tetano
Editor, Senior Moderator
Rev Neurol
. 2022 Oct 1;75(7):199-202.
doi: 10.33588/rn.7507.2021323.
Fatal intracerebral haemorrhage associated with thrombosis with thrombocytopenia syndrome after ChAdOx1-S vaccine
[Article in Spanish, English]
A Gómez-Roldós[SUP] 1 [/SUP], M González-Sánchez[SUP] 1 [/SUP], M Vales-Montero[SUP] 1 [/SUP], P Vázquez-Alen[SUP] 1 [/SUP], Y Fernández-Bullido[SUP] 1 [/SUP], A M Iglesias-Mohedano[SUP] 1 [/SUP], F Díaz-Otero[SUP] 1 [/SUP], A García-Pastor[SUP] 1 [/SUP], A Gil-Núñez[SUP] 1 [/SUP]
Affiliations
Abstract
in English, Spanish
Introduction: The COVID-19 pandemic has had a devastating impact on health, society and economics worldwide. Therefore, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently emerged as an important measure to fight the pandemic. ChAdOx1-S (Oxford-AstraZeneca) is an adenovirus-vectored vaccine that expresses the SARS-CoV-2 spike protein. It shows an acceptable safety profile. Nevertheless, several cases of unusual thrombosis and thrombocytopenia have been reported after initial vaccination with ChAdOx1-S mimicking autoimmune heparin-induced thrombocytopenia. This condition has been called thrombosis with thrombocytopenia syndrome (TTS) and complications such as intracerebral haemorrhage have been described.
Case report: We present a case of intracerebral haemorrhage after ChAdOx1-S vaccination. Middle-aged patient with no prior medical history was seen in the emergency room 16 days after the first dose of ChAdOx1-S vaccine with sudden onset left hemiplegia and severe holocranial oppressive headache. She did not receive heparin treatment in the previous 100 days. Blood test showed moderate thrombocytopenia and a right frontal lobar haemorrhage was seen on computed tomography scan, computed tomography venography was negative for thrombosis. The presence of antibodies against platelet factor 4 was confirmed. The patient's neurological condition progressively worsened. She developed a treatment resistant intracranial hypertension syndrome and she died three weeks later.
Conclusions: TTS is a rare adverse effect of ChAdOx1-S vaccine, defined by the presence of thrombosis in uncommon locations. In our case we report an spontaneous intracerebral haemorrhage probable due to the thrombocytopenia related to probable TTS. It represents a rare clinical presentation of TTS.
. 2022 Oct 1;75(7):199-202.
doi: 10.33588/rn.7507.2021323.
Fatal intracerebral haemorrhage associated with thrombosis with thrombocytopenia syndrome after ChAdOx1-S vaccine
[Article in Spanish, English]
A Gómez-Roldós[SUP] 1 [/SUP], M González-Sánchez[SUP] 1 [/SUP], M Vales-Montero[SUP] 1 [/SUP], P Vázquez-Alen[SUP] 1 [/SUP], Y Fernández-Bullido[SUP] 1 [/SUP], A M Iglesias-Mohedano[SUP] 1 [/SUP], F Díaz-Otero[SUP] 1 [/SUP], A García-Pastor[SUP] 1 [/SUP], A Gil-Núñez[SUP] 1 [/SUP]
Affiliations
- PMID: 36169326
- DOI: 10.33588/rn.7507.2021323
Abstract
in English, Spanish
Introduction: The COVID-19 pandemic has had a devastating impact on health, society and economics worldwide. Therefore, vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently emerged as an important measure to fight the pandemic. ChAdOx1-S (Oxford-AstraZeneca) is an adenovirus-vectored vaccine that expresses the SARS-CoV-2 spike protein. It shows an acceptable safety profile. Nevertheless, several cases of unusual thrombosis and thrombocytopenia have been reported after initial vaccination with ChAdOx1-S mimicking autoimmune heparin-induced thrombocytopenia. This condition has been called thrombosis with thrombocytopenia syndrome (TTS) and complications such as intracerebral haemorrhage have been described.
Case report: We present a case of intracerebral haemorrhage after ChAdOx1-S vaccination. Middle-aged patient with no prior medical history was seen in the emergency room 16 days after the first dose of ChAdOx1-S vaccine with sudden onset left hemiplegia and severe holocranial oppressive headache. She did not receive heparin treatment in the previous 100 days. Blood test showed moderate thrombocytopenia and a right frontal lobar haemorrhage was seen on computed tomography scan, computed tomography venography was negative for thrombosis. The presence of antibodies against platelet factor 4 was confirmed. The patient's neurological condition progressively worsened. She developed a treatment resistant intracranial hypertension syndrome and she died three weeks later.
Conclusions: TTS is a rare adverse effect of ChAdOx1-S vaccine, defined by the presence of thrombosis in uncommon locations. In our case we report an spontaneous intracerebral haemorrhage probable due to the thrombocytopenia related to probable TTS. It represents a rare clinical presentation of TTS.