TY - JOUR T1 - Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp-2021-326984 SP - jnnp-2021-326984 AU - Talal Al-Mayhani AU - Sadia Saber AU - Matthew J Stubbs AU - Nicholas A Losseff AU - Richard J Perry AU - Robert J Simister AU - David Gull AU - Hans Rolf Jäger AU - Marie A Scully AU - David J Werring Y1 - 2021/05/20 UR - http://jnnp.bmj.com/content/early/2021/06/03/jnnp-2021-326984.abstract N2 - 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 … ER -