COVID-19 infection has been associated with a state of hypercoagulability. The hypercoagulability typically presents as a Deep Venous thrombus or Pulmonary Embolism but rarely can manifest as CVST even after recovery from the original COVID-19 infection.

27-year-old Caucasian female who had a COVID-19 infection 2 weeks prior, presented with 4 days of persistent headaches associated with nausea and vomiting. Patient also had episodes of rightward gaze without loss of awareness. No prior history of seizures. NIHStrokeScale was 0.

CT head showed a hyper density within the sylvian fissure and the sulci of the right temporal and right lateral frontal lobes suggestive of subarachnoid hemorrhage(SAH); CTA head showed cerebral venous sinus thrombosis(CVST) involving straight sinus, most of vein of Gale, right transverse and right sigmoid sinuses that was also seen on MR venogram. MRI brain showed ill-defined edema in a distribution concerning for venous infarct due to CVST. CTA chest also showed multiple bilateral pulmonary emboli. 

EEG showed focal slowing in the right hemisphere and no epileptiform discharges. Patient was started on heparin and transitioned to Dabigatran on discharge.

Past medical history was remarkable for Wolf-Parkinson-White syndrome (s/p ablation), obesity and depression. Patient has no personal or family history of hypercoagulability or malignancy. Patient reported birth control use which she stopped 3 weeks prior to this presentation. Patient stopped cigarette smoking 5 years ago. Patient has a healthy 2.5-year-old son and has no history of miscarriages. Patient was not vaccinated for COVID. 

This is a case of CVST without major classical predisposing factors for CVST however patient had recent COVID-19 infection which should be considered as a potential risk factor for CVST.  Considering MR venogram of the head in patients presenting with persistent post-COVID headaches can help identify this potential life threating condition in a timely manner.