Dados do Trabalho

Título

DEEP CEREBRAL VENOUS THROMBOSIS MIMITING COVID-19-RELATED ENCEPHALITIS: DISCUSSION OF A CASE IN PANDEMIC TIMES

RESUMO

Apresentação do Caso
V.Z, 19 years old, female, ballet dancer. Diagnosed by RT-PCR with COVID-19 7 days before arriving at the hospital, came up with a holocranial headache. One day after, she evolved with apathy and motor aphasia, not witnessed. At hospital admission, the examination revealed a bedridden patient, Glasgow Coma Scale of 8, with muscular strength overall reduced. Her risk factors for trombotic events were the use of combined oral contraceptive, current infection and recent vaccination against SARS-CoV-2.
The patient was submited to a Magnetic Nuclear Resonance (MRI) of the brain and lumbar puncture for Cerebrospinal Fluid (CSF) collection. The MRI showed a symmetrical T2/Flair hyperintensity in both thalamus and basal ganglia. Also, sparse foci of diffusion restriction in the supratentorial white matter. In SWI weighting, were hypointense foci in the deep venous structures. With administration of Gadolinium, failure of filling of venous structures and of the straight sinus were evidenced. The CSF did not show abnormalities. Also, D-dimer in blood was 562 ng/mL.
Having Cerebral Venous Thrombosis (CVT) and Encephalitis as differential diagnoses, we started anticoagulation with enoxaparin (1mg/kg 12/12h) and pulsotherapy with methylprednisolone (1g for 5 days).
Ten days after admission, she was discharged from hospital walking, with fluent speech and no sequelae, taking dabigatran 150mg 12/12h. After thirty days of discharge, the MRI showed an area of sequela gliosis in both thalami. The patient is clinically well and remains under outpatient follow-up, without neurological sequelae. She has even returned to ballet practice.
Discussão
COVID-19 is clearly related to thromboembolic events and neurological manifestations, through several mechanisms. CVT is a cerebrovascular disease that can eventually mimic encephalitis, with a non-specific and progressive clinical scenery, mainly due to changes in the level of consciousness, as presented by the patient.
The diagnosis was only concluded after a venous Magnetic Resonance Angiography (MRA), performed as soon as the resources were available for this purpose.
Comentários Finais
The early approach to the patient and the study of possible differential diagnoses allowed the medical team to quickly start therapies with LMWH and pulsotherapy, which contributed to the good outcome. The cause of CVT was attributed to COVID-19, by the fact that the patient had an active infection, added to the other risk factors.

Palavras Chave

CEREBRAL VENOUS THROMBOSIS; ENCEPHALITIS; COVID-19;