A case report on cerebral venous sinus thrombosis (CVST) after COVID 19 vaccination

Background and Aims: Background A rare syndrome comprising of thrombocytopenia, raised D dimers and thrombosis mainly in cerebral venous sinus is noted after COVID 19 vaccination. In the UK, 20.2 million doses of COVID 19 AstraZenaca vaccine were given and 44 CVST with thrombocytopenia cases were reported. Methods: Pathophysiology The vaccine stimulates the immune system to produce platelet antibodies as in Heparin induced thrombocytopenia (HIT). This leads to investigation for HIT screen and anti PF4 assays and treatment with IV immunoglobulin and heparin free anticoagulants. Results: Case report A 52 years old lady had the first dose of AstraZenaca vaccine and after 6 days, headache started and on 11thday, seizures and left sided weakness developed. Hypothyroidism is her only comorbidity. CT head showed right frontal lobar bleed and CT venogram identified extensive venous sinus thrombosis in anterior and superior sagittal sinus and superficial cortical sinus. Platelet count was 46. D Dimer was 26594 with normal fibrinogen. The vaccine induced prothrombotic immune thrombocytopenia (VIPIT) was suspected and liaised with neurology and haematology teams. Her HIT screen and other autoimmune profiles were negative. CT body requested to look for malignancy incidentally found bilateral pulmonary embolism. She was treated with fondaparinux on Day 2 and IVIG on Day 3. Her weakness significantly improved after 7 days and 6 months treatment with DOAC was decided. Conclusions: The incidence of thrombosis with thrombocytopenia in vaccinated population is still very low though severity and mortality is significant. The selection of more appropriate vaccinees for AstraZenaca vaccine could be the area for further research.