Background

: There has been increasing reports associating the coronavirus disease 2019 (COVID-19) with thromboembolic phenomenon including ischemic strokes and venous thromboembolism. Cerebral venous thrombosis (CVT) is a rare neurovascular emergency that has been observed in some COVID-19 patients, yet much remains to be learnt of its underlying pathophysiology.

Objective

: We present a case series of local patients with concomitant COVID-19 infection and CVT; and aim to perform a systematic review of known cases in the current literature.

Methods

: We describe two patients with concomitant COVID-19 infection and CVT from a nationwide registry in Singapore. We then conducted a literature search in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 11th June 2020. All studies reporting CVT in COVID-19 patients were included.

Results

: Nine studies and 14 COVID-19 patients with CVT were studied. The median age was 43 years (IQR=36-58) and majority had no significant past medical conditions (60.0%). The time taken from onset of COVID-19 symptoms to CVT diagnosis was a median of 7 days (IQR=6-14). CVT was commonly seen in the transverse (75.0%) and sigmoid sinus (50.0%); 33.3% had involvement of the deep venous sinus system. A significant proportion of patients had raised D-dimer (75.0%) and CRP levels (50.0%). Two patients reported presence of antiphospholipid antibodies. Most patients received anticoagulation (91.7%) while overall mortality rate was 45.5%.

Conclusions

: The high mortality rate of CVT in COVID-19 infection warrants a high index of suspicion from physicians, and early treatment with anticoagulation should be initiated.

中文翻译：

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COVID-19感染患者的脑静脉血栓形成：病例系列和系统评价

背景

：越来越多的报告将 2019 年冠状病毒病 (COVID-19) 与血栓栓塞现象（包括缺血性中风和静脉血栓栓塞）联系起来。脑静脉血栓形成 (CVT) 是一种罕见的神经血管急症，已在一些 COVID-19 患者中观察到，但其潜在的病理生理学仍有许多待了解。

客观的

：我们介绍了当地同时感染 COVID-19 和 CVT 的患者的病例系列；旨在对当前文献中的已知案例进行系统回顾。

方法

：我们描述了新加坡全国登记处的两名同时感染 COVID-19 和 CVT 的患者。然后，我们于 2019 年 12 月 1 日至 2020 年 6 月 11 日期间使用合适的关键词搜索策略在 PubMed 和 Embase 中进行了文献检索。所有报告 COVID-19 患者 CVT 的研究均被纳入。

结果

：对 9 项研究和 14 名患有 CVT 的 COVID-19 患者进行了研究。中位年龄为 43 岁（IQR=36-58），大多数人过去没有明显的医疗状况（60.0%）。从出现 COVID-19 症状到诊断出 CVT 所需的时间中位数为 7 天 (IQR=6-14)。CVT常见于横窦（75.0%）和乙状窦（50.0%）；33.3%的患者累及深静脉窦系统。很大一部分患者的 D-二聚体 (75.0%) 和 CRP 水平 (50.0%) 升高。两名患者报告存在抗磷脂抗体。大多数患者接受了抗凝治疗（91.7%），而总死亡率为45.5%。

结论

：COVID-19 感染中 CVT 的高死亡率值得医生高度怀疑，并应尽早开始抗凝治疗。