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Prognoza koja nija udružena sa kovid 19 infekcijom (2–8%). Faktori
koji predviđaju lošu prognozu TMVS uključuju: stariju živo-
Većina pacijenata (oko 80%) obolelih od TMVS ima dobru tnu dob, muški pol, komu, poremećaj mentalnog statusa,
prognozu sa potpunim funkcionalnim oporavkom (modifi- moždano krvarenje, epileptični status, trombozu dubokih
kovani Rankin skor – mRS od 0–1), ali neretko sa rezidualnim venskih sinusa mozga, višestruko zahvaćene venske sinuse
simptomima (depresije ili anksioznosti) . Bolnički mortalitet i težak do kritični oblik kovid 19 infekcije .
5
1
je relativno visok i kreće se i do 20% . Ova stopa smrtnosti je
3
značajno viša nego u populaciji bolesnih od TMVS

Zaključak

TMVS izazvana hiperkoagulabilnim stanjem povezanim sa kovid 19 infekcijom najčešće se javlja
kod mlađih pacijentkinja bez postojanja poznatih faktora rizika za cerebralnu vensku trombozu.
Visoka stopa smrtnosti od TMVS udružene sa kovidom 19 opravdava visok indeks sumnje na
postojanje oboljenja kod pacijenata sa nespecifičnim neurološkim simptomima udruženim sa čak
i oligosimptomatskom kliničkom slikom kovid 19 infekcije, kako bi se obezbedilo pravovremeno i

adekvatno lečenje i sprečile komplikacije.

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 SARS-
CoV-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.

Keywords: cerebral venous thrombosis, COVID 19, anticoagulant therapy

Literatura 4. Kristoffersen ES, Harper CE, Vetvik KG, Faiz KW. Cerebral venous
thrombosis - epidemiology, diagnosis and treatment. Tidsskr
Nor Laegeforen. 2018 Aug 20;138(12). English, Norwegian.
1. Nikolić D, Basta Nikolic M, Manojlovic, Zivanovic Z, Vickovic S,
Till V. Cerebral venous sinus thrombosis associated with severe 5. Baldini T, Asioli GM, Romoli M, Carvalho Dias M, Schulte EC,
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Hauer L, et al. Cerebral venous thrombosis and severe acute
Srpski arhiv za celokupno lekarstvo. 2021;149(11-12):702-7. respiratory syndrome coronavirus-2 infection: A systematic review
and meta-analysis. Eur J Neurol. 2021 Oct;28(10):3478-90.
2. Siegler JE, Cardona P, Arenillas JF, Talavera B, Guillen AN, 6. Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DJ. Cerebral venous
Chavarría-Miranda A, et al. Cerebrovascular events and outcomes thrombosis: a practical guide. Pract Neurol. 2020 Oct;20(5):356-67.
in hospitalized patients with COVID-19: The SVIN COVID-19
Multinational Registry. Int J Stroke. 2021 Jun;16(4):437-47. 7. Xu W, Gao L, Li T, Ramdoyal ND, Zhang J, Shao A. The Performance
of CT versus MRI in the Differential Diagnosis of Cerebral Venous
3. Dakay K, Cooper J, Bloomfield J, Overby P, Mayer SA, Nuoman Thrombosis. Thromb Haemost. 2018 Jun;118(6):1067-77.
R, et al. Cerebral Venous Sinus Thrombosis in COVID-19
Infection: A Case Series and Review of The Literature. J 8. Hughes C, Nichols T, Pike M, Subbe C, Elghenzai S. Cerebral
Stroke Cerebrovasc Dis. 2021 Jan;30(1):105434. Venous Sinus Thrombosis as a Presentation of COVID-19.
Eur J Case Rep Intern Med. 2020 Apr 29;7(5):001691.

74 DOI: 10.5937/Galmed2202071N