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Abstract Details

Seizure and Dural Sinus Thrombosis in setting of COVID-19 with 3 and 6 Month Outcomes after Long-Term Anticoagulation
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
015
To report how a case of coronavirus-19 (COVID-19) can lead to seizure and dural sinus thrombosis with subsequent clinical outcome after several months of long-term anticoagulation.
COVID-19 has led to more than 40 million infections worldwide and over 1 million deaths. Although the pulmonary sequelae of COVID-19 have been well documented, the effects on the CNS are less well known. Common neurologic presentations of COVID-19 include altered mental status, confusion, and stroke, but venous sinus thromboses are a rarer hypercoagulable presentation of COVID-19. Headache and seizure are often associated with cerebral venous thromboses, but are atypical in the setting of more commonly understood COVID-19 neurologic presentations.
N/A
A 39 year old woman with history of migraines and recent COVID-19 presented after suspected witnessed seizure. She reported 5 days of worsening headache associated with nausea and vomiting, worse than her typical migraines. Exam was only remarkable for hyperreflexia of the upper extremities bilaterally. Labs were remarkable for thrombophilia to 659K/cumm, microcytosis to MCV 69.1 fL, elevated D-dimer to 0.97 mcg/mL, and SARS-CoV-2 RNA+ nasopharyngeal swab. CT venogram (CTV) of the head demonstrated venous sinus thrombosis of the right sigmoid and transverse sinus. CTV also demonstrated asymmetric leptomeningeal enhancement of the right temporal lobe, likely reflecting vascular engorgement in the setting of venous sinus thrombosis. MRI Brain demonstrated foci of susceptibility artifact and restricted diffusion in the right temporal lobe that was suggestive for venous infarction. The patient was started on therapeutic anticoagulation and levetiracetam for seizure prophylaxis. After 3 days of inpatient anticoagulation treatment, the patient’s symptoms stabilized and was placed on therapeutic rivaroxaban with outpatient follow-up at 3 and 6 months after discharge.
Seizure and dural sinus thrombosis can present in the setting of COVID-19. We report clinical outcomes after long-term anticoagulation.
Authors/Disclosures
Michael A. Connerney, MD (UCLA Department of Neurology)
PRESENTER 		Dr. Connerney has nothing to disclose.
Rohit Gummi, MD (Stanford Medicine) Dr. Gummi has nothing to disclose.
No disclosure on file
Christopher M. DeGiorgio, MD, FÂ鶹´«Ã½Ó³»­ (UCLA Department of Neurology At Olive View) Dr. DeGiorgio has received intellectual property interests from a discovery or technology relating to health care.