- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Researchers report stroke in young adults after COVID-19 vaccination
The cases described suggest that, in addition to cerebral venous thrombosis, vaccine-induced immune thrombotic thrombocytopaenia (VTT) can also lead to clots that block arteries supplying the brain, causing ischemic stroke.
London, UK: Researchers from London have reported three cases of vaccine-induced ischemic stroke following the administration of the Oxford–AstraZeneca vaccine (ChAdOx1 nCoV-19).
The case report is published in the Journal of Neurology Neurosurgery & Psychiatry.
Arterial thrombosis, clots in the arteries, are the most common cause of stroke and have been reported in detail for the first time in young adults who received the Oxford–AstraZeneca covid-19 vaccine in a letter from UK stroke specialists.
While rare cases of blood clots have been reported previously after administration of the Oxford–AstraZeneca covid-19 vaccine, these have affected veins and most specifically veins in the brain (cerebral venous sinuses).
People who have experienced this unusual form of stroke (cerebral venous sinus thrombosis) have also had low platelet counts (thrombocytopenia) and antibodies to platelet factor 4 (PF4) - proteins that help form clots.
The most common form of stroke, where blood clots occur in arteries supplying blood to the brain (ischaemic stroke), has not been previously described as the presenting feature of thrombosis following administration of the Oxford–AstraZeneca vaccine, but the authors of this letter report three cases in detail.
In all cases, the ischaemic stroke was associated with blockages of large arteries (both carotid and middle cerebral artery) and two patients also had venous thrombosis involving the portal and cerebral venous system. All three also had extremely low platelet counts, confirmed anti-PF4 antibodies, and raised D-dimer (also linked to clotting).
The first patient, a woman in her 30s, experienced an intermittent headache on the right side and around her eyes six days after the vaccine. Five days later she awoke feeling drowsy and with weakness to her left face, arm and leg. Imaging revealed a blocked right middle cerebral artery with brain infarction, and blood clots in the right portal vein thrombosis. She underwent brain surgery to reduce the pressure in her skull, plasma removal and replacement, and received the anti-clotting drug fondaparinux, but unfortunately died.
The second patient, a woman in her late 30s, presented with headache, confusion, weakness in her left arm and loss of vision on the left side 12 days after having received the vaccine. Imaging showed blockages in several vessels including both carotid arteries (the main blood supply to the hemispheres of the brain), arteries supplying the heart and lungs (pulmonary embolism) and the left transverse sinus (one of the cerebral venous sinuses). Her platelet count increased following plasma removal and replacement and intravenous corticosteroids. She was then given fondaparinux and improved.
The third patient, a man in his early 40s, presented 3 weeks after receiving his vaccination with problems speaking and understanding language (dysphasia). Imaging showed a clot in the left middle cerebral artery, but there was no evidence of clots in the cerebral venous sinuses. He received a platelet and plasma transfusion, and fondaparinux, and remains stable.
The lead author, Professor David Werring from the Stroke Research Centre, UCL Queen Square Institute of Neurology, says that the cases described suggest that, in addition to cerebral venous thrombosis, vaccine-induced immune thrombotic thrombocytopaenia (VTT) can also lead to clots that block arteries supplying the brain, causing ischaemic stroke.
"Young patients presenting with ischaemic stroke after receiving the [Oxford-AstraZeneca] vaccine should urgently be evaluated for VITT with laboratory tests (including platelet count, D-dimers, fibrinogen and anti-PF4 antibodies), and managed by a multidisciplinary team (haematology, neurology, stroke, neurosurgery, neuroradiology) for rapid access to treatments including intravenous immune globulin, methylprednisolone, plasmapheresis and non-heparin anticoagulants, for example fondaparinux, argatroban, or direct oral anticoagulants," say the authors.
In a linked commentary, Professor Hugh Markus, from the Department of Clinical Neurosciences, at the University of Cambridge, writes: "This report emphasises that the immune mediated coagulopathy can also cause arterial thrombosis including ischaemic stroke, although venous thrombosis and especially cerebral venous sinus thrombosis appear more frequent."
He adds: "During the current period of covid vaccination a high index of suspicion is required to identify thrombotic episodes following vaccination. However, it is important to remember that these side-effects are rare, and much less common than both cerebral venous thrombosis and ischaemic stroke associated with covid-19 infection itself."
Reference:
"Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia," is published in Journal of Neurology Neurosurgery & Psychiatry.
DOI: https://jnnp.bmj.com/content/early/2021/05/20/jnnp-2021-326984
MSc. Biotechnology
Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at  editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751