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Intracranial complications of hypercoagulability and superinfection in the setting of COVID-19: illustrative cases.

Authors:
Sarah E Blitz J Tanner McMahon Joshua I Chalif Casey A Jarvis David J Segar Weston T Northam Jason A Chen Regan W Bergmark Jennifer M Davis Sigal Yawetz Omar Arnaout

J Neurosurg Case Lessons 2022 May 23;3(21):CASE22127. Epub 2022 May 23.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Background: Hypercoagulability with thrombosis and associated inflammation has been well-documented in COVID-19, and catastrophic cerebral venous sinus thromboses (CVSTs) have been described. Another COVID-19-related complication is bacterial superinfection, including sinusitis. Here, the authors reported three cases of COVID-19-associated sinusitis, meningitis, and CVST and summarized the literature about septic intracranial thrombotic events as a cause of headache and fever in COVID-19.

Observations: The authors described three adolescent patients with no pertinent past medical history and no prior COVID-19 vaccinations who presented with subacute headaches, photosensitivity, nausea, and vomiting after testing positive for COVID-19. Imaging showed subdural collections, CVST, cerebral edema, and severe sinus disease. Two patients had decline in mental status and progression of neurological symptoms. In all three, emergency cranial and sinonasal washouts uncovered pus that grew polymicrobial cultures. After receiving broad-spectrum antimicrobials and various additional treatments, including two of three patients receiving anticoagulation, all patients eventually became neurologically intact with varying ongoing sequelae.

Lessons: These cases demonstrated similar original presentations among previously healthy adolescents with COVID-19 infections, concurrent sinusitis precipitating CVST, and subdural empyemas. Better recognition and understanding of the multisystem results of severe acute respiratory syndrome coronavirus 2 and the complicated sequelae allows for proper treatment.

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http://dx.doi.org/10.3171/CASE22127DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9204919PMC
May 2022

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