Cerebral deep venous thrombosis and COVID-19: case report

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  • Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Herein, the authors present the case of a 54-year-old male diagnosed with coronavirus disease 2019 (COVID-19) during a screening test. The patient was asked to self-isolate at home and report with any exacerbations of symptoms. He presented later with pneumonia complicated by encephalopathy at days 14 and 15 from initial diagnosis, respectively. MRI of the brain showed bithalamic and gangliocapsular FLAIR signal abnormality with mild right-sided thalamic and periventricular diffusion restriction. A CT venogram was obtained given the distribution of edema and demonstrated deep venous thrombosis involving the bilateral internal cerebral veins and the vein of Galen. CSF workup was negative for encephalitis, as the COVID-19 polymerase chain reaction (PCR) test and bacterial cultures were negative. A complete hypercoagulable workup was negative, and the venous thrombosis was attributed to a hypercoagulable state induced by COVID-19. The mental decline was attributed to bithalamic and gangliocapsular venous infarction secondary to deep venous thrombosis. Unfortunately, the patient’s condition continued to decline, and care was withdrawn.

ABBREVIATIONS COVID-19 = coronavirus disease 2019; CSF = cerebrospinal fluid; EVD = external ventricular drain; ICP = intracranial pressure; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2.

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Contributor Notes

Correspondence Syed Omar Shah: Thomas Jefferson University Hospital, Philadelphia, PA. syed.shah@jefferson.edu.

INCLUDE WHEN CITING Published online September 4, 2020; DOI: 10.3171/2020.5.JNS201542.

Disclosures Dr. Jabbour is a consultant for Medtronic and MicroVention. Drs. Tjoumakaris and Gooch are consultants for Stryker.

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