Rapid progressive vaccine-induced immune thrombotic thrombocytopenia with cerebral venous thrombosis after ChAdOx1 nCoV-19 (AZD1222) vaccination: A case report

Figure 1 The initial brain computed tomography without contrast. Asterisk: A low-density area at the right parietal lobe indicating acute ischemic stroke.

Figure 2 The serial brain computed tomography scans. A: Day 17; B: Day 33; C: Day 61. Arrowhead: A hyperacute thrombus is found in the right cortical vein on day 17 after the vaccination. The cortical vein thrombus resolved on day 33.

Figure 3 Brain magnetic resonance imaging at two hours after the initial brain computed tomography. These series demonstrated hyperacute hemorrhage at the right parietal lobe. A: T1 image showing a hypointense lesion at the right parietal lobe; B: T2 FLAIR showing a hyperintense lesion; C: SWAN image showing hypointense “black dots” at the right parietal lobe; D: T1 with gadolinium enhancement did not enhance the lesion. FLAIR: Fluid-attenuated inversion recovery; SWAN: Susceptibility-weighted angiography.

Figure 4 Magnetic resonance venography. Arrowhead: An irregular contour of the right transverse sinus is noted.

Figure 5 Follow-up brain computed tomography on day 3 of hospitalization. Arrowhead: Hyperdense acute hemorrhage at the right parietal lobe, in resolution. Asterisk: Hypodense perifocal edema around the acute hemorrhage, indicating the early phase of hematoma absorption.

Figure 6 The clinical time course after vaccination with ChAdOx1 nCoV-19 vaccine (AZD1222). AZ: AstraZeneca; ChAdOx1 nCoV-19 vaccine (AZD1222); PLT: Platelet; IVIG: Intravenous immunoglobulin; mRS: Modified Rankin scale; MRI: Magnetic resonance imaging.