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Hsu JL, Chin SC, Cheng MH, Wu YR, Ro A, Ro LS. Postpartum Spinal Cord Infarction: A Case Report and Review of the Literature. MEDICINES (BASEL, SWITZERLAND) 2022; 9:54. [PMID: 36355059 PMCID: PMC9698876 DOI: 10.3390/medicines9110054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Background: Postpartum spinal cord infarction is a very rare disease. Only two cases have been reported in the English literature. Methods: We reported a 26 year old female who received second doses of the mRNA-1273 vaccine 52 days before delivery. She presented as sudden onset of paraplegia, sensory level, and sphincter incontinence at postpartum period. No history of heparin exposure was noted. Imaging findings confirmed the T10-11 level infarction and her anti-human heparin platelet factor 4 (anti-PF4) antibody was positive. After 7 days of dexamethasone therapy, her paraplegia and urinary incontinence gradually improved. Results: The CT angiography (CTA) of the artery of Adamkiewicz (Aka) showed tandem narrowing, most conspicuous at the T10-11 level, which was presumably due to partial occlusion of the arteriolar lumen. The thoracolumbar spine magnetic resonance imaging with contrast medium showed owl's eyes sign at the T10 and T11 levels. We compared our case with two other case reports from the literature. Conclusions: Post-partum spinal cord infarction with positive anti-PF4 antibody and relatively thrombocytopenia are the characteristics of our case.
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Affiliation(s)
- Jung-Lung Hsu
- Department of Neurology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei City 236, Taiwan
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Humanities in Medicine and Research Center for Brain and Consciousness, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan
| | - Shy-Chyi Chin
- Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48105, USA
| | - Yih-Ru Wu
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
| | - Aileen Ro
- Department of Obstetrics and Gynecology, College of Medicine, Linkou Chang Gung Memorial Hospital and Chang-Gung University, Taoyuan 333, Taiwan
| | - Long-Sun Ro
- Department of Neurology, Chang Gung Memorial Hospital Linkou Medical Center and College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
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2
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Safety of COVID-19 Vaccines: Spotlight on Neurological Complications. Life (Basel) 2022; 12:life12091338. [PMID: 36143376 PMCID: PMC9502976 DOI: 10.3390/life12091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has led to unprecedented demand on the global healthcare system. Remarkably, at the end of 2021, COVID-19 vaccines received approvals for human use in several countries worldwide. Since then, a solid base for response in the fight against the virus has been placed. COVID-19 vaccines have been shown to be safe and effective drugs. Nevertheless, all kinds of vaccines may be associated with the possible appearance of neurological complications, and COVID-19 vaccines are not free from neurological side effects. Neurological complications of COVID-19 vaccination are usually mild, short-duration, and self-limiting. However, severe and unexpected post-vaccination complications are rare but possible events. They include the Guillain-Barré syndrome, facial palsy, other neuropathies, encephalitis, meningitis, myelitis, autoimmune disorders, and cerebrovascular events. The fear of severe or fatal neurological complications fed the “vaccine hesitancy” phenomenon, posing a vital communication challenge between the scientific community and public opinion. This review aims to collect and discuss the frequency, management, and outcome of reported neurological complications of COVID-19 vaccines after eighteen months of the World Health Organization’s approval of COVID-19 vaccination, providing an overview of safety and concerns related to the most potent weapon against the SARS-CoV-2.
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3
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Salih F, Kohler S, Schönborn L, Thiele T, Greinacher A, Endres M. Early recognition and treatment of pre-VITT syndrome after adenoviral vector-based SARS-CoV-2 vaccination may prevent from thrombotic complications: review of published cases and clinical pathway. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac036. [PMID: 35919343 PMCID: PMC9242075 DOI: 10.1093/ehjopen/oeac036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/30/2022] [Indexed: 11/26/2022]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but highly morbid complication after adenoviral vector-based SARS-CoV-2 vaccination. The pre-VITT syndrome is defined as vaccine-induced immune thrombocytopenia without thrombosis typically presenting with new-onset headache. This review aims to identify at-risk patients before complications such as cerebral venous sinus thrombosis occur. We review previously published reports of 19 patients (median age 35 years, range 23-74; 16 females) who met the diagnostic criteria for a pre-VITT syndrome. Seven patients progressed to VITT, 12 patients did not. Patients who experienced VITT received delayed treatment. The median interval between the onset of headache and VITT-treatment (i.e. anticoagulation, immune globulins, or corticosteroids) was 5 days (range 1-8 days) compared with 2 days (0-5 days) in those without subsequent VITT (P = 0.033). The interval from onset of headache to anticoagulation was longer in patients with VITT (median 7 vs. 2 days; range 3-9 vs. 0-7 days; P = 0.01). Anticoagulation was safe in all patients with a pre-VITT syndrome as no haemorrhagic complications occurred after anticoagulation was started despite low platelets. The transient decline of platelet count after admission was significantly more pronounced in patients who progressed to VITT (median 67 vs. 0 × 103/µL; range 0-77 × 103/µL vs. 0-10 × 103/µL; P = 0.005). d-dimers did not differ between groups. Pre-VITT syndrome is a 'red flag' and allows to identify and preemptively treat patients at-risk of further progression to VITT. However, it must be distinguished from post-vaccination immune thrombocytopenia.
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Affiliation(s)
| | | | - Linda Schönborn
- Universitätsmedizin Greifswald, Institute of Immunology and Transfusion Medicine, Sauerbruch-Straße, 17489 Greifswald, Germany
| | - Thomas Thiele
- Universitätsmedizin Greifswald, Institute of Immunology and Transfusion Medicine, Sauerbruch-Straße, 17489 Greifswald, Germany
| | | | - Matthias Endres
- Corresponding author. Tel: +49 30 450 560101, Fax: +49 30 450 7560 932,
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Ornelas-Aguirre JM, Gómez-Alcalá AV, Ramírez-Leyva DH. Increment of D-dimer Associated with Immune Thrombotic Thrombocytopenia in ChAdOx1 nCoV-19 (AstraZeneca-Oxford) Vaccinated Individuals: A Systematic Review. Arch Med Res 2022; 53:341-351. [DOI: 10.1016/j.arcmed.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/02/2022] [Accepted: 03/31/2022] [Indexed: 12/15/2022]
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Uzun G, Pelzl L, Singh A, Bakchoul T. Immune-Mediated Platelet Activation in COVID-19 and Vaccine-Induced Immune Thrombotic Thrombocytopenia. Front Immunol 2022; 13:837629. [PMID: 35273612 PMCID: PMC8901500 DOI: 10.3389/fimmu.2022.837629] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/01/2022] [Indexed: 12/26/2022] Open
Abstract
Both qualitative and quantitative platelet abnormalities are common in patients with coronavirus disease 2019 (COVID-19) and they correlate with clinical severity and mortality. Activated platelets contribute to the prothrombotic state in COVID-19 patients. Several groups have shown immune-mediated activation of platelets in critically ill COVID-19 patients. Vaccine-induced immune thrombotic thrombocytopenia is an autoimmune condition characterized by thrombocytopenia and life-threatening thrombotic events in the arterial and venous circulation. Although the initial trigger has yet to be determined, activation of platelets by immune complexes through Fc gamma RIIA results in platelet consumption and thrombosis. A better understanding of platelet activation in COVID-19 as well as in vaccine-induced thrombotic complications will have therapeutic implications. In this review, we focused on the role of immune-mediated platelet activation in thrombotic complications during COVID-19 infection and vaccine-induced immune thrombotic thrombocytopenia.
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Affiliation(s)
- Günalp Uzun
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Lisann Pelzl
- Institute of Clinical and Experimental Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Anurag Singh
- Institute of Clinical and Experimental Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Institute of Clinical and Experimental Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
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Curcio R, Gandolfo V, Alcidi R, Giacomino L, Campanella T, Casarola G, Rossi R, Chiatti L, D'abbondanza M, Commissari R, Gresele P, Pucci G, Vaudo G. VACCINE-INDUCED MASSIVE PULMONARY EMBOLISM AND THROMBOCYTOPENIA FOLLOWING A SINGLE DOSE OF JANSSEN AD26.COV2.S VACCINATION. Int J Infect Dis 2022; 116:154-156. [PMID: 34986404 PMCID: PMC8720302 DOI: 10.1016/j.ijid.2021.12.345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 12/01/2022] Open
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) has emerged as a rare side effect of adenoviral vector-based vaccines against Coronavirus disease 2019 (COVID-19), and it is most frequently reported after Vaxzevria (AstraZeneca) vaccine. We described a case of severe thrombocytopenia associated with massive pulmonary embolism and portal vein thrombosis, occurring 13 days after the administration of the single dose adeno viral vector-based vaccine Ad26.COV2.S (Janssen vaccines, Leiden, Netherlands). Based on an early clinical suspect, the patient quickly received treatment with corticosteroids and intravenous immunoglobulins, followed by a rapid increase in platelet count that allowed full dose anticoagulation to be timely administered. Treatment with intravenous immunoglobulins, however, could mask the ability of anti-PF4-heparin antibodies to bind and activate platelets in the presence of heparin, leading to false negative results at the immunoassay functional test. Therefore, if VITT is suspected, blood samples for diagnostic confirmation should be collected prior to any treatment to improve diagnostic performance.
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Affiliation(s)
- Rosa Curcio
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Vito Gandolfo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Riccardo Alcidi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Luciano Giacomino
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Emergency, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Tommaso Campanella
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Genni Casarola
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Rachele Rossi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Lorenzo Chiatti
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Marco D'abbondanza
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Rita Commissari
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Emergency, "Santa Maria" Terni University Hospital, Terni, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy.
| | - Gaetano Vaudo
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy; Unit of Internal Medicine, "Santa Maria" Terni University Hospital, Terni, Italy
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Rodríguez-Pardo J, Gilo-Arrojo F, Ruiz-Ares G, Sánchez-Manso JC, Valiente-Gordillo E, de Celis E, Fuentes B, Ximénez-Carrillo Á, Alonso de Leciñana M, Rigual R, Vivancos-Mora J, Díez-Tejedor E. Thrombosis and Thrombocytopenia Syndrome Causing Isolated Symptomatic Carotid Occlusion after Covid-19 Vaccine. Thromb Haemost 2021; 122:300-303. [PMID: 34670287 DOI: 10.1055/a-1674-0341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jorge Rodríguez-Pardo
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Francisco Gilo-Arrojo
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Gerardo Ruiz-Ares
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Juan Carlos Sánchez-Manso
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Esther Valiente-Gordillo
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena de Celis
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Blanca Fuentes
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Alonso de Leciñana
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - Ricardo Rigual
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
| | - José Vivancos-Mora
- Department of Neurology, La Princesa University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Department of Neurology, Hospital La Paz Institute for Health Research - IdIPAZ (La Paz University Hospital, Universidad Autónoma de Madrid), Madrid, Spain
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