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Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia
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  1. Talal Al-Mayhani1,
  2. Sadia Saber1,
  3. Matthew J Stubbs2,
  4. Nicholas A Losseff1,
  5. Richard J Perry1,3,
  6. Robert J Simister1,3,
  7. David Gull4,
  8. Hans Rolf Jäger3,5,
  9. Marie A Scully2,
  10. David J Werring1,3
  1. 1Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
  2. 2Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
  3. 3Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
  4. 4Stroke Service, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  5. 5Academic Neuroradiological Unit, UCL Queen Square Institute of Neurology, London, UK
  1. Correspondence to Professor David J Werring, Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK; d.werring{at}ucl.ac.uk

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A syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) has recently been reported following the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) recombinant adenoviral vector vaccine encoding the spike glycoprotein of SARS-CoV-2.1–4 Previously described patients developed thrombosis, mainly affecting cerebral venous sinuses, with thrombocytopenia and antibodies to platelet factor 4 (PF4), but the characteristics of VITT with arterial thrombosis have not previously been described. Here, we report three patients with VITT who presented with ischaemic stroke.

Patient 1, a 35-year-old Asian woman, developed episodic right temporal and periorbital headache 6 days after receiving the ChAdOx1 nCoV-19 vaccine. Five days later, she awoke with left face, arm and leg weakness, right gaze preference and drowsiness. Non-contrast CT and CT angiography (CTA) revealed occlusion of the right middle cerebral artery (MCA) distal M1 segment with extensive ischaemia and haemorrhagic transformation (figure 1A-C)). Subsequent imaging revealed right portal vein thrombosis. The platelet count was 64 x 109/L (reference range 150 –400 x 109/L); D-dimer was raised at 11 220 µg/L (reference range 0–550); and the Asserachrom HPIA IgG assay for anti-PF4 antibodies was positive (76.1%). The patient underwent urgent decompressive hemicraniectomy …

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Footnotes

  • Contributors DJW and MAS had the idea for the paper. TA-M prepared the first draft with DJW and SS. HRJ prepared the draft figures. MJS, NAL, RJP, RS and DG were involved in the clinical care of the patients. All authors critically reviewed the manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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