A 76-year-old female with cerebral venous sinus thrombosis after ChAdOx1 nCoV-19 vaccination: A case report and review literature

Authors

  • Chalinee Puangpoon Narathiwat hospital

Keywords:

cerebral venous sinus thrombosis, vaccine, COVID-19

Abstract

A 76-year-old female presented with acute progressive onset of global aphasia with right hemiparesis for 7 days after COVID-19, ChAdOx1 nCoV-19, vaccination. Magnetic resonance imaging/ venography showed cerebral venous sinus thrombosis in the left transverse sinus, left sigmoid sinus, and left jugular vein. Laboratory results reviewed elevated d-dimer levels and thrombocytopenia. At first, vaccine-induced immune thrombotic thrombocytopenia (VITT) was suspected. She was treated with intravenous immunoglobulin, corticosteroid and apixaban. Finally, she was found to meet the criteria for diagnosis of probable antiphospholipid syndrome. VITT was excluded due to negative anti-platelet factor 4 antibodies by ELISA.

References

Pinho AC. COVID-19 Vaccine AstraZeneca: benefits still outweigh the risks despite possible link to rare blood clots with low platelets. European Medicines Agency. Published March 18, 2021. Accessed March 24, 2021.

Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Lund-Johansen F, Ahlen MT, et al. Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;384(22):2124-30.

Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 Vaccination. N Engl J Med. 2021;384(22):2092-101.

See I, Su JR, Lale A, Woo EJ, Guh AY, Shimabukuro TT, et al. US Case Reports of Cerebral Venous Sinus Thrombosis With Thrombocytopenia After Ad26.COV2.S Vaccination, March 2 to April 21, 2021. JAMA. 2021;325(24):2448-56.

Scully M, Singh D, Lown R, Poles A, Solomon T, Levi M, et al. Pathologic Antibodies to Platelet Factor 4 after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021;384(23):2202-11.

สมาคมโลหิตวิทยาแห่งประเทศไทย. คำแนะนำการดูแลรักษาผู้ป่วยที่เกิดภาวะเกล็ดเลือดต่ำที่กระตุ้นการเกิดหลอดเลือดอุดตันจากภูมิคุ้มกันภายหลังได้รับวัคซีน Vaccine-induced immune thrombotic thrombocytopenia (VITT). 2564.

Greinacher A, Selleng K, Warkentin TE. Autoimmune heparin-induced thrombocytopenia. J Thromb Haemost. 2017;15(11):2099-114.

Oldenburg J, Klamroth R, Langer F, Albisetti M, von Auer C, Ay C, et al. Diagnosis and Management of Vaccine-Related Thrombosis following AstraZeneca COVID-19 Vaccination: Guidance Statement from the GTH. Hamostaseologie. 2021;41(3):184-9.

Mahase E. AstraZeneca vaccine: Blood clots are “extremely rare” and benefits outweigh risks, regulators conclude. BMJ (Clinical research ed). 2021;373:n931.

Tan BK, Mainbourg S, Friggeri A, Bertoletti L, Douplat M, Dargaud Y, et al. Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax. 2021;thoraxjnl-2020-215383.

Omer T, Mullaguri N, George P, Newey CR. False-Negative Platelet Factor 4 Antibodies and Serotonin Release Assay and the Utility of Repeat Testing in the Diagnosis of Heparin-Induced Thrombocytopenia and Thrombosis. Case Rep Hematol. 2019;2019:1585014.

Patel R, Varga C. Heparin-induced thrombocytopenia in a cardiac surgery patient with early and persistent thrombocytopenia and initial negative immunological and functional assays. Thromb Res. 2018;169:93-5.

Downloads

Published

2021-08-24

How to Cite

1.
Puangpoon C. A 76-year-old female with cerebral venous sinus thrombosis after ChAdOx1 nCoV-19 vaccination: A case report and review literature. J Thai Stroke Soc [Internet]. 2021 Aug. 24 [cited 2024 Jun. 21];20(2):29. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/250836

Issue

Section

Case Report