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Al-Mufti F, Amuluru K, Sahni R, Bekelis K, Karimi R, Ogulnick J, Cooper J, Overby P, Nuoman R, Tiwari A, Berekashvili K, Dangayach N, Liang J, Gupta G, Khandelwal P, Dominguez JF, Sursal T, Kamal H, Dakay K, Taylor B, Gulko E, El-Ghanem M, Mayer SA, Gandhi C. Cerebral Venous Thrombosis in COVID-19: A New York Metropolitan Cohort Study. AJNR Am J Neuroradiol 2021; 42:1196-1200. [PMID: 33888450 DOI: 10.3174/ajnr.a7134] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area. MATERIALS AND METHODS We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020. RESULTS Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36-62 years; range, 17-95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%. CONCLUSIONS Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection.
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Affiliation(s)
- F Al-Mufti
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.) .,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Amuluru
- Department of Radiology (K.A.), Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - R Sahni
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Bekelis
- Department of Neurosurgery (K. Bekelis), Catholic Health Services and Good Samaritan Hospital, West Islip, New York
| | - R Karimi
- Department of Neurosurgery (R.K.), Hackensack University Medical Center, Hackensack, New Jersey
| | - J Ogulnick
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - J Cooper
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - P Overby
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - R Nuoman
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - A Tiwari
- Department of Neurosurgery (A.T., K. Berekashvili), New York University, New York, New York
| | - K Berekashvili
- Department of Neurosurgery (A.T., K. Berekashvili), New York University, New York, New York
| | - N Dangayach
- Department of Neurosurgery (N.D., J.L.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Liang
- Department of Neurosurgery (N.D., J.L.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - G Gupta
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - P Khandelwal
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - J F Dominguez
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - T Sursal
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - H Kamal
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Dakay
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - B Taylor
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - E Gulko
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - M El-Ghanem
- Department of Neurology (M.E.-G.), University of Arizona-Tuscon, Tuscon, Arizona
| | - S A Mayer
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - C Gandhi
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
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