In this paper, the authors report a series of young COVID-19 patients presenting with cerebral venous system thrombosis. Three patients younger than 41 years with confirmed SARS-Cov-2 infection had neurological findings related to cerebral venous thrombosis. They were admitted during a period of ten days, between March and April 2020, and managed in a single academic institution in a large city. One patient had thrombosis in both superficial and deep venous systems; the second had involvement of the straight sinus, vein of Galen and internal cerebral veins; the third had thrombosis of the deep medullary veins. Two patients presented with haemorrhagic venous infarcts. The median time from COVID-19 symptoms to the thrombotic event was seven days (range 2-7 days). Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir/ritonavir. All patients had a fatal outcome. These reports underline that severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19.
by Marialuisa Zedde and Francesco Cavallieri