Malignant middle cerebral artery syndrome with thrombotic thrombocytopenia following vaccination against SARS-CoV-2

• Published in: Journal of the Intensive Care Society 2022-11, Vol.23 (4), p.479-484
• Main Authors: Jacob, Carmen, Rani, Khairil Amir, Holton, Patrick James, Boyce, Sara Rosalind, Weir, Nicolas Ulrick, Griffith, Colin Roderick, Eynon, Colin Andrew
• Format: Article
• Language: English
• Subjects: Special
• ISSN: 1751-1437; 2057-360X
• DOI: 10.1177/17511437211027496

Cases of thromboses at unusual sites with thrombocytopenia have been reported following vaccination against Sars-CoV-2. This new syndrome, christened vaccine-induced thrombotic thrombocytopenia (VITT), mainly results in venous thromboses. We report the case of a young woman with a right middle cerebral artery stroke following vaccination with ChAdOx1 nCoV-19. A diagnosis of VITT was made and platelet counts began to recover shortly after commencing treatment with argatroban, intravenous immunoglobulins and corticosteroids. On day 6 following admission, the patient deteriorated neurologically and decision made to proceed with decompressive hemicraniectomy. There were no perioperative complications and anticoagulation with argatroban was reinitiated on the first postoperative day. VITT is a rare condition resembling auto-immune heparin-induced thrombocytopenia. All critical care staff should be aware of the rare link between vaccination against SARS-CoV-2 and VITT and the need to rapidly commence both anticoagulation, using heparin alternatives, and immunomodulation.