Table 3. Description of Cerebral Venous Thrombosis Following Messenger RNA SARS-CoV-2 Vaccination.
| Vaccine received | Sex/age, years | Co-morbidities | Presenting symptoms | Days from 1st dose of vaccine | Days from 2nd dose of vaccine | Location of CVT | Platelet count, per 109/L, (range 150-450) | Normal thrombotic tests | Abnormal thrombotic tests | COVID-19 test | Treatment | mRS on discharge |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BNT162b2 | F/61-70 y | Hypertension | Headache | 30 | 9 | Right transverse, sigmoid, IJV | 383 | HIPA, Protein C, Protein S, anti-thrombin III, ACL, LAC, B2GP1 | None | PCR negative | Surgical decompression, heparin or warfarin | 5 |
| BNT162b2 | M/71-80 y | Hypertension, hyperlipidemia, diabetes | Headache | 28 | 7 | Right transverse and sigmoid sinuses | 292 | LAC present, ACL, B2GP1, Protein C protein S | None | PCR negative | Heparin or warfarin | 3 |
| BNT162b2 | F/51-60 y | Hypertension, hyperlipidemia, diabetes, TIA, family history of unprovoked PE | Right sided weakness and sensory loss, Seizure | 29 | 8 | SSS, right transverse sinus, right sigmoid sinus, right IJV, bilateral cortical veins | 250 | Protein C, Protein S, ACL, LAC, B2GP1 | Antithrombin III = 55% (normal range: 80%-120%) | Not performed | LMWH or warfarin | 2 |
| BNT162b2 | M/51-60 y | Hyperlipidemia | Headache, left sided weakness and vomiting | 22 | 1 | Right transverse, sigmoid sinus, IJV | 300 | Anti-PF4 antibody, Protein C, Protein S, anti-thrombin III, ACL, LAC, B2GP1 | None | PCR and serology negative | LMWH or warfarin | 2 |
| BNT162b2 | M/61-70 y | Hypertension, hyperlipidemia, diabetes | Seizures and left upper limb weakness | 33 | 11 | SSS, right transverse sinus, bilateral sigmoid sinuses | 333 | Protein C, Protein S, anti-thrombin III, ACL, LAC | None | PCR negative | LMWH warfarin | 0 |
| BNT162b2 | M/51-60 y | DVT, scar epilepsy, encephalitis, hyperlipidemia | Headache, right sided weakness and seizure | 19 | NA | SSS, cortical veins | 212 | HIPA, Protein C, Protein S, ACL, B2GP1 | Anti-PF4 antibody positive, Anti-thrombin III = 73% (normal range: 80%-130%). | PCR negative | Heparin or LMWH or dabigatran | 3 |
| mRNA-1273 | M/41-50 y | Smoker | Right sided weakness and seizure | 39 | 11 | SSS, left transverse and sigmoid sinuses | 224 | Protein S, ACL, LAC, B2GP1 normal | Anti-thrombin III = 79% (normal range: 93%-125%), Protein C = 66% (normal range: 83%-144%) | PCR and serology negative | SSS thrombectomy | 2 |
| D-dimer = 1.57 (normal range: <0.5ug/mL) | Heparin or LMWH or warfarin | |||||||||||
| mRNA-1273 | M/61-70 y | Hypertension, hyperlipidemia, ischemic stroke | Right sided weakness | 29 | 1 | Right frontal superior cerebral vein | 244 | LAC present, Protein C, Protein S, anti-thrombin III, ACL, B2GP1 | None | PCR negative | LMWH | 4 |
| mRNA-1273 | M/51-60 y | None | Headache, vomiting, diplopia | 23 | NA | SSS, right transverse and sigmoid sinus | 251 | HIPA, Protein C, Protein S, anti-thrombin III, ACL, LAC | None | PCR negative | LMWH then warfarin | 0 |
Abbreviations: ACL, anticardiolipin antibodies; B2GP1, B2 glycoprotein 1; CVT, cerebral venous thrombosis; DVT, deep vein thrombosis; HIPA, heparin-induced platelet activation; ICH, intracranial hemorrhage; IJV, internal jugular vein; LAC, lupus anticoagulant; LMWH, low molecular weight heparin; mRS, modified Rankin scale; PCR, polymerase chain reaction; PF4, platelet factor 4 reactive antibodies; PE, pulmonary embolism; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; SSS, superior sagittal sinus; TIA, transient ischemic attack.
SI conversion factor: To convert platelet counts to ×103/μL, multiply by 1.0.