Massive cerebral venous thrombosis related to oligosymptomatic COVID-19 infection: a case report

Abstract Background: The development of thrombotic coagulopathy is frequent in COVID-19 patients, but the timing after infection, cerebral venous system involvement, treatment and outcome are uncertain.Case Presentation: We report a case of massive cerebral venous thrombosis occurring in the late phase of COVID-19 infection. Mild respiratory symptoms, without fever, started three weeks before headache and acute neurological deficits. She had no dyspnea, although she was hypoxic and with typical COVID-19 associated interstitial pneumonia. Brain CT scan showed a left parietal hypodense lesion with associated sulcal subarachnoid haemorrhage. CT angiography showed a massive cerebral vein thrombosis. An asymptomatic concomitant right internal iliac vein thrombosis was found. Both cerebral venous thrombosis and deep venous 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. Conclusions: 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 neurological outcome.