scholarly journals Cerebral venous sinus thrombosis secondary to ChAdOx-1 nCov-19 vaccine

2021 ◽  
Vol 14 (12) ◽  
pp. e246200
Author(s):  
Syed Noman Atta ◽  
Nariman Othman ◽  
Munir Babar
Keyword(s):  
Sinus Thrombosis ◽  
Rare Condition ◽  
Cerebral Venous Sinus Thrombosis ◽  
Platelet Factor 4 ◽  
Prior History ◽  
Cerebral Veins ◽  
Thromboembolic Events ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
History Of

Thrombosis and thrombocytopaenia secondary to ChAdOx-1 nCov-19 vaccine is a new phenomenon that usually occurs after the first dose of vaccine. Most of these patients are healthy without any prior history of thromboembolic events or heparin use. Hall marks of this condition include detectable antibodies to platelet factor 4 and thrombosis at atypical sites particularly cerebral veins and sinuses mimicking atypical heparin induced thrombocytopaenia. We describe a case of a patient who was diagnosed with this rare condition and treated successfully.

scholarly journals Cerebral venous sinus thrombosis after ChAdOx1 nCov-19 vaccination with a misleading first cerebral MRI scan

2021 ◽  
pp. svn-2021-001095
Author(s):  
Benno Ikenberg ◽  
Antonia Franziska Demleitner ◽  
Thomas Thiele ◽  
Benedikt Wiestler ◽  
Katharina Götze ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Intravenous Immunoglobulins ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Pathological Findings ◽  
Mri Scan ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Activation Assay ◽  
Cerebral Mri

Vaccine-induced immune thrombotic thrombocytopenia (VITT) and cerebral venous sinus thrombosis (CVST) have been recently described as rare complications following vaccination against SARS-CoV-2 with vector vaccines. We report a case of a young woman who presented with VITT and cerebral CVST 7 days following vaccination with ChAdOx1 nCov-19 (AstraZeneca). While the initial MRI was considered void of pathological findings, MRI 3 days later revealed extensive CVST of the transversal and sigmoidal sinus with intracerebral haemorrhage. Diagnostic tests including a platelet-factor-4-induced platelet activation assay confirmed the diagnosis of VITT. Treatment with intravenous immunoglobulins and argatroban resulted in a normalisation of platelet counts and remission of CVST.

scholarly journals Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Derya Uluduz ◽  
Sevki Sahin ◽  
Taskin Duman ◽  
Serefnur Ozturk ◽  
Vildan Yayla ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Previous History ◽  
Epileptic Seizures ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Venous Sinus Thrombosis ◽  
History Of ◽  
The Mean

Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38±9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). Conclusion. The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.

scholarly journals A Lady with Systemic Lupus Erythematosus Complicated with Central Venous Sinus Thrombosis: A Case Report

2020 ◽  
Vol 20 (01) ◽  
pp. 42-46
Author(s):  
Alexandra Hoi Yan Ng ◽  
Daniel Kam Hung Ng
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Antiphospholipid Antibodies ◽  
Sinus Thrombosis ◽  
Rare Condition ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Systemic Lupus ◽  
Venous Sinus Thrombosis ◽  
Increased Risk

Systemic lupus erythematosus (SLE) is associated with an increased risk of venous thromboses and cerebrovascular diseases. Herein, we discuss the case of a young 38-year-old Asian lady who was presented with cerebral venous sinus thrombosis (CVST) shortly after she was diagnosed with SLE. She developed headache, right hemiparesis and sustained an episode of seizure on the first presentation. CVST was diagnosed with plain computed tomography (CT) of the brain and CT venogram. With prompt administration of anticoagulation and immunosuppressant treatment for SLE, she had an excellent neurological recovery. There are many different risk factors for developing CVST in SLE patients. It has been reported in literature that CVST is usually associated with antiphospholipid antibodies but only around 40% of them would have positive antiphospholipid antibodies indicating that there are also other mechanisms contributing to the process [1]. As CVST in SLE is a rare condition, no standardized treatment strategy has been delineated. The main cornerstone of treatment would be anticoagulation and appropriate treatment for SLE as these patients are commonly associated with underlying active SLE. With timely management, the prognosis for CVST in SLE patients is generally favourable.

scholarly journals Prothrombotic immune thrombocytopenia after COVID-19 vaccine

Blood ◽  
2021 ◽  
Author(s):  
Andreas Tiede ◽  
Ulrich J Sachs ◽  
Andreas Czwalinna ◽  
Sonja Werwitzke ◽  
Rolf Bikker ◽  
...  
Keyword(s):  
Healthy Donor ◽  
Immune Thrombocytopenia ◽  
Sinus Thrombosis ◽  
Clinical Manifestations ◽  
Cerebral Venous Sinus Thrombosis ◽  
Dependent Manner ◽  
Thromboembolic Events ◽  
Platelet Factor ◽  
Vein Thrombosis ◽  
Heparin Anticoagulation

We report five cases of prothrombotic immune thrombocytopenia after exposure to the ChAdOx1 vaccine (AZD1222, Vaxzevria) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients presented 5 to 11 days after first vaccination. The spectrum of clinical manifestations included cerebral venous sinus thrombosis (CVST), splanchnic vein thrombosis (SVT), arterial cerebral thromboembolism, and thrombotic microangiopathy (TMA). All patients had thrombocytopenia and markedly elevated D-Dimer. Autoantibodies against platelet factor 4 (PF4) were detected in all patients although they had never been exposed to heparin. Immunoglobulin from patient sera bound to healthy donor platelets in an AZD1222-dependant manner, suppressed by heparin. Aggregation of healthy donor platelets by patient sera was demonstrated in the presence of buffer or AZD1222 and was also suppressed by heparin. Anticoagulation alone or in combination with eculizumab or intravenous immunoglobulin (IVIG) resolved the pathology in three patients. Two patients had thromboembolic events despite anticoagulation at a time when platelets were increasing after IVIG. In summary, an unexpected autoimmune prothrombotic disorder is described after vaccination with AZD1222. It is characterized by thrombocytopenia and anti-PF4 antibodies binding to platelets in AZD1222-dependent manner. Initial clinical experience suggests a risk of unusual and severe thromboembolic events.

Abstract 1122‐000170: Stent Retrievers Utilization in Endovascular Treatment of Cerebral Venous Sinus Thrombosis

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Abdallah O Amireh ◽  
Hassan Ali ◽  
Muhammad Nagy ◽  
Siddhart Mehta ◽  
Haralabos Zacharatos ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Sinus Thrombosis ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Stent Retriever ◽  
Venous Sinus ◽  
Heparin Infusion ◽  
Venous Sinus Thrombosis ◽  
History Of ◽  
Stent Retrievers

Introduction : Patients with Cerebral Venous Sinus Thrombosis (CVT) are candidates for Endovascular Mechanical Thrombectomy (EMT) in cases of coma on presentation or clinical deterioration despite anticoagulation. We present two cases of CVT successfully treated with mechanical thrombectomy using Medtronic’s Solitaire Stent retriever. Methods : A retrospective review at a single center university hospital was performed for all cerebral venous sinus thrombosis case log from December 2018 to November 2020. Cases resistant to conventional medical therapy that underwent intrasinus stent retriever endovascular thrombectomy were noted. Results : Case 1: 26 year‐old male with a history of hypertension presented with 2 weeks of headaches, left sided numbness and blurriness of vision. Imaging revealed superior sagittal (SSS) and bilateral transverse sinus thrombosis. Patient was treated with heparin infusion and discharged home on oral apixaban. The following day he presented with new onset expressive aphasia. Imaging was unchanged. Due to worsening symptoms despite anticoagulation, Patient underwent mechanical thrombectomy using a stent retriever. Solitaire 6 × 40 mm stent was advanced and deployed through the microcatheter and retracted in the upper segment of posterior one third of SSS followed by alteplase infusion at 1 mg/hr (25 ml/hr) via Berenstein catheter for the next 36 hours. Intravenous heparin infusion was also started with aPTT goal 60–80. Cerebral angiogram was repeated two days later revealing successful recanalization of previously thrombosed SSS and bilateral transverse sinuses with significantly improved cerebral venous drainage. Patient was transitioned again to oral apixaban. Repeat CTA in 3 months showed significantly improved patency and recanalization. Case 2: A 42 year‐old male with history of ulcerative colitis presented with sudden onset right‐sided hemiparesis and hemisensory loss along with one month of headaches. Presenting NIHSS 14. Imaging revealed SSS thrombosis with thrombosis of the left transverse sinus complicated by left frontal intraparenchymal hemorrhage and subarachnoid hemorrhage. Patient underwent mechanical thrombectomy of SSS using Solitaire 6 × 40mm stent retriever with distal aspiration resulting in improved flow. Clinical course was complicated by seizures and acute respiratory distress syndrome requiring intubation followed by tracheostomy and G‐tube placement which were eventually removed during recovery. Patient was treated with high intensity heparin during his hospitalization and eventually transitioned to apixaban. Work up revealed protein S deficiency. Serial CT angiograms at 6 and 11 months revealed resolution of CVT. NIHSS improved to 1 with mRS of 2. Conclusions : These cases imply that intra‐cerebrovenous sinus mechanical thrombectomy with stent retrievers may be considered in patients with continuing worsening despite optimal medical management.

Cerebral Venous Sinus Thrombosis due to Thrombosis with Thrombocytopenia Syndrome Following Ad26.COV2.S: A First Real-World Case Report of a Male Subject

2021 ◽  
pp. 194187442110550
Author(s):  
Samia Asif ◽  
Meghana Kesireddy ◽  
Scott A. Koepsell ◽  
Marco A. Gonzalez-Castellon ◽  
Krishna Gundabolu ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Young Male ◽  
Cerebral Venous Sinus Thrombosis ◽  
Venous Sinus ◽  
Platelet Factor ◽  
Venous Sinus Thrombosis ◽  
Vein Thrombosis ◽  
First Case ◽  
Control And Prevention ◽  
Underlying Pathophysiology

Thrombosis with Thrombocytopenia Syndrome (TTS) or Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) had been reported in patients receiving the Ad26.COV2.S vaccination (Johnson & Johnson [J&J]/Janssen) vaccine. They frequently presented with cerebral venous sinus thrombosis (CVST), but venous or arterial thrombosis at other locations can be present. The majority of those affected are younger adult females. Therefore, after a brief pause from April 13–23, 2021, the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) recommended caution in using this vaccine in females under 50 years. Based on the reported 28 cases of TTS after this vaccination (data till April 21, 2021) by CDC, 22 were females (78%), and 6 were male. None of those males had CVST but had thrombosis at other locations. We report the first case of a young male with TTS and CVST following Ad26.COV2.S vaccine presented with severe headache and diagnosed with acute right transverse and sigmoid cerebral venous sinus thrombosis, multiple right-sided pulmonary emboli, and right hepatic vein thrombosis. He was treated with parenteral anticoagulation with argatroban and intravenous immune globulin with the improvement of his symptoms. A heparin-induced thrombocytopenia with thrombosis (HITT) like syndrome caused by the genesis of a platelet-activating autoantibody against platelet factor 4 (PF4) triggered by adenoviral vector-based COVID-19 vaccinations is understood to be the underlying pathophysiology. TTS with CVST should be considered when patients present with headaches, stroke-like neurological symptoms, thrombocytopenia, and symptom onset 6–15 days after Ad26.COV2.S vaccination.

scholarly journals Diagnosis and treatment of headache probably attributed to cerebral venous sinus thrombosis

2014 ◽  
Vol 8 (4) ◽  
pp. 97-101
Author(s):  
Rosario Iannacchero ◽  
Amerigo Costa ◽  
Antonio Sergi ◽  
Aida Squillace ◽  
Giuseppe Vescio ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Sinus Thrombosis ◽  
Rare Condition ◽  
Transverse Sinus ◽  
Cerebral Venous Sinus Thrombosis ◽  
Warning Signs ◽  
Venous Sinus ◽  
Diagnosis And Treatment ◽  
Secondary Headache ◽  
Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is a rare condition whose most common and sometimes only symptom is headache. Alas, diagnosis and treatment of CVST is often delayed or overlooked because of its high clinical variability. Using guidelines advices in detecting warning signs or symptoms of secondary headaches might ease the diagnosis of CVST.The article presents the case of a woman who is in treatment for chronic migraine and assessed for secondary headache in a multidisciplinary outpatient headache program. Alert symptoms like sudden worsening headache presentation, along with anamnestic cues, prompted neuroimaging that detected left transverse sinus thrombosis whose onset was difficult to date.

scholarly journals Cerebral venous sinus thrombosis (CVST) is not significantly linked to COVID-19 vaccines or non-COVID vaccines in a large multi-state US health system

2021 ◽  
Author(s):  
Colin Pawlowski ◽  
John Rincón-Hekking ◽  
Samir Awasthi ◽  
Viral Pandey ◽  
Patrick Lenehan ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Time Windows ◽  
Cerebral Venous Sinus Thrombosis ◽  
Incidence Rates ◽  
Venous Sinus ◽  
Vaccine Hesitancy ◽  
Prior History ◽  
Venous Sinus Thrombosis ◽  
Before And After ◽  
Study Population

Cerebral venous sinus thrombosis (CVST) has been reported in a small number of individuals who have received the mRNA vaccines1 or the adenoviral vector vaccines for COVID-19 in the US2 and Europe3. Continued pharmacovigilance is integral to mitigating the risk of rare adverse events that clinical trials are underpowered to detect, however, these anecdotal reports have led to the pause or withdrawal of some vaccines in many jurisdictions and exacerbated vaccine hesitancy at a critical moment in the fight against the COVID-19 pandemic. We investigated the frequencies of CVST seen among individuals who received FDA-authorized COVID-19 vaccines from Pfizer-BioNTech (n = 94,818 doses), Moderna (n = 36,350 doses) and Johnson & Johnson - J&J (n = 1,745 doses), and among individuals receiving one of 10 FDA-approved non-COVID-19 vaccines (n = 771,805 doses). Comparing the incidence rates of CVST in 30-day time windows before and after vaccination, we found no statistically significant differences for the COVID-19 vaccines or any other vaccines studied in this population. In total, we observed 3 cases of CVST within the 30 days following Pfizer-BioNTech vaccination (2 females, 1 male; Ages (years): [79, 80, 84]), including one individual with a prior history of thrombosis and another individual with recent trauma in the past 30 days. We did not observe any cases of CVST among the patients receiving Moderna or J&J vaccines in this study population. We further found the baseline CVST incidence in the study population between 2017 and 2021 to be 45 to 98 per million patient years. Overall, this real-world evidence-based study highlights that CVST is rare and is not significantly associated with COVID-19 vaccination. In addition, there is a need for a concerted international effort to monitor EHR data across diverse patient populations and to investigate the underlying biological mechanisms leading to these rare clotting events.

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