The Incidence of Cerebral Sinus Venous Thrombosis in Patients Diagnosed with Pseudotumor Cerebri During the COVID-19 Pandemic

Objective: To emphasize the increasing frequency of cerebral sinus venous thrombosis (CSVT) among the causes of pseudotumor cerebri (PTC) and the necessity of investigating it in patients presenting with papilledema during the COVID-19 pandemic. Material and Methods: Complete ophthalmological examinations, magnetic resonance imaging (MRI) and contrast-enhanced magnetic resonance venography (MRV) data of 44 patients diagnosed with PTC in a tertiary neuro-ophthalmology clinic, from the beginning of the COVID-19 pandemic to the present were recorded. Patients without documented increases in intracranial pressure by lumbar puncture, patients with abnormalities in cerebrospinal fluid (CSF) biochemistry and microbiology analysis, and patients with intracranial mass, obstructive hydrocephalus, or meningitis on MRI were excluded. Results: MRI and contrast-enhanced MRV imaging were evaluated together in 36 of the 44 patients with COVID-19 positivity. The mean age of the included patients was 36.9 years (minimum: 9-maximum: 63). Among these 36 patients who underwent combined imaging, 14 (38.8%) showed findings indicative of CSVT: 5 had superior sagittal sinus thrombosis, 5 had transverse sinus thrombosis, 2 had sigmoid sinus thrombosis, 1 had inferior sagittal sinus thrombosis, and 1 had extensive CSVT. Conclusion: While we had a CSVT rate of 9.2% which is compatible with previous studies before the pandemic period; in this retrospective study covering the pandemic period, we detected CSVT in 38.8% of patients with suspected PTC. We think that CSVT should be investigated in all patients who are considered to have increased intracranial pressure with combined MRI-MRV imaging.