Submitting/Presenting Author

Erin Bolen, Children's Mercy HospitalFollow

Presenter Status

Resident/Psychology Intern

Abstract Type

Case report

Primary Mentor

Mukta Sharma

Start Date

2-5-2022 11:30 AM

End Date

2-5-2022 1:30 PM

Presentation Type

Poster Presentation

Description

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous sinus thrombosis,” and “sinus thrombosis.” Articles were individually reviewed to identify specific cases.

Results: Six cases were identified, five from the literature in addition to the case from the presenting institution. Notably, four cases were published individually, one as the only pediatric patient in a small case series on CVST in COVID, and one as part of a retrospective cohort study of thrombosis in children with COVID-19 or MIS-C. Four patients were previously healthy, one had cancer, and the other had tuberculosis meningitis. Patients ranged in age from 2-17; five of the patients were at least 12 years old, and the two-year-old was the patient with tuberculosis. Four of the six were males. Five patients had identified timelines of COVID symptoms; one patient had asymptomatic COVID, while the other four presented for medical care between 3-16 days after initial COVID symptoms. Five of the patients had identified presenting symptoms, which most commonly included altered mental status, headache, papilledema, and emesis. Notably, the patient at our institution was not suspected of having symptoms of CVST, with episodes of emesis initially attributed to pain from his cellulitis. These same five patients had identified imaging modalities and timelines; four of the five were identified using MRA/MRV, and four were identified on initial presentation, with our patient having a three-day lag from presentation to diagnosis. All patients were treated with anticoagulants. One patient had an identified major bleeding event from this treatment.

Conclusions: These cases highlight the importance of consideration of CVST as a potential late sequalae of COVID-19 infection in the pediatric population. They remind clinicians to consider the heightened risk of serious thrombotic complications in the immediate post-COVID period and to have a low threshold for vascular imaging in these children.

MeSH Keywords

CVST, COVID-19, pediatrics

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May 2nd, 11:30 AM May 2nd, 1:30 PM

CVST As A Rare Complication of Acute Pediatric COVID-19

Background: A previously healthy 13-year-old male was admitted to the hospital for a bacterial superinfection in the setting of recent COVID-19, including orbital cellulitis and pansinusitis with subgaleal, epidural, and subdural empyema. Further workup identified an occult, non-occlusive cerebral venous sinus thrombosis (CVST) along the length of the superior sagittal sinus.

Objectives/Goal: To evaluate the reported cases of CVST as a potential complication of COVID-19 in the pediatric population and identify meaningful trends in demographics, presentation, and diagnostic course.

Methods/Design: A literature search was run with various combinations of the following terms, always including “COVID”: “pediatric,” “adolescent,” “CVST,” “cerebral venous sinus thrombosis,” and “sinus thrombosis.” Articles were individually reviewed to identify specific cases.

Results: Six cases were identified, five from the literature in addition to the case from the presenting institution. Notably, four cases were published individually, one as the only pediatric patient in a small case series on CVST in COVID, and one as part of a retrospective cohort study of thrombosis in children with COVID-19 or MIS-C. Four patients were previously healthy, one had cancer, and the other had tuberculosis meningitis. Patients ranged in age from 2-17; five of the patients were at least 12 years old, and the two-year-old was the patient with tuberculosis. Four of the six were males. Five patients had identified timelines of COVID symptoms; one patient had asymptomatic COVID, while the other four presented for medical care between 3-16 days after initial COVID symptoms. Five of the patients had identified presenting symptoms, which most commonly included altered mental status, headache, papilledema, and emesis. Notably, the patient at our institution was not suspected of having symptoms of CVST, with episodes of emesis initially attributed to pain from his cellulitis. These same five patients had identified imaging modalities and timelines; four of the five were identified using MRA/MRV, and four were identified on initial presentation, with our patient having a three-day lag from presentation to diagnosis. All patients were treated with anticoagulants. One patient had an identified major bleeding event from this treatment.

Conclusions: These cases highlight the importance of consideration of CVST as a potential late sequalae of COVID-19 infection in the pediatric population. They remind clinicians to consider the heightened risk of serious thrombotic complications in the immediate post-COVID period and to have a low threshold for vascular imaging in these children.

 

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