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Case Reports: Unusual association of diseases/symptoms
Sagittal sinus thrombosis with subarachnoid haemorrhage in a patient with COVID-19 infection
  1. Nikhil Murali1,
  2. Elizabeth Marrinan2,
  3. Chemindra Biyanwila3 and
  4. Senussi Hussein4
  1. 1Acute Medicine, Eastbourne District General Hospital, Eastbourne, UK
  2. 2Haematology, East Sussex Healthcare NHS Trust, Eastbourne, UK
  3. 3Stroke Medicine, East Sussex Healthcare NHS Trust, Eastbourne, UK
  4. 4Stroke Medicine, Eastbourne District General Hospital, Eastbourne, UK
  1. Correspondence to Dr Nikhil Murali; nikhil.murali{at}nhs.net

Abstract

A man in his late 50s was admitted with a 10-day history of right frontotemporal headache, left arm and leg weakness, and a sudden decline in visual acuity in the right eye. The patient had recent exposure to COVID-19 infection and tested positive for the same on admission. A CT scan of the head done on arrival demonstrated a subarachnoid haemorrhage in the right central sulcus with an underlying superior sagittal sinus thrombosis. No other known risk factors for central venous sinus thrombosis could be identified. The patient had a normal level of consciousness on admission clinically; however, he was in severe pain. A collective decision was made to administer anticoagulants to the patient with heparin after carefully deliberating the risk-to-benefit ratio of a superior sagittal thrombus with an associated subarachnoid haemorrhage. Our patient recovered and was discharged after 2 weeks on warfarin. We present this case to highlight the potential risks of hypercoagulable and neurotropic complications of COVID-19 infections, with special emphasis on cerebral venous thrombosis.

  • COVID-19
  • Neurological injury

https://doi.org/10.1136/bcr-2022-249501

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    Footnotes

    • Contributors NM is the primary and corresponding author of the paper who wrote and edited the paper in total. CB, the acute stroke consultant, is the supervising consultant who provided guidance and input regarding the aetiology and pathogenesis of CVST in patients with COVID-19 infection. SH, the acute stroke consultant, is the other supervising consultant for the case. He has provided help and guidance by proofreading the case report and making changes wherever necessary. EM is the haematology registrar who helped with providing inputs regarding the pathogenesis of hypercoagulable states in patients with COVID-19. She also actively contributed to the management of the patient. All four authors of the paper were actively involved in the management of the patient.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.