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Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection

Thrombotic complications are common in COVID-19 patients, but cerebral venous system involvement, timing after infection, optimal treatment, and long-term outcome are uncertain. We report a case of massive cerebral venous thrombosis and concomitant internal iliac vein thrombosis occurring in the lat...

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Autores principales: Beretta, Simone, Da Re, Fulvio, Francioni, Valentina, Remida, Paolo, Storti, Benedetta, Fumagalli, Lorenzo, Piatti, Maria Luisa, Santoro, Patrizia, Cereda, Diletta, Cutellè, Claudia, Pirro, Fiammetta, Montisano, Danilo Antonio, Beretta, Francesca, Pasini, Francesco, Cavallero, Annalisa, Appollonio, Ildebrando, Ferrarese, Carlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902908/
https://www.ncbi.nlm.nih.gov/pubmed/33643200
http://dx.doi.org/10.3389/fneur.2021.622130
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author Beretta, Simone
Da Re, Fulvio
Francioni, Valentina
Remida, Paolo
Storti, Benedetta
Fumagalli, Lorenzo
Piatti, Maria Luisa
Santoro, Patrizia
Cereda, Diletta
Cutellè, Claudia
Pirro, Fiammetta
Montisano, Danilo Antonio
Beretta, Francesca
Pasini, Francesco
Cavallero, Annalisa
Appollonio, Ildebrando
Ferrarese, Carlo
author_facet Beretta, Simone
Da Re, Fulvio
Francioni, Valentina
Remida, Paolo
Storti, Benedetta
Fumagalli, Lorenzo
Piatti, Maria Luisa
Santoro, Patrizia
Cereda, Diletta
Cutellè, Claudia
Pirro, Fiammetta
Montisano, Danilo Antonio
Beretta, Francesca
Pasini, Francesco
Cavallero, Annalisa
Appollonio, Ildebrando
Ferrarese, Carlo
author_sort Beretta, Simone
collection PubMed
description Thrombotic complications are common in COVID-19 patients, but cerebral venous system involvement, timing after infection, optimal treatment, and long-term outcome are uncertain. We report a case of massive cerebral venous thrombosis and concomitant internal iliac vein thrombosis occurring in the late phase of paucisymptomatic COVID-19 infection. Mild respiratory symptoms, without fever, started 3 weeks before headache and acute neurological deficits. The patient had silent hypoxemia and typical COVID-19 associated interstitial pneumonia. Brain CT scan showed a left parietal hypodense lesion with associated sulcal subarachnoid hemorrhage. CT cerebral venography showed a massive cerebral venous thrombosis involving the right transverse sinus, the right jugular bulb, the superior sagittal sinus, the straight sinus, the vein of Galen, and both internal cerebral veins. Abdominal CT scan showed no malignancy but revealed an asymptomatic right internal iliac vein thrombosis. Both cerebral venous thrombosis and pelvic vein thrombosis were effectively treated with unfractionated heparin started on the day of admission, then shifted to low molecular weight heparin, with a favorable clinical course. Nasopharyngel swab, repeated twice, tested negative for SARS-CoV-2. Serological tests confirmed SARS-CoV-2 infection. Our case supports active surveillance and prevention of thrombotic complications associated with COVID-19, which may affect both peripheral and cerebral venous system. Early initiation of unfractionated heparin may lead to good neurologic outcome.
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spelling pubmed-79029082021-02-25 Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection Beretta, Simone Da Re, Fulvio Francioni, Valentina Remida, Paolo Storti, Benedetta Fumagalli, Lorenzo Piatti, Maria Luisa Santoro, Patrizia Cereda, Diletta Cutellè, Claudia Pirro, Fiammetta Montisano, Danilo Antonio Beretta, Francesca Pasini, Francesco Cavallero, Annalisa Appollonio, Ildebrando Ferrarese, Carlo Front Neurol Neurology Thrombotic complications are common in COVID-19 patients, but cerebral venous system involvement, timing after infection, optimal treatment, and long-term outcome are uncertain. We report a case of massive cerebral venous thrombosis and concomitant internal iliac vein thrombosis occurring in the late phase of paucisymptomatic COVID-19 infection. Mild respiratory symptoms, without fever, started 3 weeks before headache and acute neurological deficits. The patient had silent hypoxemia and typical COVID-19 associated interstitial pneumonia. Brain CT scan showed a left parietal hypodense lesion with associated sulcal subarachnoid hemorrhage. CT cerebral venography showed a massive cerebral venous thrombosis involving the right transverse sinus, the right jugular bulb, the superior sagittal sinus, the straight sinus, the vein of Galen, and both internal cerebral veins. Abdominal CT scan showed no malignancy but revealed an asymptomatic right internal iliac vein thrombosis. Both cerebral venous thrombosis and pelvic vein thrombosis were effectively treated with unfractionated heparin started on the day of admission, then shifted to low molecular weight heparin, with a favorable clinical course. Nasopharyngel swab, repeated twice, tested negative for SARS-CoV-2. Serological tests confirmed SARS-CoV-2 infection. Our case supports active surveillance and prevention of thrombotic complications associated with COVID-19, which may affect both peripheral and cerebral venous system. Early initiation of unfractionated heparin may lead to good neurologic outcome. Frontiers Media S.A. 2021-02-10 /pmc/articles/PMC7902908/ /pubmed/33643200 http://dx.doi.org/10.3389/fneur.2021.622130 Text en Copyright © 2021 Beretta, Da Re, Francioni, Remida, Storti, Fumagalli, Piatti, Santoro, Cereda, Cutellè, Pirro, Montisano, Beretta, Pasini, Cavallero, Appollonio and Ferrarese. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Beretta, Simone
Da Re, Fulvio
Francioni, Valentina
Remida, Paolo
Storti, Benedetta
Fumagalli, Lorenzo
Piatti, Maria Luisa
Santoro, Patrizia
Cereda, Diletta
Cutellè, Claudia
Pirro, Fiammetta
Montisano, Danilo Antonio
Beretta, Francesca
Pasini, Francesco
Cavallero, Annalisa
Appollonio, Ildebrando
Ferrarese, Carlo
Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection
title Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection
title_full Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection
title_fullStr Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection
title_full_unstemmed Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection
title_short Case Report: Concomitant Massive Cerebral Venous Thrombosis and Internal Iliac Vein Thrombosis Related to Paucisymptomatic COVID-19 Infection
title_sort case report: concomitant massive cerebral venous thrombosis and internal iliac vein thrombosis related to paucisymptomatic covid-19 infection
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902908/
https://www.ncbi.nlm.nih.gov/pubmed/33643200
http://dx.doi.org/10.3389/fneur.2021.622130
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