Case Report
Cerebral venous thrombosis: Atypical presentation of COVID-19 in the young

https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104989Get rights and content

Abstract

Objective

Identify clinical and radiographic features of venous infarct as a presenting feature of COVID-19 in the young.

Background

SARS-CoV-2 infection causes hypercoagulability and inflammation leading to venous thrombotic events (VTE). Although elderly patients with comorbidities are at higher risk, COVID-19 may also cause VTE in a broader patient population without these risks. Neurologic complications and manifestations of COVID-19, including neuropathies, seizures, strokes and encephalopathy usually occur in severe established cases of COVID-19 infection who primarily present with respiratory distress.

Case description

Case report of a 29-year-old woman, with no significant past medical history or comorbidities, presenting with new onset seizures. Further questioning revealed a one-week history of headaches, low-grade fever, mild cough and shortness of breath, diagnosed as COVID-19. Imaging revealed a left temporoparietal hemorrhagic venous infarction with left transverse and sigmoid sinus thrombosis treated with full dose anticoagulation and antiepileptics.

Conclusion

Although elderly patients with comorbidities are considered highest risk for COVID-19 neurologic complications, usually when systemic symptoms are severe, this case report emphasizes that young individuals are at risk for VTE with neurologic complications even when systemic symptoms are mild, likely induced by COVID-19 associated hypercoagulable state.

Key words

Cerebral venous thrombosis (CVT)
COVID-19
Venous thrombotic events (VTE)
Stroke in young

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