A Rare Case Series of Cerebral Venous Thrombosis and Stroke in Young Male COVID-19 Positive Patients without Significant Comorbidities and Importance of Various Laboratory Investigations
Background: Pandemic COVID-19 has irreversibly affected all nations worldwide leading to crisis in Global healthcare of unprecedented proportions. Here we present seven cases of CVT in COVID-19 patients with three rare cases one having cerebellar CVT and the other having deep seated basal ganglia bleed, one patient with CVT with known history of ALL. We evaluated 98 cases with covid positive status presenting to our institute with neurological symptoms. All patients underwent brain and chest CT imaging. Methods: It is an observational retrospective study conducted in pre-vaccination era. All covid positive cases who were operated in NIMHANS for Cerebral venous thrombosis are included. These surgeries are typically emergency surgeries. A proper consent was taken prior to surgery. Study period—march 2020 to December 2020 before vaccination drive started in India. Place of study— National institute of mental health and neurosciences, NIMHANS, Bengaluru. Results and Interpretation: Also among the 7 cases presented 6 of them are young males. 5 did not have any prior known comorbidity. Not only the young females are being less operated, but also the young males are presenting more and most of them requiring surgical treatment. Conclusions: This neurotropism for young healthy males is far from understood. The eosinophil in peripheral blood was also extremely low in all the patients. Our data suggests that low eosinophil count though points towards severity in cerebral and pulmonary COVID-19, its non-improvement in these primary cases may suggest continued poor prognosis. Whether low eosinophil count portends to poor prognosis or severe COVID-19 leads to low eosinophil count is unclear and difficult to tell.
Cite this paper
Siroya, H. L. , Devi, B. I. , Pulickal, S. J. and Bhat, D. I. (2022). A Rare Case Series of Cerebral Venous Thrombosis and Stroke in Young Male COVID-19 Positive Patients without Significant Comorbidities and Importance of Various Laboratory Investigations
. Open Access Library Journal, 9, e8343. doi: http://dx.doi.org/10.4236/oalib.1108343.
Wang, Y., Wang, Y., Chen, Y. and Qin, Q. (2020) Unique Epidemiological and Clinical Features of the Emerging 2019 Novel Coronavirus Pneumonia (COVID-19) Implicate Special Control Measures. Journal of Medical Virology, 92, 568-576.
https://doi.org/10.1002/jmv.25748
Wrapp, D., et al. (2020) Cryo-EM Structure of the 2019-nCoV Spike in the Prefusion Conformation. Science, 367, 1260-1263.
https://doi.org/10.1126/science.abb2507
Zhou, P., et al. (2020) A Pneumonia Outbreak Associated with a New Coronavirus of Probable Bat Origin. Nature, 579, 270-273.
https://www.nature.com/articles/s41586-020-2012-7
https://doi.org/10.1038/s41586-020-2012-7
Letko, M., Marzi, A. and Munster, V. (2020) Functional Assessment of Cell Entry and Receptor Usage for SARS-CoV-2 and Other Lineage B Betacoronaviruses. Nature Microbiology, 5, Article No. 4. https://doi.org/10.1038/s41564-020-0688-y
Hamming, I., et al. (2004) Tissue Distribution of ACE2 Protein, the Functional Receptor for SARS Coronavirus. A First Step in Understanding SARS Pathogenesis. The Journal of Pathology, 203, 631-637. https://doi.org/10.1002/path.1570
Bohmwald, K., Gálvez, N.M.S., Ríos, M. and Kalergis, A.M. (2018) Neurologic Alterations Due to Respiratory Virus Infections. Frontiers in Cellular Neuroscience, 12, Article No. 386. https://doi.org/10.3389/fncel.2018.00386
https://www.frontiersin.org/articles/10.3389/fncel.2018.00386/full
Cavalcanti, D.D., et al. (2020) Cerebral Venous Thrombosis Associated with COVID- 19. American Journal of Neuroradiology, 41, 1370-1376.
https://doi.org/10.3174/ajnr.A6644
Chougar, L., Mathon, B., Weiss, N., Degos, V. and Shor, N. (2020) Atypical Deep Cerebral Vein Thrombosis with Hemorrhagic Venous Infarction in a Patient Positive for COVID-19. American Journal of Neuroradiology, 41, 1377-1379.
https://doi.org/10.3174/ajnr.A6642
Garaci, F., Di Giuliano, F., Picchi, E., Da Ros, V. and Floris, R. (2020) Venous Cerebral Thrombosis in COVID-19 Patient. Journal of the Neurological Sciences, 414, Article ID: 116871. https://doi.org/10.1016/j.jns.2020.116871
Helms, J., et al. (2020) Neurologic Features in Severe SARS-CoV-2 Infection. New England Journal of Medicine, 382, 2268-2270.
https://doi.org/10.1056/NEJMc2008597
Robinson, C.P. and Busl, K.M. (2020) Neurologic Manifestations of Severe Respiratory Viral Contagions. Critical Care Explorations, 2, e0107.
https://doi.org/10.1097/CCE.0000000000000107
Hughes, C., Nichols, T., Pike, M., Subbe, C. and Elghenzai, S. (2020) Cerebral Venous Sinus Thrombosis as a Presentation of COVID-19. European Journal of Case Reports in Internal Medicine, 7, Article ID: 001691.
Zhou, Z., Kang, H., Li, S. and Zhao, X. (2020) Understanding the Neurotropic Characteristics of SARS-CoV-2: From Neurological Manifestations of COVID-19 to Potential Neurotropic Mechanisms. Journal of Neurology, 267, 2179-2184.
https://doi.org/10.1007/s00415-020-09929-7
Tang, N., Li, D., Wang, X. and Sun, Z. (2020) Abnormal Coagulation Parameters Are Associated with Poor Prognosis in Patients with Novel Coronavirus Pneumonia. Journal of Thrombosis and Haemostasis, 18, 844-847.
https://doi.org/10.1111/jth.14768
Ullah, W., Saeed, R., Sarwar, U., Patel, R. and Fischman, D.L. (2020) COVID-19 Complicated by Acute Pulmonary Embolism and Right-Sided Heart Failure. JACC: Case Reports, 2, 1379-1382. https://doi.org/10.1016/j.jaccas.2020.04.008
UPI.com (2020) High Number of Patients with Severe COVID-19 Develop Deep Vein Thrombosis.
https://www.upi.com/Health_News/2020/05/29/High-number-of-patients-with-sev ere-COVID-19-develop-deep-vein-thrombosis/4171590761951
Conti, P., et al. (2020) Induction of Pro-Inflammatory Cytokines (IL-1 and IL-6) and Lung Inflammation by Coronavirus-19 (CoV-19 or SARS-CoV-2): Anti-In- flammatory Strategies. Journal of Biological Regulators and Homeostatic Agents, 34, 327-331.
https://www.biolifesas.org/biolife/2020/03/15/induction-of-pro-inflammatory-cytokines-il-1-and-il-6-and-lung-inflammation-by-covid-19-anti-inflammatory-strategies
Huang, C.L., et al. (2020) Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China. The Lancet, 395, 497-506.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
https://doi.org/10.1016/S0140-6736(20)30183-5
Li, W., et al. (2003) Angiotensin-Converting Enzyme 2 Is a Functional Receptor for the SARS Coronavirus. Nature, 426, Article No. 6965.
https://doi.org/10.1038/nature02145
Bennion, D.M., Haltigan, E., Regenhardt, R.W., Steckelings, U.M. and Sumners, C. (2015) Neuroprotective Mechanisms of the ACE2-Angiotensin-(1-7)-Mas Axis in Stroke. Current Hypertension Reports, 17, 3.
https://doi.org/10.1007/s11906-014-0512-2
Hofmann, H., et al. (2004) Susceptibility to SARS Coronavirus S Protein-Driven Infection Correlates with Expression of Angiotensin Converting Enzyme 2 and Infection Can Be Blocked by Soluble Receptor. Biochemical and Biophysical Research Communications, 319, 1216-1221. https://doi.org/10.1016/j.bbrc.2004.05.114
Haschke, M., et al. (2013) Pharmacokinetics and Pharmacodynamics of Recombinant Human Angiotensin-Converting Enzyme 2 in Healthy Human Subjects. Clinical Pharmacokinetics, 52, 783-792. https://doi.org/10.1007/s40262-013-0072-7
Couturier, M.-A., et al. (2015) Cerebral Venous Thrombosis in Adult Patients with Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma during Induction Chemotherapy with l-Asparaginase: The GRAALL Experience. American Journal of Hematology, 90, 986-991. https://doi.org/10.1002/ajh.24130
Hunault-Berger, M., et al. (2008) Changes in Antithrombin and Fibrinogen Levels during Induction Chemotherapy with L-asparaginase in Adult Patients with Acute Lymphoblastic Leukemia or Lymphoblastic Lymphoma. Use of Supportive Coagulation Therapy and Clinical Outcome: The CAPELAL Study. Haematologica, 93, 1488-1494. https://doi.org/10.3324/haematol.12948
Mitchell, L.G., et al. (2003) A Prospective Cohort Study Determining the Prevalence of Thrombotic Events in Children with Acute Lymphoblastic Leukemia and a Central Venous Line Who Are Treated with L-asparaginase: Results of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia Treated with Asparaginase (PARKAA) Study. Cancer, 97, 508-516.
https://doi.org/10.1002/cncr.11042
Xie, G., Ding, F., Han, L., Yin, D., Lu, H. and Zhang, M. (2021) The Role of Peripheral Blood Eosinophil Counts in COVID-19 Patients. Allergy, 76, 471-482.
https://doi.org/10.1111/all.14465
Lindsley, A.W., et al. (2020) Eosinophil Responses during COVID-19 Infections and Coronavirus Vaccination. The Journal of Allergy and Clinical Immunology, 146, 1-7.
https://doi.org/10.1016/j.jaci.2020.04.021
https://www.researchgate.net/publication/340942003_Eosinophil_Responses_During_COVID-19_Infections_and_Coronavirus_Vaccination
Sun, D., et al. (2020) The Underlying Changes and Predicting Role of Peripheral Blood Inflammatory Cells in Severe COVID-19 Patients: A Sentinel? Clinica Chimica Acta, 508, 122-129. https://doi.org/10.1016/j.jaci.2020.04.021
Henry, B.M., et al. (2020) Lactate Dehydrogenase Levels Predict Coronavirus Disease 2019 (COVID-19) Severity and Mortality: A Pooled Analysis. The American Journal of Emergency Medicine, 38, 1722.
https://doi.org/10.1016/j.ajem.2020.05.073
