Cerebral venous sinus thrombosis after adenovirus-vectored COVID-19 vaccination: review of the neurological-neuroradiological procedure
Open Access
- 19 February 2022
- journal article
- review article
- Published by Springer Science and Business Media LLC in Neuroradiology
- Vol. 64 (5), 865-874
- https://doi.org/10.1007/s00234-022-02914-z
Abstract
Cerebral venous and sinus thrombosis (CVST) after adenovirus-vectored COVID-19 ChAdOx1 nCov-19 (Oxford–AstraZeneca) and Ad26.COV2.S (Janssen/Johnson & Johnson) is a rare complication, occurring mainly in individuals under 60 years of age and more frequently in women. It manifests 4–24 days after vaccination. In most cases, antibodies against platelet factor-4/polyanion complexes play a pathogenic role, leading to thrombosis with thrombocytopenia syndrome (TTS) and sometimes a severe clinical or even fatal course. The leading symptom is headache, which usually increases in intensity over a few days. Seizures, visual disturbances, focal neurological symptoms, and signs of increased intracranial pressure are also possible. These symptoms may be combined with clinical signs of disseminated intravascular coagulation such as petechiae or gastrointestinal bleeding. If TTS-CVST is suspected, checking d-dimers, platelet count, and screening for heparin-induced thrombocytopenia (HIT-2) are diagnostically and therapeutically guiding. The imaging method of choice for diagnosis or exclusion of CVST is magnetic resonance imaging (MRI) combined with contrast-enhanced venous MR angiography (MRA). On T2*-weighted or susceptibility weighted MR sequences, the thrombus causes susceptibility artefacts (blooming), that allow for the detection even of isolated cortical vein thromboses. The diagnosis of TTS-CVST can usually be made reliably in synopsis with the clinical and laboratory findings. A close collaboration between neurologists and neuroradiologists is mandatory. TTS-CVST requires specific regimens of anticoagulation and immunomodulation therapy if thrombocytopenia and/or pathogenic antibodies to PF4/polyanion complexes are present. In this review article, the diagnostic and therapeutic steps in cases of suspected TTS associated CSVT are presented.Funding Information
- Universitätsmedizin Rostock
This publication has 33 references indexed in Scilit:
- Incidence and Mortality of Cerebral Venous Thrombosis in a Norwegian PopulationStroke, 2020
- Effect of Endovascular Treatment With Medical Management vs Standard Care on Severe Cerebral Venous ThrombosisJAMA Neurology, 2020
- The Brighton Collaboration standardized template for collection of key information for benefit-risk assessment of nucleic acid (RNA and DNA) vaccinesVaccine, 2020
- MRI safety considerations during pregnancyClinical Imaging, 2020
- Safety and Efficacy of Dabigatran Etexilate vs Dose-Adjusted Warfarin in Patients With Cerebral Venous ThrombosisJAMA Neurology, 2019
- Cerebral Venous Thrombosis: an UpdateCurrent Neurology and Neuroscience Reports, 2019
- Autoimmune heparin‐induced thrombocytopeniaJournal of Thrombosis and Haemostasis, 2017
- Management of the multiple phases of heparin-induced thrombocytopeniaThrombosis and Haemostasis, 2016
- Aufklärung über die Heparin-induzierte Thrombozytopenie im Rahmen der Thromboseprophylaxe mit HeparinDeutsche Medizinische Wochenschrift (1946), 2003
- Cerebral Vein and Dural Sinus Thrombosis in Portugal: 1980–1998Cerebrovascular Diseases, 2001