33743411 PMCID: PMC7931726 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105733] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 infection has been known to predispose patients to both arterial and venous thromboembolic events such as deep venous thrombosis, pulmonary embolism, myocardial infarction, and stroke. A few reports from the literature suggest that Cerebral Venous Sinus Thrombosis (CVSTs) may be a direct complication of COVID-19. OBJECTIVE To review the clinical and radiological presentation of COVID-19 positive patients diagnosed with CVST. METHODS This was a multicenter, cross-sectional, retrospective study of patients diagnosed with CVST and COVID-19 reviewed from March 1, 2020 to November 8, 2020. We evaluated their clinical presentations, risk factors, clinical management, and outcome. We reviewed all published cases of CVST in patients with COVID-19 infection from January 1, 2020 to November 13, 2020. RESULTS There were 8 patients diagnosed with CVST and COVID-19 during the study period at 7 out of 31 participating centers. Patients in our case series were mostly female (7/8, 87.5%). Most patients presented with non-specific symptoms such as headache (50%), fever (50%), and gastrointestinal symptoms (75%). Several patients presented with focal neurologic deficits (2/8, 25%) or decreased consciousness (2/8, 25%). D-dimer and inflammatory biomarkers were significantly elevated relative to reference ranges in patients with available laboratory data. The superior sagittal and transverse sinuses were the most common sites for acute CVST formation (6/8, 75%). Median time to onset of focal neurologic deficit from initial COVID-19 diagnosis was 3 days (interquartile range 0.75-3 days). Median time from onset of COVID-19 symptoms to CVST radiologic diagnosis was 11 days (interquartile range 6-16.75 days). Mortality was low in this cohort (1/8 or 12.5%). CONCLUSIONS Clinicians should consider the risk of acute CVST in patients positive for COVID-19, especially if neurological symptoms develop.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA.
| | - Shamsh P Shaikh
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA
| | - James E Siegler
- Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Anna M Cervantes-Arslanian
- Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA; Department of Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Cristina Tiu
- Department of Neurology, Elias University Emergency Hospital, Bucharest, Romania
| | | | - Vlad Eugen Tiu
- Department of Neurology, Elias University Emergency Hospital, Bucharest, Romania
| | - Dinesh V Jillella
- Department of Neurology, Emory University Hospital, Atlanta, Georgia, USA
| | - Ossama Yassin Mansour
- Department of Neurology, Alexandria University School of Medicine, Alexandria, Egypt
| | - Víctor Vera
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Ángel Chamorro
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Blasco
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Antonio López
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Lauren Thau
- Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Ainsley Smith
- Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Thanh N Nguyen
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA; Department of Neurology, Boston Medical Center, Boston, Massachusetts, USA; Department of Neurology, Cooper University Hospital, Camden, New Jersey, USA
| | - Tudor G Jovin
- Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA
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Zhang JH, Obenaus A, Liebeskind DS, Tang J, Hartman R, Pearce WJ. Recanalization, reperfusion, and recirculation in stroke. J Cereb Blood Flow Metab 2017; 37:3818-3823. [PMID: 28925323 PMCID: PMC5718333 DOI: 10.1177/0271678x17732695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recirculation, from arterial inflow routes through venous outflow pathways, was conceptualized in stroke research 50 years ago. As new technologies were developed, blocked arteries could be reopened, capillaries could be reperfused, and the use of recanalization and reperfusion grew to dominate therapeutic strategies. These approaches overwhelmingly focused on restoration of arterial and capillary inflow, but not on veins even though venous disorders may initiate or exacerbate brain injury. In this commentary, we advance the term "recirculation" after "recanalization" and "reperfusion" as a primary concept of stroke pathophysiology that targets the restoration of both the arterial and venous cerebral circulations.
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Affiliation(s)
- John H Zhang
- 1 Center for Neuroscience Research, 4608 Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Andre Obenaus
- 1 Center for Neuroscience Research, 4608 Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - David S Liebeskind
- 2 Neurovascular Imaging Research Core and Department of Neurology, UCLA, CA, USA
| | - Jiping Tang
- 1 Center for Neuroscience Research, 4608 Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Richard Hartman
- 1 Center for Neuroscience Research, 4608 Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - William J Pearce
- 1 Center for Neuroscience Research, 4608 Loma Linda University School of Medicine, Loma Linda, CA, USA
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