Malignant middle cerebral artery syndrome with thrombotic thrombocytopenia following vaccination against SARS-CoV-2.
Carmen JacobKhairil Amir RaniPatrick James HoltonSara Rosalind BoyceNicolas Ulrick WeirColin Roderick GriffithColin Andrew EynonPublished in: Journal of the Intensive Care Society (2021)
Cases of thromboses at unusual sites with thrombocytopenia have been reported following vaccination against Sars-CoV-2. This new syndrome, christened vaccine-induced thrombotic thrombocytopenia (VITT), mainly results in venous thromboses. We report the case of a young woman with a right middle cerebral artery stroke following vaccination with ChAdOx1 nCoV-19. A diagnosis of VITT was made and platelet counts began to recover shortly after commencing treatment with argatroban, intravenous immunoglobulins and corticosteroids. On day 6 following admission, the patient deteriorated neurologically and decision made to proceed with decompressive hemicraniectomy. There were no perioperative complications and anticoagulation with argatroban was reinitiated on the first postoperative day. VITT is a rare condition resembling auto-immune heparin-induced thrombocytopenia. All critical care staff should be aware of the rare link between vaccination against SARS-CoV-2 and VITT and the need to rapidly commence both anticoagulation, using heparin alternatives, and immunomodulation.
Keyphrases
- middle cerebral artery
- sars cov
- venous thromboembolism
- internal carotid artery
- case report
- atrial fibrillation
- respiratory syndrome coronavirus
- high glucose
- patients undergoing
- diabetic rats
- growth factor
- drug induced
- high dose
- oxidative stress
- low dose
- endothelial cells
- risk factors
- coronavirus disease
- decision making
- blood brain barrier
- subarachnoid hemorrhage
- replacement therapy