COVID-19-Associated Cerebral Developmental Venous Anomaly Thrombosis With Hemorrhagic Transformation.

Developmental venous anomaly thrombosis is a rare complication associated with hypercoagulable states, including COVID-19 infection.

A 35-year-old man with a 1-week history of fever, cough, and myalgias presented with left hemiparesis and seizures requiring intubation. A COVID-19 polymerase chain reaction test was positive. No other thrombotic risk factors were identified. Neuroimaging demonstrated right-sided intracerebral hemorrhages associated with a thrombosed developmental venous anomaly (Figure 1). Computed tomography venography showed thrombus within a dilated caput medusae venous trunk (Figure 2A). He was started on heparin infusion but worsened neurologically with expanding hematoma. He underwent emergency decompressive craniectomy before resuming anticoagulation, with recanalization of the developmental venous anomaly (Figure 2B). One month later, he entered inpatient rehabilitation with mild left-sided weakness. Severe COVID-19 infection has been linked to venous thromboembolic events such as deep venous thrombosis, pulmonary embolism,[1] and cerebral venous sinus thrombosis.[2] This patient’s synchronous COVID-19 infection was presumed to have contributed to his developmental venous anomaly thrombosis.

Figure 1.

Axial head computed tomography (CT) and magnetic resonance imaging in a patient with seizures and COVID-19 infection. A, Axial noncontrast CT and at the level of the centrum semiovale showing a thrombosed developmental venous anomaly (arrowhead) with large right hemisphere intracerebral hematoma (arrows) and midline shift. B, Axial 3-dimensional susceptibility-weighted angiography at a slightly caudal cut showing 2 foci of intracerebral hemorrhage and the developmental venous anomaly in greater detail.

Figure 2.

Computed tomography (CT) venogram in a patient with seizures and COVID-19 infection. A, Paramedian sagittal CT venogram showing the caput medusae trunk of the developmental venous anomaly (DVA; arrowhead) feeding towards the superior sagittal sinus, with the large hematoma seen posteriorly (arrow). B, Coronal CT venogram showing a partially recanalized thrombosed DVA (arrowhead) leading towards the superior sagittal sinus, after decompressive craniectomy.

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Disclosures

Dr Field reports compensation from BMS-Pfizer for consultant services; compensation from HLS Therapeutics for consultant services; service as Board Member for Destine Health; and grants from Bayer. The other authors report no conflicts.