Post COVID19 cerebral venous thrombosis

Case contribution: Dr Radhiana Hassan


  • 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)
MR venography showing absent signal of superior sagittal sinus to right sigmoid

Diagnosis: Cerebral venous thrombosis


  • 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.
Author: radhianahassan