Cerebral venous sinus thrombosis associated with thrombocytopenia after the second dose of Chadox1 nCov-19 vaccination
Case Study
Abstract
Introduction: Reports of cerebral venous sinus thrombosis (CVST) after vaccination against SARS-CoV-2 have raised safety concerns and an emerging mechanism termed vaccine-induced immune thrombotic thrombocytopenia (VITT) was identified.
Objective: We aimed to estimate the frequency of CVST and other cerebrovascular events after vaccination.
Case study: We describe the case of a young male, who developed severe thrombocytopenia and CVST following the second dose of the covid 19 vaccine. He presented with a headache, with subsequent rapid neurological deterioration. The patient was successfully treated and discharged with the stable condition after 09 days of admission. We attribute this Adverse Event following Immunization (AEFI) of thrombotic condition to the vaccine due to the remarkable temporal relationship.
Conclusions: The proposed mechanism of VITT is the production of rogue antibodies against platelet factor-4 resulting in massive platelet aggregation. Radiologists and physicians should be aware and pay attention to early imaging signs of cerebral venous sinus thrombosis for timely diagnosis and treatment.
Downloads
References
Coutinho, J. M., Zuurbier, S. M., Aramideh, M., & Stam, J. (2012). The incidence of cerebral venous thrombosis: a cross-sectional study. Stroke, 43(12), 3375–3377.
Devasagayam, S., Wyatt, B., Leyden, J., & Kleinig, T. (2016). Cerebral Venous Sinus Thrombosis Incidence Is Higher Than Previously Thought: A Retrospective Population-Based Study. Stroke, 47(9), 2180–2182.
Furie, K. L., Cushman, M., Elkind, M., Lyden, P. D., Saposnik, G., & American Heart Association/American Stroke Association Stroke Council Leadership (2021). Diagnosis and Management of Cerebral Venous Sinus Thrombosis With Vaccine-Induced Immune Thrombotic Thrombocytopenia. Stroke, 52(7), 2478–2482.
Joly, B. S., Coppo, P., & Veyradier, A. (2017). Thrombotic thrombocytopenic purpura. Blood, 129(21), 2836–2846.
Lee, E. J., Cines, D. B., Gernsheimer, T., Kessler, C., Michel, M., Tarantino, M. D., Semple, J. W., Arnold, D. M., Godeau, B., Lambert, M. P., & Bussel, J. B. (2021). Thrombocytopenia following Pfizer and Moderna SARS-CoV-2 vaccination. American journal of hematology, 96(5), 534–537.
Nazy, I., Sachs, U. J., Arnold, D. M., McKenzie, S. E., Choi, P., Althaus, K., Ahlen, M. T., Sharma, R., Grace, R. F., & Bakchoul, T. (2021). Recommendations for the clinical and laboratory diagnosis of VITT against COVID-19: Communication from the ISTH SSC Subcommittee on Platelet Immunology. Journal of thrombosis and haemostasis : JTH, 19(6), 1585–1588.
Sangli, S., Virani, A., Cheronis, N., Vannatter, B., Minich, C., Noronha, S., Bhagavatula, R., Speredelozzi, D., Sareen, M., & Kaplan, R. B. (2021). Thrombosis With Thrombocytopenia After the Messenger RNA-1273 Vaccine. Annals of internal medicine, 174(10), 1480–1482.
Schulz, J. B., Berlit, P., Diener, H. C., Gerloff, C., Greinacher, A., Klein, C., Petzold, G., Poli, S., Piccininni, M., Kurth, T., Roehrig, R. (2021.) COVID-19 vaccine-associated cerebral venous thrombosis in Germany: a descriptive study. medRxiv. 2021 Jan 1.
Scully, M., Singh, D., Lown, R., Poles, A., Solomon, T., Levi, M., Goldblatt, D., Kotoucek, P., Thomas, W., & Lester, W. (2021). Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination. The New England journal of medicine, 384(23), 2202–2211.
Silvis, S. M., de Sousa, D. A., Ferro, J. M., & Coutinho, J. M. (2017). Cerebral venous thrombosis. Nature reviews. Neurology, 13(9), 555–565.
Wise J. (2021). Covid-19: European countries suspend use of Oxford-AstraZeneca vaccine after reports of blood clots. BMJ (Clinical research ed.), 372, n699.
Yavaşoğlu İ. (2020). Vaccination and Thrombotic Thrombocytopenic Purpura. Turkish journal of haematology : official journal of Turkish Society of Haematology, 37(3), 218–219.
Copyright (c) 2021 Sagar Bhimani, Harsha Makwana, Supriya Malhotra
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
