中青年新冠肺炎相关脑静脉窦血栓形成的临床过程与诊断

E. Klocheva, V. V. Goldobin, F. Olimova
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摘要

脑静脉血栓形成(CVT)是一种难以识别的脑血管疾病,是一种潜在的危及生命的疾病,需要及时的抗凝治疗。在2019冠状病毒病大流行时期,CVT稳步上升(4.2%对0.5-1%)。同时,COVID-19背景下CVT患者的死亡率明显超过无COVID-19 CVT患者的死亡率(45.5% vs. 15%)。目的:研究新冠肺炎背景下中青年CVT的临床病程,探讨影像学检查的诊断价值及血栓形成的遗传危险因素在CVT发展中的意义。材料和方法。检查了7例患者:6名女性(其中5名育龄)和1名男性,年龄26至57岁(平均37岁)。分析CVT的主要临床和神经学表现、实验室检查结果、神经影像学检查结果以及血栓形成危险因素的分子遗传学分析数据。结果。1例病例病程为重症,其余病例病程为中度。COVID-19症状出现和CVT发展之间的间隔为7至25天。3例CVT有急性病程,并伴有卒中的发展(2例为出血性卒中,1例为多灶性缺血性卒中),其他病例为亚急性病程CVT。所有患者均确定了血栓形成的遗传危险因素。在COVID-19大流行时代,CVT的诊断尤其困难,因为CVT最常见的症状-头痛(90%)-可视为COVID-19的表现。同时,及时诊断CVT,立即开始抗凝治疗,预后相对较好。
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Clinical course and diagnosis of cerebral vein and sinus thrombosis associated with COVID-19 in young and middle-aged patients
Cerebral venous thrombosis (CVT) is a form of cerebrovascular disorders that is difficult to recognize, it is potentially a life threatening condition and requires timely anticoagulant therapy. In the era of the COVID-19 pandemic, there is a steady increase in CVT (4.2% vs. 0.5–1%). At the same time, mortality in patients with CVT on the background of COVID-19 significantly exceeds the mortality in patients with CVT without COVID-19 (45.5% vs. 15%). Objective: to study the clinical course of CVT, to determine the diagnostic value of radiological methods and the significance of genetic risk factors for thrombosis in the development of CVT in young and middle-aged patients against the background of COVID-19. Material and methods. Seven patients were examined: six women (five of them of reproductive age) and one man, aged 26 to 57 years (mean age 37 years). The main clinical and neurological manifestations of CVT, the results of laboratory examination, neuroimaging, and the data of molecular genetic analysis of risk factors for thrombosis were analyzed. Results. The course of COVID-19 was severe in one case, and moderate in the rest of cases. The interval between the onset of COVID-19 symptoms and the development of CVT ranged from 7 to 25 days. In three cases CVT had an acute course and was accompanied by the development of a stroke (in two cases, hemorrhagic stroke was noted, in one case, multifocal ischemic stroke), in other cases, a subacute course of CVT was noted. Genetic risk factors for thrombosis were identified in all patients.Conclusion. The diagnosis of CVT in the era of the COVID-19 pandemic is particularly difficult, since the most common symptom of CVT – headache (90%) – can be regarded as a manifestation of COVID-19. At the same time, timely diagnosis of CVT and immediate initiation of anticoagulant therapy are associated with a relatively favorable prognosis.
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