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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(04): e354-e357
DOI: 10.1055/s-0042-1756458
Case Report

Bilateral Cerebral Venous Thrombosis with a Rare Presentation in a COVID-19 Patient: A Case Report

Trombose venosa cerebral bilateral com apresentação rara em paciente com COVID-19: Relato de caso
Iman Ahrari 
1   Department of Neurosurgery, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
,
Arash Saffarian
1   Department of Neurosurgery, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
,
Abbas Rakhsha
1   Department of Neurosurgery, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
,
Mahsa Ghavipisheh
2   Department of Psychiatry, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
,
Mohamad Reza Gholami
3   Department of Ophthalmology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
› Author Affiliations Funding None.
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Abstract

Since the COVID-19 pandemic started, millions of peoples are involved. The presentation of the disease varies from mild respiratory symptoms and multiple organ failure to coma and death. Neurological symptoms such as headache or seizure are also coincident with COVID-19. Thromboembolic events increase in COVID-19 patients due to hypercoagulability and inflammation, particularly in severely ill patients. Thrombosis may cause venous thrombosis, pulmonary embolism, or cerebral sinus venous thrombosis (CSVT). Cerebral sinus venous thrombosis is a rare phenomenon that is usually found in critically ill patients with bad prognoses. In the present case report, we present a 40-year-old man with COVID-19 confirmed by real-time polymerase chain reaction (RT-PCR) who was admitted due to acute bilateral visual loss due to bilateral transverse sinus thrombosis. Pseudotumor cerebri disease was confirmed through high lumbar puncture. Early surgical intervention (optic nerve fenestration) was performed and, fortunately, his visual acuity improved. Cerebral sinus venous thrombosis is a rare incident in COVID-19 patients, but due to irreversible complications, an early diagnosis is fundamental. In any neurologic change in COVID-19 patients, CSVT must be considered. Also, prophylactic thrombolytic therapy should be kept in mind as the patient is admitted.

Resumo

Desde o início da pandemia da COVID-19, milhões de pessoas estão envolvidas. A apresentação da doença varia desde sintomas respiratórios leves e falência de múltiplos órgãos até coma e morte. Sintomas neurológicos, como dor de cabeça ou convulsão, também coincidem com COVID-19. Os eventos tromboembólicos aumentam em pacientes com COVID-19 devido à hipercoagulabilidade e inflamação, particularmente em pacientes gravemente enfermos. A trombose pode causar trombose venosa, embolia pulmonar ou trombose venosa do seio cerebral (TVC). A trombose venosa do seio cerebral é um fenômeno raro, geralmente encontrado em pacientes gravemente enfermos e com mau prognóstico. No presente relato de caso, apresentamos um homem de 40 anos com COVID-19 confirmado por reação em cadeia da polimerase em tempo real (RT-PCR) que foi internado devido a perda visual bilateral aguda causada pela trombose bilateral do seio transverso. A doença pseudotumor cerebral foi confirmada através de punção lombar alta. Foi realizada intervenção cirúrgica precoce (fenestração do nervo óptico) e, felizmente, sua acuidade visual melhorou. A trombose venosa do seio cerebral é um incidente raro em pacientes com COVID-19, mas devido a complicações irreversíveis, um diagnóstico precoce é fundamental. Em qualquer alteração neurológica em pacientes com COVID-19, a TVCS deve ser considerada. Além disso, a terapia trombolítica profilática deve ser lembrada quando o paciente é internado.

Keywords

SARS-COV-19 - CSVT - thrombosis - pseudotumor cerebri - venous thrombotic event - visual loss

Palavras-chave

SARS-COV-19 - CSVT - trombose - pseudotumor cerebral - evento trombótico venoso - perda visual


Publication History

Received: 07 February 2022

Accepted: 12 July 2022

Article published online:
18 October 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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