Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

Tobias Braun; Maxime Viard; Martin Juenemann; Tobias Struffert; Frank Schwarm; Hagen B Huttner; Florian C Roessler

doi:10.3389/fneur.2021.763049

Case Report: Take a Second Look: Covid-19 Vaccination-Related Cerebral Venous Thrombosis and Thrombotic Thrombocytopenia Syndrome

Front Neurol. 2021 Nov 22:12:763049. doi: 10.3389/fneur.2021.763049. eCollection 2021.

Authors

Tobias Braun¹, Maxime Viard¹, Martin Juenemann¹, Tobias Struffert², Frank Schwarm³, Hagen B Huttner¹, Florian C Roessler¹

Affiliations

¹ Department of Neurology, University Hospital Giessen, Giessen, Germany.
² Department of Neuroradiology, University Hospital Giessen, Giessen, Germany.
³ Department of Neurosurgery, University Hospital Giessen, Giessen, Germany.

Abstract

We present two cases of ChAdOx1 nCov-19 (AstraZeneca)-associated thrombotic thrombocytopenia syndrome (TTS) and cerebral venous sinus thrombosis (CVST). At the time of emergency room presentation due to persistent headache, blood serum levels revealed reduced platelet counts. Yet, 1 or 4 days after the onset of the symptom, the first MR-angiography provided no evidence of CVST. Follow-up imaging, performed upon headache refractory to nonsteroidal pain medication verified CVST 2-10 days after initial negative MRI. Both the patients received combined treatment with intravenous immunoglobulins and parenteral anticoagulation leading to an increase of platelet concentration in both the individuals and resolution of the occluded cerebral sinus in one patient.

Keywords: ChAdOx1 nCoV-19 vaccine; Covid-19-vaccination; cerebral venous thrombosis; thrombotic thrombocytopenia syndrome; vaccine-induced thrombotic thrombocytopenia.

Publication types

Case Reports