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

Stroke Vasc Neurol. 2021 Dec;6(4):668-670. doi: 10.1136/svn-2021-001095. Epub 2021 Jul 8.

Abstract

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.

Keywords: COVID-19; MRI; blood platelets; complication; haemorrhage.

Publication types

  • Case Reports

MeSH terms

  • COVID-19 Vaccines
  • COVID-19*
  • ChAdOx1 nCoV-19
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • SARS-CoV-2
  • Sinus Thrombosis, Intracranial* / chemically induced
  • Sinus Thrombosis, Intracranial* / diagnostic imaging
  • Sinus Thrombosis, Intracranial* / drug therapy
  • Vaccination

Substances

  • COVID-19 Vaccines
  • ChAdOx1 nCoV-19