Demyelinating disease in a patient with cerebral venous thrombosis and covid-19 clinical manifestations

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Abstract

Actually, verifying neurological disorders associated with COVID-19 make clinicians ask several questions: the manifestation of neurological pathology is due to COVID-19, or there is a combination of several CNS pathologies with COVID-19. We report a clinical case of a 57-year-old female patient with demyelinating disease of the central nervous system, cerebral venous thrombosis associated with clinically transferred COVID-19. Differential diagnosis was performed with multiple sclerosis, acute multiple encephalomyelitis, opticomyelitis, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, sarcoidosis, antiphospholipid syndrome, mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) and thrombosis veins of the large hemispheres. Probable pathogenetic variants of demyelination development and possible connection with cerebral venous thrombosis and COVID-19 are highlighted.

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About the authors

Yelena G. Klocheva

North-Western State Medical University named after I.I. Mechnikov

Email: klocheva@mail.ru
ORCID iD: 0000-0001-6814-0454

M.D, Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Farakhnoz Z. Olimova

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: farahnoz.zafarovna1994@gmail.com
ORCID iD: 0000-0003-2239-0073
SPIN-code: 5339-9323

postgraduate student

Russian Federation, St. Petersburg

Vitalii V. Goldobin

North-Western State Medical University named after I.I. Mechnikov

Email: Goldobin@szgmu.ru
ORCID iD: 0000-0001-9245-8067
SPIN-code: 4344-5782

M.D., Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Julia D. Bogatenkova

City Consulting and Diagnostic Center No. 1

Email: gkdc1@zdrav.spb.ru
ORCID iD: 0000-0002-0101-715X

M.D. Cand. Sci. (Med), Head of the Stroke Prevention Center

Russian Federation, Saint-Petersburg

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Supplementary files

Supplementary Files
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1. Figure 1. Mechanisms of development of cerebral venous thrombosis and demyelination

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2. Figure 2. Hyperintense magnetic resonance lesions on T2-weighted image and FLAIR impulse sequence in the right temporal lobe (B); in the white matter of the frontal lobes

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3. Figure 3. Magnetic resonance venographic picture: absence of a signal from the blood flow in a significant part of the left transverse sinus (A), which does not allow to exclude thrombosis or slowing of blood flow (B), taking into account the Cor N1 weighted image

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4. Figure 4. Magnetic resonance venographic features suggestive of a single thrombus in the right transverse sinus (A). However, considering raw data (B) and native T2-weighted image, these changes are arachnoid granulations growing into the sinus (C)

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Copyright (c) 2022 Klocheva Y.G., Olimova F.Z., Goldobin V.V., Bogatenkova J.D.

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