Abstract
During a 2-week period, we have encountered five cases presenting with the combination of cerebral venous thrombosis (CVT), intracerebral hemorrhage and thrombocytopenia. A clinical hallmark was the rapid and severe progression of disease in spite of maximum treatment efforts, resulting in fatal outcome in for 4 out of 5 patients. All cases had received ChAdOx1 nCov-19 vaccine 1–2 weeks earlier and developed a characteristic syndrome thereafter. The rapid progressive clinical course and high fatality rate of CVT in combination with thrombocytopenia in such a cluster and in otherwise healthy adults is a recent phenomenon. Cerebral autopsy findings were those of venous hemorrhagic infarctions and thrombi in dural venous sinuses, including thrombus material apparently rich in thrombocytes, leukocytes and fibrin. Vessel walls were free of inflammation. Extra-cerebral manifestations included leech-like thrombi in large veins, fibrin clots in small venules and scattered hemorrhages on skin and membranes. CVT with thrombocytopenia after adenovirus vectored COVID-19 vaccination is a new clinical syndrome that needs to be recognized by clinicians, is challenging to treat and seems associated with a high mortality rate.
Highlights
In Norway, a country with a population of 5.4 million, the SARSCoV-2 vaccination program started December 27th 2020
vaccine induced immune thrombotic thrombocytopenia (VITT) was not more common in women than in men (RR = 1.47 95% CI 0.17, 12.6) and was not more common in the age group 20–39 compared to 40–69 (RR = 3.27 95% CI 0.60, 17.9). Five of those VITT patients presented with a characteristic clinical syndrome of cerebral venous thrombosis, parenchymal hemorrhage and severe thrombocytopenia, of whom four cases were described in detail in a previous case report [2]
We describe five patients presenting with rapid progressive neurological symptoms, cerebral venous thrombosis (CVT) with intracerebral hemorrhage and thrombocytopenia, occurring 7–10 days after vaccination with ChAdOx1 nCoV-19
Summary
In Norway, a country with a population of 5.4 million, the SARSCoV-2 vaccination program started December 27th 2020. Within 2 weeks, five cases of severe cerebral venous thrombosis (CVT), associated with intra-cerebral hemorrhage and thrombocytopenia and one case with splanchnic vein thrombosis and thrombocytopenia were encountered in previously healthy health care workers after having received ChAdOx1 CoV-19 vaccine. This vaccine-induced immune syndrome of severe thrombosis, high levels of antibodies to platelet factor 4– polyanion complexes and thrombocytopenia was recently reported by our group and the term VITT was proposed [1]. Including our previously reported cohort of VITT patients, we further characterize the malignant clinical entity of CVT and thrombocytopenia caused by this syndrome, with focus on neurological symptoms, radiology and pathology findings
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call