Disclosures: Alex Z. Schumaker, MD: No financial relationships or conflicts of interest

Case Diagnosis: 23-year-old female with past medical history significant for morbid obesity and prior oral contraceptive use diagnosed with right sigmoid and transverse sinus thrombosis resulting in visual impairment nineteen days after testing positive for COVID-19 infection.

Case Description or Program Description: Patient initially presented to the emergency department for evaluation of worsening dyspnea and chest tightness eight days after diagnosis of COVID-19 infection. At that time a diagnosis of right lower lobe pulmonary embolism was established. She was discharged home with warfarin for anticoagulation. Prior to discharge, the patient did not have visual disturbance or focal neurological deficits. Five days after discharge and nineteen days after COVID-19 diagnosis patient returned to the emergency department for evaluation of new onset blurry vision and tinnitus.

Setting: Tertiary care hospital

Assessment/Results: Physical examination revealed bilateral mydriasis, abducens palsy, and papilledema. Patient with a therapeutic INR at time of admission. Full neurological workup was performed including MRI/MRV of brain which revealed extensive venous sinus thrombosis involving the right transverse and sigmoid sinuses and significant bilateral optic nerve head edema. Patient underwent left optic nerve sheath fenestration followed by thrombectomy of right sigmoid sinus with angioplasty. Serial lumbar punctures were performed for cerebrospinal fluid pressure reduction. Despite treatment the patient was left with permanent vision loss and was admitted to an inpatient rehabilitation facility (IRF) for three weeks prior to discharge home.

Discussion (relevance): The inflammatory response related to COVID-19 infection places patients in a hypercoagulable state and those who have pre-existing risk factors for venous thrombosis should be monitored closely for complications related to acute thrombosis.

Conclusions: This case brings awareness to possible neurological deficits seen following the acute phase of a COVID-19 infection. It is important for physiatrists to be mindful of these complications as they may present following acute phase of infection within an IRF to assist with early detection and improved outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/visual-impairment-secondary-to-right-sigmoid-and-transverse-sinus-thrombosis-in-setting-of-covid-19-viral-infection-a-case-report/