Cerebral venous thrombosis: A typical presentation of COVID-19 in the young
Cerebral venous thrombosis: A typical presentation of COVID-19 in the young
复制标题
DOI：
10.1016/j.jstrokecerebrovasdis.2020.104989
复制
发表时间：
2020-08-01
影响因子：
2.5
通讯作者：
Arora, Rohan
中科院分区：
文献类型：
--
作者：
Klein, David E.;Libman, Richard;Arora, Rohan
目的：确定静脉梗死的临床和影像学特征作为年轻人COVID-19的表现特征。背景：SARS-CoV-2感染引起高凝状态和炎症，导致静脉血栓事件（VTE）。尽管患有合并症的老年患者风险较高，但COVID-19也可能在更广泛的患者人群中引起VTE，而没有这些风险。COVID-19的神经系统并发症和表现，包括神经病变、癫痫发作、中风和脑病，通常发生在严重的COVID-19感染病例中，主要表现为呼吸窘迫。病例描述：一名29岁女性的病例报告，无明显既往病史或合并症，出现新发癫痫发作。进一步询问发现，患者有一周头痛、低热、轻度咳嗽和呼吸急促病史，诊断为COVID-19。影像学检查显示左颞顶出血性静脉梗死伴左横窦和乙状窦血栓形成，接受全剂量抗凝和抗癫痫药物治疗。结论：尽管合并症的老年患者被认为是COVID-19神经系统并发症的最高风险，通常当全身症状严重时，但本病例报告强调，即使全身症状轻微，年轻人也有发生VTE伴神经系统并发症的风险，可能是由COVID-19相关的高凝状态引起的。
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 hyper-coagulability 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.