Michelangelo Mancuso1, Dario Luca Lauretti2, Nadia Cecconi3, Massimo Santini4, Valentina Lami4, Giovanni Orlandi5, Sergio Casagli6, Antonella Ghetta6, Gaetano Liberti7, Benini Maria Elena7, Gabriele Siciliano5, Mirco Cosottini2. 1. Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy. michelangelo.mancuso@unipi.it. 2. Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy. 3. Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 4. U.O. Medicina D'Urgenza E Pronto Soccorso, Emergency Department, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria of Pisa, Pisa, Italy. 5. Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy. 6. Neuroanestesia E Rianimazione, Nuovo Santa Chiara Hospital, Azienda Ospedaliero-Universitaria of Pisa, Pisa, Italy. 7. Neurosurgery Unit, Azienda Ospedaliero-Universitaria of Pisa, Pisa, Italy.
Abstract
OBJECTIVE: We describe a severe case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after the first dose of the ChAdOx1 nCoV-19 vaccine leading to massive ischemic stroke. METHODS: A 42-year-old woman developed acute left hemiparesis (NIHSS 12) 9 days after the first vaccine dose. RESULTS: The blood tests revealed low platelets (70 103/μL) and severe increment of D-dimer (70,745 ng/mL FEU). Brain non-contrast computed tomography and multiphasic CT angiography demonstrated a right middle cerebral artery occlusion. The patient was treated with primary thrombectomy, steroids, immunoglobulin, and fondaparinux. Despite the treatment, the neurological status deteriorated and underwent decompressive hemicraniectomy. She was transferred to the rehab's unit 52 days after the onset. DISCUSSION: Healthcare providers should be aware of the possibility of ischemic stroke as a manifestation of VITT. Awareness on this very rare and possibly fatal complication should be reinforced on both the vaccine recipients and general practitioners.
OBJECTIVE: We describe a severe case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after the first dose of the ChAdOx1 nCoV-19 vaccine leading to massive ischemic stroke. METHODS: A 42-year-old woman developed acute left hemiparesis (NIHSS 12) 9 days after the first vaccine dose. RESULTS: The blood tests revealed low platelets (70 103/μL) and severe increment of D-dimer (70,745 ng/mL FEU). Brain non-contrast computed tomography and multiphasic CT angiography demonstrated a right middle cerebral artery occlusion. The patient was treated with primary thrombectomy, steroids, immunoglobulin, and fondaparinux. Despite the treatment, the neurological status deteriorated and underwent decompressive hemicraniectomy. She was transferred to the rehab's unit 52 days after the onset. DISCUSSION: Healthcare providers should be aware of the possibility of ischemic stroke as a manifestation of VITT. Awareness on this very rare and possibly fatal complication should be reinforced on both the vaccine recipients and general practitioners.
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