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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(02): 342-346
DOI: 10.1055/s-0042-1750388
Case Report

Long-Delayed Manifestation of COVID-19 Coagulopathy Presenting with Severe Cerebral Venous Thrombosis Causes Massive Brain Hemorrhage

Mardjono Tjahjadi
1   Department of Surgery, Faculty of Medicine, Universitas Katolik Indonesia Atma Jaya, Jakarta, Indonesia
2   Department of Neurosurgery, Mitra Keluarga Kemayoran Hospital, Jakarta, Indonesia
,
Sinatrya Caropeboka
2   Department of Neurosurgery, Mitra Keluarga Kemayoran Hospital, Jakarta, Indonesia
,
Christian Permana
2   Department of Neurosurgery, Mitra Keluarga Kemayoran Hospital, Jakarta, Indonesia
,
Krisandi Susanto
2   Department of Neurosurgery, Mitra Keluarga Kemayoran Hospital, Jakarta, Indonesia
,
Eka Susanto
3   Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Abstract

COVID-19 infection causes coagulopathy, which may lead to cerebral venous thrombotic (CVT) event. It usually occurs in patients with higher severity level of infection and manifests mostly within a month after the infection. However, in rare cases, the CVT may happen long after the infection and unrelated to the degree of the infection severity. We present the case of a previously healthy 62-year-old male patient with very mild COVID-19 symptoms that resolved in 3 weeks of home isolation treatment. Immediately after the infection, he developed hypercoagulability and was treated routinely with a novel oral anti-coagulant drug. Four months after the infection, he developed a worsening headache which, in several days, deteriorated to cause reduction in his consciousness level. Imaging showed a right temporoparietooccipital massive brain hemorrhage with right transverse and sigmoid sinus thrombosis. Emergency decompressive craniectomy was performed and the patient recovery was excellent. In patients with a hypercoagulable state after COVID-19 infection, the possibility of CVT event should be observed. It may not be related to the severity of the infection, and it may happen long after the infection.

Keywords

cerebral venous thrombosis - COVID-19 - long covid - decompressive craniectomy


Publication History

Article published online:
24 August 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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