Rapid progressive vaccine-induced immune thrombotic thrombocytopenia with cerebral venous thrombosis after ChAdOx1 nCoV-19(AZD1222)vaccination:A case report  

作　　者：Shin-Kuang Jiang Wei-Liang Chen Chun Chien Chi-Syuan Pan Sheng-Ta Tsai 

机构地区：[1]Department of Neurology,China Medical University Hospital,Taichung 404332,Taiwan [2]Department of Radiology,China Medical University Hospital,Taichung 404332,Taiwan [3]Department of Neurology,China Medical University Hsinchu Hospital,Hsinchu 30272,Taiwan [4]Department of Emergency,China Medical University Hospital,Taichung 404332,Taiwan [5]Neuroscience and Brain Disease Center,China Medical University,Taichung 404332,Taiwan

出　　处：《World Journal of Clinical Cases》2022年第26期9462-9469,共8页世界临床病例杂志

摘　　要：BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia(VITT)is a rare and potentially life-threatening condition after receiving coronavirus disease vaccines.It is characterized by symptom onset at 5 to 30 d postvaccination,thrombocytopenia,thrombosis,high D-dimer level,and antiplatelet factor 4(anti-PF4)antibody positivity.VITT can progress very fast,requiring urgent management.Only few studies have described its detailed clinical course and imaging changes.We report a typical VITT case in a patient who underwent regular repeated brain imaging examinations.CASE SUMMARY A young woman presented with headaches at 7 d after the ChAdOx1 nCoV-19vaccine(AZD1222)injection.She then showed progressive symptoms of left upper limb clumsiness.Brain computed tomography revealed venous infarction at the right parietal lobe with a hyperacute thrombus in the cortical vein.Two hours later,brain magnetic resonance imaging revealed hemorrhage at the same area.Magnetic resonance venography showed an irregular contour of the right transverse sinus.Laboratory examination revealed a high D-dimer level,thrombocytopenia,and a high titer for anti-PF4 antibodies.She was treated with anticoagulants,intravenous immunoglobulin,and steroids and analgesic agents were administered for pain control.She had a marked improvement on headaches and clumsiness after treatment along with radiological thrombus resolution.During follow-up at the outpatient department,her modified Rankin scale at 90 d was 1.CONCLUSION Clinicians should be alerted whenever patients present with persistent and progressive headaches or focal motor/sensory deficits postvaccination.

关 键 词：Vaccine-induced immune thrombotic thrombocytopenia Intracranial Sinus Thrombosis ChAdOx1 nCoV-19 vaccine(AZD1222) Headache Serial brain image Case report 

分 类 号：R558.2[医药卫生—血液循环系统疾病] R743[医药卫生—内科学]