Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination

Germany, 14 April 2021, Bayas et al, Lancet

Summary

A 55-year-old woman presented with conjunctival congestion, retro-orbital pain, and diplopia. She had received her first vaccine against SARS-CoV-2—ChAdOx1 nCoV-19—10 days before admission. Both on the night after the vaccination and 7 days later, the patient reported marked flu-like symptoms and a fever. On examination, she had binocular diplopia at vertical and right lateral gaze, and her visual acuity was 0·85 in both eyes. MRI showed superior ophthalmic vein thrombosis (SOVT) with no contrast filling (figure) and bilateral high T2 signal intensity of the superior ophthalmic vein.Laboratory investigations on admission showed a marked isolated thrombocytopenia of 30 × 109 per L (figure). IgG antiplatelet antibodies were positive. Despite the therapeutic heparinisation, 8 days after admission, the patient developed a transient, mild, right-sided hemiparesis, and aphasia. An MRI showed an ischaemic stroke in the left parietal lobe, middle cerebral artery territory, with restricted diffusion which had not been detected in the earlier scan. The patient then developed right-sided focal seizures.

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