An Australian case series of vaccine-induced thrombotic thrombocytopenia (VITT) following first ChAdOx1 COVID-19 vaccinations highlights the fact that the presentation can include arterial thrombosis in addition to venous involvement.
The case series, published in BMJ Neurology Open, comprised three women in their 50-60s.
Two women developed severe headaches within 7-10 days of vaccination which progressed to right-sided weakness in one case and reduced level of consciousness in the other. The third woman presented to hospital with convulsive status epilepticus 10 days after vaccination.
In Case 1, a CT demonstrated an extensive left common carotid thrombus extending into the left internal carotid artery (ICA) with a large penumbra of the left middle cerebral artery territory.
“The patient was administered intravenous alteplase and transferred for emergency endovascular clot retrieval. En route, the patient was found to have marked thrombocytopenia (platelet count 40×109/L), an elevated D-dimer of 8.55 mg/L (normal <0.50 mg/L) and fibrinogen level at the lower limit of normal (2.1 g/L, reference 2–4 g/L). Thrombolysis was promptly ceased given the severe thrombocytopenia and she underwent endovascular clot retrieval with excellent angiographic result.”
CT in Case 2 demonstrated extensive right-sided temporal lobe haemorrhage with mass effect.
The patient underwent an emergency right-sided decompressive craniectomy and temporal intracranial haemorrhage removal.
In Case 3, CT brain and venogram demonstrated extensive CVST with a large left temporo-occipital haemorrhagic transformation of a venous infarct with a mild degree of midline shift and transtentorial herniation