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Management of Severe Cerebral Venous Sinus Thrombosis After Post-vaccination Breakthrough COVID-19 Infection: A Case Report and Review of the Literature

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Abstract

Neurological manifestations related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may involve both peripheral and central nervous systems, including acute ischemic stroke and cerebral venous sinus thrombosis (CVST). Hereby, we present an adult patient with post-vaccination breakthrough COVID-19 infection and CVST, treated with venous mechanical thrombectomy (MT). The patient manifested continuous tonic-clonic seizures, after an insidious presentation with headache and left-sided weakness. SARS-CoV-2 testing was positive, despite full vaccination, using two approved mRNA platforms. Factor V Leiden polymorphism was detected. The patient was initially managed with anticoagulation, followed by MT with a positive response. We provided a comparison to similar cases of COVID-19-associated CVST undergoing mechanical thrombectomy. High index of suspicion and prompt diagnosis are extremely important to ensure immediate hospitalization and therapy, since CVST associated with either vaccines or COVID-19 seems to evolve rapidly and with a high mortality rate. Even a breakthrough infection may present severe vascular complications. In addition, evaluation of acquired and hereditary thrombophilia may be beneficial in acute phase, also without a previous history of thrombosis. Clinicians should start early medical treatment and additionally consider the endovascular approach as an optimistic choice in refractory CVST related to SARS-CoV-2 infection.

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Anonymized data not published within this article will be made available by request from any qualified investigator.

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Acknowledgements

We thank the patient and the patient’s family for their kind cooperation. We would like to thank all professionals involved in stroke care during the pandemic.

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Author notes

  1. Fabrizio Giammello, Francesco Grillo, and Agostino Tessitore contributed equally to this work and should be considered co-first authors.

  2. Paolino La Spina and Sergio Lucio Vinci contributed equally to this work and should be considered co-last authors.

Authors and Affiliations

  1. International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy

    Fabrizio Giammello

  2. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Fabrizio Giammello, Francesco Grillo, Anna Gardin, Ludovica Ferraù, Antonio Toscano & Paolino La Spina

  3. Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Agostino Tessitore, Domenico Iatì, Antonio Armando Caragliano, Mariano Velo, Orazio Buonomo & Sergio Lucio Vinci

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  1. Fabrizio Giammello
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Contributions

FGi, FGr, and ATe contributed to the study design. F Gi, AG, and LF performed data collections. ATe and DI performed imaging analysis. AAC, MV, and OB performed endovascular treatment. FGi and AG wrote the article. FGr reviewed and critiqued the manuscript. ATo, PLS, and SLV supervised the research.

Corresponding author

Correspondence to Fabrizio Giammello.

Ethics declarations

Ethics Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The paper does not report on primary research. Our analysis looked retrospectively at outcomes for a large cohort of patients treated. All data analyzed were collected as part of routine diagnosis and treatment.

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A handwritten signature was obtained from the patient.

Consent for Publication

A handwritten signature was obtained from the patient.

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The authors declare no competing interests.

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This article is part of the Topical Collection on COVID-19

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Giammello, F., Grillo, F., Tessitore, A. et al. Management of Severe Cerebral Venous Sinus Thrombosis After Post-vaccination Breakthrough COVID-19 Infection: A Case Report and Review of the Literature. SN Compr. Clin. Med. 5, 167 (2023). https://doi.org/10.1007/s42399-023-01506-z

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