A rare cause of headache-cerebral sinus venous thrombosis after COVID-19 vaccination

Introduction: Cerebral sinus venous thrombosis (CSVT) is a rare complication of COVID-19 vaccination. There is an incidence of 0.55 per 100,000 person-months. We describe a case of CSVT post COVID-19 vaccine. Case description: A 58-year-old male presented to a district General hospital after being involved in an RTC with a 3 month history of left sided headache which had followed his first COVID-19 vaccine (AstraZeneca). No focal neurological deficits were elicited. Blood results were unremarkable. Radiological workup suggested left transverse and sigmoid sinus thrombosis with no other intracranial complications. The patient was admitted and managed with low molecular weight heparin with an uneventful recovery. Discussion(s): CSVT is a rare and sometimes fatal disease. An increased risk of CSVT after COVID-19 vaccination has been suggested. An underlying immunological mechanism is suspected with The involvement of platelet factor-4 (PF4) antibody. Headache is The most common presenting symptom with onset within one week of vaccination. Positive D-dimer, PF4 IgG assay and thrombocytopenia may also support The diagnosis. CSVT may progress to major complications including intracranial haemorrhage and even death. Prompt diagnosis and appropriate treatment prevents neuroSurgical intervention such as decompressive craniotomy and may improve neurological outcome. Conclusion(s): This case describes an important and rare finding of complications following COVID-19 vaccine. Consideration should be made in management for patients with a recent history of COVID 19 vaccination presenting with features of headache. A high level of clinical suspicion is needed to investigate and manage these patients appropriately with potential CSVT.

A Ticking Time Bomb-incidental finding of a giant thoracoabdominal aneurysm

Background: Giant aortic aneurysm is a rare clinical entity. They may present with typical features of chest pain, or most feared complications with dissection and rupture. However, an asymptomatic and unruptured giant thoracic aneurysm is extremely rare with only two case reports in the literature. Case presentation: An 80-year-old lady admitted to a local district general hospital with a 5-day history of productive cough with shivers. She tested positive for COVID-19 on admission. Diagnostic workup demonstrated an incidental finding of a giant TAAA. Her case was referred to a tertiary hospital for vascular Multidisciplinary Team (MDT) discussion and planning. It was decided that for her to have pre-operative assessment and MDT discussion after her recovery from infection to have definitive management of the TAAA. The patient is currently being managed supportively in hospital. Discussion: According to National Institute for Health and Care Excellence (NICE), asymptomatic and 5.5cm or larger aneurysm should be considered for repair. The case should be discussed in terms of the overall balance of benefits and risks with repair and conservative management, based on the current status of health and the expected future health. In this case, it was deemed that the risk of proceeding with repair at present outweighed the benefits. Conclusion: This case describes a rare incidental finding of a giant TAAA. It emphasises the importance of MDT approach to direct and achieve appropriate management for a complex TAAA. Care treatment prioritisation, surgical planning and full complement expertise are required in complex cases such as this.

The important role of in-situ simulation in preparing surgeons for the COVID-19 pandemic

Background: Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods: This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results: 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion: In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.