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Cerebral venous sinus thrombosis associated with COVID-19
  1. Ameeka Thompson1,
  2. Catherine Morgan2,3,
  3. Paul Smith4,
  4. Christopher Jones1,
  5. Harriet Ball2,3,
  6. Elizabeth J Coulthard2,3,
  7. Ed Moran1,
  8. Konrad Szewczyk-Krolikowski2,
  9. Claire M Rice2,3
  1. 1 Department of Infectious Disease, North Bristol NHS Trust, Bristol, UK
  2. 2 Department of Neurology, North Bristol NHS Trust, Bristol, UK
  3. 3 Clinical Neurosciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  4. 4 Department of Neuroradiology, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Claire M Rice, Clinical Neurosciences, Level 1 Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK; c.m.rice{at}

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Coronavirus disease of 2019 (COVID-19) is well known to increase the risk of developing venous thromboembolism; thus, patients with COVID-19 may present to neurologists with cerebral venous sinus thrombosis. We present a patient presenting acutely with delirium, who after initial negative viral testing, was diagnosed with cerebral venous sinus thrombosis in association with COVID-19.


A 50-year-old man presented with delirium. PCR nasopharyngeal swabs for the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) were negative but we made a diagnosis of probable COVID-19 based on clinical and radiological features according to European Centre for Disease Control case definition criteria.1 Fibrinogen was 3.8 g/L (1.8–5.4) and neutrophil:lymphocyte ratio 14.4; age ≥50 years and neutrophil:lymphocyte ratio ≥3.13 have been associated with severe disease.2 D-dimer was not recorded acutely. A non-contrast CT scan of head and CSF analysis on admission were normal. We started enoxaparin 40 mg once daily subcutaneously as prophylaxis for venous thromboembolism and he did not need ventilator support.

Despite clinical improvement, he had persisting problems with executive dysfunction and dyspraxia. Repeat CT scan of head and CT venogram 1 week following admission showed dural venous sinus thrombosis involving the whole of the superior sagittal sinus, left transverse sinus and left sigmoid sinus down to the level of the …

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