Case contribution: Dr Radhiana Hassan
Clinical:
- A 36 years old lady
- No known medical illness
- Recently had Covid-19 Category 2
- Presented with severe headache, not relieved by analgesic
- No fever, no history of trauma
- No body weakness
- Clinical examination shows no neurological deficit
MRI findings:
- Extensive filling defects are seen in the superior sagittal sinus, straight sinus, transverse sinus and right sigmoid sinus
- The thrombus are hyperintense on T1WI and T2WI in keeping with late subacute blood product
- Minimal subarachnoid hemorrhage is seen at posterior parietal region (images not shown)
Diagnosis: Cerebral venous thrombosis
Discussion:
- Numerous factors are related to cerebral venous thrombosis (CVT), including the use of oral contraceptives, pregnancy, and puerperium, which produce transient prothrombotic states.
- Diabetes mellitus, systemic inflammatory disease, cancer, hematologic disorders, head and neck infections, and CNS infections and hyperhomocysteinemia are other significant causes.
- With recent COVID19 pandemic, increasing cases of thrombosis also seen in these cases.
- SARS-CoV-2, responsible for COVID-19 infection, is known to bind angiotensin-converting enzyme (ACE) 2 receptors, which are variably present in the arterial and venous vascular endothelium which explains the high frequency of arterial stroke in these patients.
- COVID-19 not only causes direct vascular damage but may also create an intense inflammatory reaction affecting hemostasis and the coagulation cascade.
- These findings may suggest a common pathway for both COVID-19-associated CVT and arterial stroke.
