Specifičnosti u dijagnostici i lečenju tromboze moždanih venskih sinusa povezane sa Kovid 19 infekcijom

Abstract

Cerebral venous sinus thrombosis (CVST) is a rare form of cerebrovascular incident (<1%) induced by partial or complete occlusion of the dural venous sinuses and/or cerebral veins. In the opposite to arterial stroke, it is more common in young adults, mostly affecting women. Predisposing factors for CVST are numerous, but CVST associated with SARSCoV-2 infection is a less known entity with no identifiable risk factors. SARS-CoV-2 infection induces hypercoagulable state, comprising elevated D-dimer, fibrinogen level, fibrin/fibrinogen degradation product, antiphospholipid antibodies and thrombocytopenia, which increase the risk of thrombus formation within dural venous sinuses and/or cerebral veins. Clinical presentation varies, depending on the affected venous sinus and/or cerebral veins, raised intracranial pressure (ICP), or extensive parenchymal damage. Non-specific clinical presentation of CVST urges clinicians to raise clinical suspicion and proceed with neuroradiological assessment. Management of CVST is based on early diagnosis with identification of thrombotic process, together with urgent conservative and endovascular treatment. Up to 80% of patients have a good outcome with a complete recovery. However, the outcome of a small proportion of patients (~20%) is poor (death or severe disability). This review summarizes current knowledge on specific risk factors, clinical presentations, diagnostic approaches, therapeutic modalities, and complications of CVST associated with COVID 19 infection in order to provide evidence-based recommendations for diagnosis, treatment and recurrence prevention.