Several cases of ischaemic stroke have been linked to vaccination for COVID-19, according to London doctors.
In recent months, researchers have been reporting rare cases of blood clots after the Oxford-AstraZeneca vaccine against SARS-CoV-2, called 'vaccine-induced immune thrombotic thrombocytopaenia'. One of the common presentations has been cerebral venous thrombosis – a form of stroke which is rare in clinical practice.
However, Professor David Werring, of University College London, and his team have now also reported three cases of ischaemic stroke (blood clots which affect the arteries of the brain), something which had not previously been linked to the vaccine.
In the Journal of Neurology Neurosurgery & Psychiatry, they report on the three patients who presented with ischaemic stroke linked to blockages of large arteries (both carotid and middle cerebral artery).
The first was a 35-year-old Asian woman who developed a headache six days after receiving the vaccine, and stroke symptoms five days later. She experienced severe brain haemorrhaging and did not survive.
The second patient was a 37-year-old white woman who also developed headache and sought medical attention 12 days after having the vaccine. Tests confirmed pulmonary embolism and thromboses, and she improved following treatment.
The third case was a 43-year-old Asian man who presented with language disorder typical of a stroke, 21 days after the vaccine. Scans showed infarct, or tissue death, in several brain areas and the patient is currently stable following treatment.
“Young patients presenting with ischaemic stroke after receiving the Oxford AstraZeneca vaccine should urgently be evaluated for vaccine-induced immune thrombotic thrombocytopaenia with laboratory tests including platelet count, D-dimers, fibrinogen and anti-PF4 antibodies," the doctors write.
Commenting on the report, Professor Hugh Markus of the University of Cambridge says: “During the current period of COVID vaccination a high index of suspicion is required to identify thrombotic episodes following vaccination. However, it is important to remember that these side-effects are rare, and much less common than both cerebral venous thrombosis and ischaemic stroke associated with COVID-19 infection itself.”
Al-Mayhani T, Saber S, Stubbs MJ, Losseff NA, Perry RJ, Simister RJ, Gull D, Jäger HR, Scully MA, Werring DJ. (2021) “Ischaemic stroke as a presenting feature of ChAdOx1 nCoV-19 vaccine-induced immune thrombotic thrombocytopenia.” Journal of Neurology Neurosurgery & Psychiatry, doi: 10.1136/jnnp-2021-326984
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