ABSTRACT
A man in his late 50s was admitted with a 10-day history of right frontotemporal headache, left arm and leg weakness, and a sudden decline in visual acuity in the right eye. The patient had recent exposure to COVID-19 infection and tested positive for the same on admission. A CT scan of the head done on arrival demonstrated a subarachnoid haemorrhage in the right central sulcus with an underlying superior sagittal sinus thrombosis. No other known risk factors for central venous sinus thrombosis could be identified. The patient had a normal level of consciousness on admission clinically; however, he was in severe pain. A collective decision was made to administer anticoagulants to the patient with heparin after carefully deliberating the risk-to-benefit ratio of a superior sagittal thrombus with an associated subarachnoid haemorrhage. Our patient recovered and was discharged after 2 weeks on warfarin. We present this case to highlight the potential risks of hypercoagulable and neurotropic complications of COVID-19 infections, with special emphasis on cerebral venous thrombosis.
Subject(s)
COVID-19 , Sagittal Sinus Thrombosis , Sinus Thrombosis, Intracranial , Subarachnoid Hemorrhage , Male , Humans , Sagittal Sinus Thrombosis/diagnostic imaging , Sagittal Sinus Thrombosis/drug therapy , Sagittal Sinus Thrombosis/etiology , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/complications , COVID-19/complications , Anticoagulants/therapeutic use , Cranial Sinuses , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/drug therapy , Sinus Thrombosis, Intracranial/etiologySubject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Sinus Thrombosis, Intracranial/chemically induced , Anticoagulants/therapeutic use , Autoantibodies/immunology , Cerebral Angiography , ChAdOx1 nCoV-19 , Heparin/therapeutic use , Humans , India , Lateral Sinus Thrombosis/chemically induced , Lateral Sinus Thrombosis/diagnostic imaging , Lateral Sinus Thrombosis/drug therapy , Magnetic Resonance Angiography , Male , Middle Aged , Phlebography , Platelet Factor 4/immunology , SARS-CoV-2 , Sagittal Sinus Thrombosis/chemically induced , Sagittal Sinus Thrombosis/diagnostic imaging , Sagittal Sinus Thrombosis/drug therapy , Sinus Thrombosis, Intracranial/diagnostic imaging , Sinus Thrombosis, Intracranial/drug therapy , Thrombocytopenia , Warfarin/therapeutic useABSTRACT
Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Although COVID-19 is primarily a disease of the lungs with florid respiratory manifestations, there are increasing reports of cardiovascular, musculoskeletal, gastrointestinal, and thromboembolic complications. Developing an effective and reliable vaccine was emergently pursued to control the catastrophic spread of the global pandemic. We report a fatal case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute this fatal thrombotic condition to the vaccine due to the remarkable temporal relationship. The proposed mechanism of VITT is production of rogue antibodies against platelet factor-4 resulting in massive platelet aggregation. Healthcare providers should be aware of the possibility of such fatal complication, and the vaccine recipients should be warned about the symptoms of VITT.