Relevance. During the COVID‑19 pandemic, there has been an increase in the frequency of cerebral venous thrombosis (CVT) by 30–60 times. At the same time, the development of CVT does not depend on the severity of COVID‑19. Diagnosis of CVT during the COVID‑19 pandemic is particularly difficult, since the most common symptom of CVT, headache, can be regarded as a manifestation of COVID‑19. A wide range of clinical symptoms and low alertness of doctors leads to late diagnosis and verification of CVT.Purpose of the study. To analyze the features of clinical manifestations and neuroimaging signs of CVT against the background of COVID‑19. Patients and methods. We examined 70 young and middle-aged patients with COVID‑19 of varying severity, who underwent inpatient treatment in angio-neurological and re-profiled infectious diseases departments of North-Western State Medical University n. a. I. I. Mechnikov (Saint Petersburg, Russia) at the age of 18 to 59 years (38.5 ± 11.58), of which 49 (70 %) women and 21 (30 %) men.Results. The most common neurological symptom in patients with CVT due to COVID‑19 was diffuse headache. The severity of COVID‑19 and the degree of lung damage did not correlate with the severity of CVT. In 32 (46 %) cases, CVT was accompanied by the development of venous stroke: ischemic – in 13 (19 %) patients, hemorrhagic – in 7 (10 %), ischemic stroke with hemorrhagic impregnation – in 12 (17 %) patients. According to the localization of the thrombus, thrombosis of the left transverse sinus was most often noted – in 39 (57 %) cases.Conclusions. The leading symptom in all patients with CVT was headache, which was not relieved by taking conventional analgesics, which caused clinical alertness of doctors. Early diagnosis of CVT ensured the immediate start of anticoagulant therapy and contributed to positive dynamics in all patients in the form of regression of neurological deficit and improvement in general condition.

The novel coronavirus (SARS‑CoV‑2) infection manifested by a pandemic and has a wide range of complications, including the nervous system’s complications. Despite the fact that older people with comorbidities are more at risk of developing complications from the sequelae of previous COVID‑19 disease, a significant link between the novel coronavirus infection and cerebrovascular disorders in young and middle‑aged people is increasingly mentioned in the literature. The development of cerebrovascular complications in these people not only depends on the damaging effect of the novel coronavirus infection on the macroorganism, but also on a number of other factors, in particular, on the genetic factors of the blood coagulation system. Further study of the possible influence the novel coronavirus infection on the development of cerebrovascular complications, taking into account the genetic factors of the blood coagulation system in young and middle‑aged people will provide early prevention and timely correction of cerebrovascular disorders.

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.

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.