Extensive Cerebral Venous Thrombosis following by COVID-19 Vaccine with Concomitant COVID-19 Infection

Cheong xk; Tan JK; Lim cj; Kori n; Periyasamy P

Case Report Published on 14 Mar, 2024

Extensive Cerebral Venous Thrombosis following by COVID-19 Vaccine with Concomitant COVID-19 Infection

Thrombosis due to COVID-19 Infection or Vaccine

Vol. 19 No. 1 : 2024 (324-329)

Cheong xk

Tan JK

Lim cj

Kori n

Periyasamy P

Abstract

Coronavirus disease 2019 (COVID-19) vaccines have been introduced to the masses for just over two years. Majority reported adverse events post vaccination are minor side effect such as pain or inflammation at local injection site. Serious side effects such as thrombotic events or myocarditis are rarely reported. Cerebral venous sinus thrombosis (CVST) is a thrombotic complication that may occur within one to two weeks from vaccine administration. We illustrated a case from our centre involving a healthy young lady who presented with headache and an episode of seizure following by vaccination. She was concurrently diagnosed with CVST and COVID-19 infection later with the aid of neuroimaging. The patient's normal platelet count made the diagnosis of vaccine induced immune related thrombotic thrombocytopenia unlikely. While serious adverse events are reported, such as our case, this should not support the growing vaccine hesitancy among the public as its benefits still greatly outweigh its risk at this juncture.

Keywords : Cerebral venous sinus thrombosis, COVID-19, vaccine,

Abstrak

Vaksin penyakit Coronavirus 2019 (COVID-19) telah diperkenalkan sejak dua tahun lepas di seluruh dunia. Kebanyakan kesan sampingan yang dilaporkan selepas vaksinasi merupakan gejala ringan seperti sakit otot dan sakit pada tempat suntikan. Kesan sampingan yang serius seperti kejadian trombotik atau miokarditis jarang berlaku. Trombosis sinus vena serebrum (CVST) adalah komplikasi trombotik yang mungkin berlaku dalam tempoh satu hingga dua minggu selepas vaksinasi. Kami ingin melaporkan kes melibatkan seorang wanita muda yang mengalami sakit kepala dan sawan selepas vaksinasi. Keputusan imbasan otak menunjukkan CVST dan juga didiagnos dengan jangkitan COVID-19. Pesakit ini mempunyai platelet yang mencukupi. Oleh demikian, punca kejadian trombosis tidak berkaitan dengan tindak balas immuniti vaksin dengan platelet yang rendah Walau bagaimanapun, kejadian kesan sampingan tidak patut dijadikan sebagai alasan untuk meragui vaksinasi kerana faedahnya melebihi daripada risikonya pada ketika ini.

Kata Kunci : COVID-19, thrombosis sinus vena serebrum, vaksin,

Correspondance Address

Xiong Khee Cheong. Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-9145 5555 Email: cheongxk@gmail.com

References

Alhashim, A., Hadhiah, K., Al Khalifah, Z., Alhaddad, F.M., Al ARhain, S.A., Bin Saif, F.H., Abid, A., Al Gamdi, O., Alsulaiman, F., AlQarni, M. 2022. Extensive cerebral venous sinus thrombosis (CVST) after the first dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine without thrombotic thrombocytopenia syndrome (TTS) in a healthy woman. Am J Case Rep 23: e934744.

Al-Mufti, F., Amuluru, K., Sahni, R., et al. 2021. Cerebral venous thrombosis in COVID-19: A New York metropolitan cohort study. AJNR Am J Neuroradiol 42(7): 1196-200.

Chirico, F., Teixeira da Silva, J.A., Tsigaris, P., Sharun, K. 2022. Safety & effectiveness of COVID-19 vaccines: A narrative review. Indian J Med Res 155(1): 91-104.

de Gregorio, C., Calcaterra, G., Kounis, N. G., Bassareo, P.P., Mehta, J.L. 2022. Cerebral venous thrombosis after COVID-19 vaccines: Do we know the mechanism? Lancet Reg Health Eur 16: 100387.

Douxfils, J., Favresse, J., Dogné, J.M., Lecompte, T., Susen, S., Cordonnier, C., Mullier, F. 2021. Hypotheses behind the very rare cases of thrombosis with thrombocytopenia syndrome after SARS-CoV-2 vaccination. Thromb Res 203: 163-171.

Elfil, M., Aladawi, M., Balian, D., Fahad, I., Zhou, D.J., Villafuerte-Trisolini, B., Diesing, T.S. 2023. Cerebral venous sinus thrombosis after COVID-19 vaccination: A case report and literature review. Oxford Medical Case Reports, 2023(1): omac154.

Greinacher, A., Thiele, T., Warkentin, T.E., Weisser, K., Kyrle, P.A., Eichinger, S. 2021. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 384(22): 2092-101.

McCullough-Hicks, M.E., Halterman, D.J., Anderson, D., Cohen, K., Lakshminarayan, K. 2022. High incidence and unique features of cerebral venous sinus thrombosis in hospitalized patients with COVID-19 infection. Stroke 53(9): e407-10.

Novaes, N., Sadik, R., Sadik, J.C., Obadia, M. 2022. Epidemiology and management of cerebral venous thrombosis during the COVID-19 pandemic. Life (Basel) 12(8): 1105.

Ohaeri, C., Thomas, D.R., Salmon, J., Cottrell, S., Lyons, J., Akbari, A., Lyons, R.A., Torabi, F., Williams, C. 2022. Comparative risk of cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination or infection: A national cohort study using linked electronic health records. Hum Vaccin Immunother 18(6): 2127572.

Rao, E., Grover, P., Zhang, H. 2022. Thrombosis after SARS-CoV2 infection or COVID-19 vaccination: Will a nonpathologic anti-PF4 antibody be a solution? A narrative review. J BioX Res 5(3): 97-103.

Smadja, D.M., Yue, Q.Y., Chocron, R., Sanchez, O., Lillo-Le Louet, A. 2021. Vaccination against COVID-19: Insight from arterial and venous thrombosis occurrence using data from VigiBase. Eur Respir J 58(1): 2100956.

Solís Arce, J.S., Warren, S.S., Meriggi, N.F., Scacco, A., McMurry, N., Voors, M., Omer, S.B. 2021. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nat Med 27(8): 1385-94.

Taquet, M., Husain, M., Geddes, J.R., Luciano, S., Harrison, P.J. 2021. Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases. EClinicalMedicine 39: 101061.

Tu, T.M., Yi, S.J., Koh, J.S., Saffari, S.E., Hoe, R.H. M., Chen, G.J., Thirugnanam, U.N. 2022. Incidence of cerebral venous thrombosis following SARS-CoV-2 infection vs mRNA SARS-CoV-2 vaccination in Singapore. JAMA Netw Open 5(3): e222940.

Correspondance Address

Alhashim, A., Hadhiah, K., Al Khalifah, Z., Alhaddad, F.M., Al ARhain, S.A., Bin Saif, F.H., Abid, A., Al Gamdi, O., Alsulaiman, F., AlQarni, M. 2022. Extensive cerebral venous sinus thrombosis (CVST) after the first dose of Pfizer-BioNTech BNT162b2 mRNA COVID-19 vaccine without thrombotic thrombocytopenia syndrome (TTS) in a healthy woman. Am J Case Rep 23: e934744.

Al-Mufti, F., Amuluru, K., Sahni, R., et al. 2021. Cerebral venous thrombosis in COVID-19: A New York metropolitan cohort study. AJNR Am J Neuroradiol 42(7): 1196-200.

Chirico, F., Teixeira da Silva, J.A., Tsigaris, P., Sharun, K. 2022. Safety & effectiveness of COVID-19 vaccines: A narrative review. Indian J Med Res 155(1): 91-104.

de Gregorio, C., Calcaterra, G., Kounis, N. G., Bassareo, P.P., Mehta, J.L. 2022. Cerebral venous thrombosis after COVID-19 vaccines: Do we know the mechanism? Lancet Reg Health Eur 16: 100387.

Douxfils, J., Favresse, J., Dogné, J.M., Lecompte, T., Susen, S., Cordonnier, C., Mullier, F. 2021. Hypotheses behind the very rare cases of thrombosis with thrombocytopenia syndrome after SARS-CoV-2 vaccination. Thromb Res 203: 163-171.

Elfil, M., Aladawi, M., Balian, D., Fahad, I., Zhou, D.J., Villafuerte-Trisolini, B., Diesing, T.S. 2023. Cerebral venous sinus thrombosis after COVID-19 vaccination: A case report and literature review. Oxford Medical Case Reports, 2023(1): omac154.

Greinacher, A., Thiele, T., Warkentin, T.E., Weisser, K., Kyrle, P.A., Eichinger, S. 2021. Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 384(22): 2092-101.

McCullough-Hicks, M.E., Halterman, D.J., Anderson, D., Cohen, K., Lakshminarayan, K. 2022. High incidence and unique features of cerebral venous sinus thrombosis in hospitalized patients with COVID-19 infection. Stroke 53(9): e407-10.

Novaes, N., Sadik, R., Sadik, J.C., Obadia, M. 2022. Epidemiology and management of cerebral venous thrombosis during the COVID-19 pandemic. Life (Basel) 12(8): 1105.

Ohaeri, C., Thomas, D.R., Salmon, J., Cottrell, S., Lyons, J., Akbari, A., Lyons, R.A., Torabi, F., Williams, C. 2022. Comparative risk of cerebral venous sinus thrombosis (CVST) following COVID-19 vaccination or infection: A national cohort study using linked electronic health records. Hum Vaccin Immunother 18(6): 2127572.

Rao, E., Grover, P., Zhang, H. 2022. Thrombosis after SARS-CoV2 infection or COVID-19 vaccination: Will a nonpathologic anti-PF4 antibody be a solution? A narrative review. J BioX Res 5(3): 97-103.

Smadja, D.M., Yue, Q.Y., Chocron, R., Sanchez, O., Lillo-Le Louet, A. 2021. Vaccination against COVID-19: Insight from arterial and venous thrombosis occurrence using data from VigiBase. Eur Respir J 58(1): 2100956.

Solís Arce, J.S., Warren, S.S., Meriggi, N.F., Scacco, A., McMurry, N., Voors, M., Omer, S.B. 2021. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nat Med 27(8): 1385-94.

Taquet, M., Husain, M., Geddes, J.R., Luciano, S., Harrison, P.J. 2021. Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases. EClinicalMedicine 39: 101061.

Tu, T.M., Yi, S.J., Koh, J.S., Saffari, S.E., Hoe, R.H. M., Chen, G.J., Thirugnanam, U.N. 2022. Incidence of cerebral venous thrombosis following SARS-CoV-2 infection vs mRNA SARS-CoV-2 vaccination in Singapore. JAMA Netw Open 5(3): e222940.