Cerebral Venous Sinus Thrombosis Associated with SARS-CoV-2; a Multinational Case Series

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Abstract Background SARS-CoV-2 induced coagulopathy can lead to thrombotic complications such as stroke. Cerebral venous sinus thrombosis (CVST) is a less common type of stroke which might be triggered by COVID-19. We present a series of CVST cases with SARS-CoV-2 infection. Methods In a multinational retrospective study, we collected all cases of CVST in SARS-CoV-2 infected patients admitted to nine tertiary stroke centers from the beginning of the pandemic to June 30 th , 2020. We compared the demographics, clinical and radiological characteristics, risk factors, and outcome of these patients with a control group of non-SARS-CoV-2 infected CVST patients in the same seasonal period of the years 2012-2016 from the country where the majority of cases were recruited. Results A total of 13 patients fulfilled the inclusion criteria (62% women, mean age 50.9± 11.2 years). Six patients were discharged with good outcomes (mRS≤2) and three patients died in hospital. Compared to the control group, the SARS-CoV-2 infected patients were significantly older (50.9 versus 36.7 years, p <0.001), had a lower rate of identified CVST risk factors (23.1% versus 84.2%, p <0.001), had more frequent cortical vein involvement (38.5% versus 10.5%, p : 0.025), and a non-significant higher rate of in-hospital mortality (23.1% versus 5.3%, p : 0.073). Conclusion CVST should be considered as potential comorbidity in SARS-CoV-2 infected patients presenting with neurological symptoms. Our data suggest that compared to non-SARS-CoV-2 infected patients, CVST occurs in older patients, with lower rates of known CVST risk factors and might lead to a poorer outcome in the SARS-CoV-2 infected group.

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