Cerebral venous sinus thrombosis after mRNA-based COVID-19 vaccination

Japan, 16 November 2021, Yagi et al, Neurological Sciences

Summary

Here, we report a case of CVST with prolonged mild headache after mRNA-based COVID-19 vaccination.

A man in his 50 s without remarkable medical history visited our department complaining of 1-week headache, which started 26–30 h after his second dose of tozinameran (Comirnaty® from Pfizer–BioNtech). He was evaluated by blood test, brain computed tomography (CT), and magnetic resonance imaging (MRI).

His headache was a combination of pulsative and tension types, predominantly felt around the bilateral occipital area. Nonetheless, it was mild; thus, he could still continue his office work, with over-the-counter pain reliever medication. No other common adverse events of vaccination were noted. On admission, he was alert and had no neurological deficit. His platelet count was normal (271,000/µL [reference range: 158,000–348,000]), but his D-dimer level was elevated (6.01 µg/mL [reference value: < 1.00]).

figure1
Brain CT and MRI (Fig. 1), which were both conducted 7 days after second vaccination, showed thrombosis in the superior sagittal sinus, right transverse sinus, right sigmoid sinus, and right internal jugular vein [3]. There were no remarkable abnormalities in brain parenchyma. Nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to the polymerase chain reaction test. Blood tests for the risk factors of venous thrombosis such as antiphospholipid antibody and protein S/C showed no remarkable abnormality, and the screening test for antibodies against PF4–heparin was negative. After heparin treatment, his headache was relieved in 2 weeks, with sinus thrombosis partially disappearing.

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