Cerebral venous sinus thrombosis after resolution of COVID-19 in a non-hospitalised patient

Abstract

© Author(s) (or their employer(s)) 2021. No commercial reuse. See rights and permissions. Published by BMJ. A man in his late thirties awoke with a rightsided thunderclap headache which subsided over hours, following which he lost consciousness just after noting his right arm jerking. Two weeks previously, he had recovered from an illness consisting of fever, myalgia and cough. He had not sought medical attention or testing, although he had COVID-19 antibodies in his blood without having been vaccinated. On examination, he had a facial laceration and a lateral tonguebite injury but no other abnormality. Plain computer tomography showed a small region of increased density over the right temporal lobe, representing subarachnoid blood (figure 1). On the suspicion that this was venous in aetiology, magnetic resonance venography was performed (figure 2). This confirmed cerebral venous sinus thrombosis (CVST) extending from the superior sagittal sinus to the right internal jugular vein. He was successfully treated with low molecular weight heparin as a bridge to warfarin therapy, and remains seizure free on levetiracetam. He has no personal or family history of thrombosis, and we have not yet identified a risk factor for CVST other than COVID-19. The association between COVID-19 and CVST is increasingly recognised, with a broad range neurological manifestations and morbidity, 3 and variable presence of typical risk factors. As it is unclear whether COVID-19 is an independent risk factor for CVST, it remains important to consider investigating for underlying causes of thrombosis. Acknowledgements We would like to thank Dr Amer Rehman, consultant radiologist at out institution, for helping with image selection and interpretation.