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

• DOI: 10.1007/s42399-023-01506-z
• Publication Date: 2023-06-19T09:02:07Z
• Authors: Fabrizio Giammello; Francesco Grillo; Agostino Tessitore; Anna Gardin; Domenico Iatì; Antonio Armando C...; Mariano Velo; Orazio Buonomo; Ludovica Ferraù; Antonio Toscano; Paolino La Spina; Sergio Lucio Vinci

Abstract Introduction: Neurological manifestations related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may involve both peripheral and central nervous system, including acute ischemic stroke and cerebral venous sinus thrombosis (CVST). Case Presentation: 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 fully 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. Conclusions: 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.