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Cerebral arterial and venous thrombosis due to COVID-19 vaccine-induced immune thrombotic thrombocytopenia
  1. Elaine Pang1,
  2. Soumya Ghosh1,
  3. Thomas Chemmanam1,
  4. Carolyn Grove2 and
  5. Tim Phillips3
  1. 1Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  2. 2Haematology and Path West, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  3. 3Neurointerventional Service of Western Australia, Sir Charles Gardiner Hospital, Nedlands, Western Australia, Australia
  1. Correspondence to Professor Soumya Ghosh; soumya.ghosh{at}health.wa.gov.au

Abstract

Vaccine-induced immune thrombotic thrombocytopenia (VITT) rarely develops after many COVID-19 vaccines. A 51-year-old woman re-presented to hospital with a 4 day history of headache, vomiting, diarrhoea and left calf pain, 11 days after her first dose of ChAdOx1nCoV-19 (AstraZenica) vaccine. Her neurological examination was normal. Blood tests demonstrated a low platelet count, raised D-dimer and CRP, and a positive heparin/anti-PF4 antibody assay. CT venogram demonstrated widespread cerebral venous sinus thrombosis. She was commenced on fondaparinux and intravenous immunoglobulins. The following day she developed an asymmetric quadriplegia and aphasia. CT angiogram demonstrated new bilateral cervical internal carotid artery (ICA) thrombi. She underwent stent-retriever mechanical thrombectomy of bilateral ICA and cerebral venous sinuses. Next day she had right hemiparesis and expressive dysphasia, which are improving. Thromboses due to VITT can progress rapidly to involve cerebral arteries and venous sinuses, and may warrant urgent arterial and venous thrombectomy to reduce morbidity and mortality.

  • neurology
  • stroke
  • vaccination/immunisation

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Footnotes

  • Contributors All authors were involved in the care of the patient, made substantial contributions to the conception of the work and interpretation of data for the work. They drafted (EP) or revised (SG, TC, CG, TP) it critically for important intellectual content. All authors approved of the submitted manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests EP is employed by the Department of Health, Government of Western Australia. She declares no conflict of interest. SG is employed by the Department of Health, Government of Western Australia, and the Perron Institute for Neurological and Translational Science, QEII Medical Centre, Western Australia. He has been on medical advisory boards of Abbvie and Ipsen. He declares no conflict of interest. TC is employed by the Department of Health, Government of Western Australia, and St John of God Health Care at the Midland Public Hospital, Western Australia. He declares no conflict of interest. CG is employed by the Department of Health, Government of Western Australia. She has received travel support to attend an educational meeting (Novartis). She has been on medical advisory boards for Abbvie and Astellas. She declares no conflict of interest. TP is employed by the Department of Health, Government of Western Australia. He has consultancy agreements with Stryker Neurovascular, Medtronic, Microvention and Penumbra. TP sits on medical advisory boards for Stryker Neurovascular and Argenica. TP has no relevant stock ownership.

  • Provenance and peer review Not commissioned; externally peer reviewed.