AstraZeneca vaccine complications [Neurosurgery Wiki]

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====== AstraZeneca vaccine complications ======

Cases have been described highlighting atypical [[thrombosis]] associated with [[COVID-19]] infection as well as with the ChAdOx1 nCoV-19 ([[AstraZeneca]]) vaccine and [[Johnson & Johnson vaccine]]
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Neurological [[COVID-19]] disease poses a considerable burden in terms of disease outcomes and use of hospital [[resource]]s from prolonged [[intensive care]] and [[inpatient]] admission; preliminary data suggest these may differ according to WHO regions and [[country]] [[income]] levels. The different risk factors for [[encephalopathy]] and [[stroke]] suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after [[hospital admission]]
((Singh B, Lant S, Cividini S, Cattrall JWS, Goodwin LC, Benjamin L, Michael BD, Khawaja A, Matos AMB, Alkeridy W, Pilotto A, Lahiri D, Rawlinson R, Mhlanga S, Lopez EC, Sargent BF, Somasundaran A, Tamborska A, Webb G, Younas K, Al Sami Y, Babu H, Banks T, Cavallieri F, Cohen M, Davies E, Dhar S, Fajardo Modol A, Farooq H, Harte J, Hey S, Joseph A, Karthikappallil D, Kassahun D, Lipunga G, Mason R, Minton T, Mond G, Poxon J, Rabas S, Soothill G, Zedde M, Yenkoyan K, Brew B, Contini E, Cysique L, Zhang X, Maggi P, van Pesch V, Lechien J, Saussez S, Heyse A, Brito Ferreira ML, Soares CN, Elicer I, Eugenín-von Bernhardi L, Ñancupil Reyes W, Yin R, Azab MA, Abd-Allah F, Elkady A, Escalard S, Corvol JC, Delorme C, Tattevin P, Bigaut K, Lorenz N, Hornuss D, Hosp J, Rieg S, Wagner D, Knier B, Lingor P, Winkler AS, Sharifi-Razavi A, Moein ST, SeyedAlinaghi S, JamaliMoghadamSiahkali S, Morassi M, Padovani A, Giunta M, Libri I, Beretta S, Ravaglia S, Foschi M, Calabresi P, Primiano G, Servidei S, Biagio Mercuri N, Liguori C, Pierantozzi M, Sarmati L, Boso F, Garazzino S, Mariotto S, Patrick KN, Costache O, Pincherle A, Klok FA, Meza R, Cabreira V, Valdoleiros SR, Oliveira V, Kaimovsky I, Guekht A, Koh J, Fernández Díaz E, Barrios-López JM, Guijarro-Castro C, Beltrán-Corbellini Á, Martínez-Poles J, Diezma-Martín AM, Morales-Casado MI, García García S, Breville G, Coen M, Uginet M, Bernard-Valnet R, Du Pasquier R, Kaya Y, Abdelnour LH, Rice C, Morrison H, Defres S, Huda S, Enright N, Hassell J, D'Anna L, Benger M, Sztriha L, Raith E, Chinthapalli K, Nortley R, Paterson R, Chandratheva A, Werring DJ, Dervisevic S, Harkness K, Pinto A, Jillella D, Beach S, Gunasekaran K, Rocha Ferreira Da Silva I, Nalleballe K, Santoro J, Scullen T, Kahn L, Kim CY, Thakur KT, Jain R, Umapathi T, Nicholson TR, Sejvar JJ, Hodel EM; Brain Infections Global COVID-Neuro Network Study Group, Tudur Smith C, Solomon T. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS One. 2022 Jun 2;17(6):e0263595. doi: 10.1371/journal.pone.0263595. PMID: 35653330; PMCID: PMC9162376.))
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Increased rates of [[thromboembolic event]]s were identified in recipients, and, subsequently, a syndrome of [[vaccine-induced immune thrombotic thrombocytopenia]] (VITT) was described whereby recipients presented with [[cerebral venous sinus thrombosis ]], hemorrhagic [[infarction]]s, and - consequently - raised [[intracranial pressure]]. 

Related [[cerebral venous sinus thrombosis]] and associated [[infarct]]s are rare complications of the [[AstraZeneca vaccine]]. Neurosurgical management involves treating [[intracranial hypertension]] however survival outcomes in a cohort were poor. In these series, decompression was performed in deteriorating patients however prophylactic decompression, in the presence of extensive [[venous sinus thrombosis]], should be considered on a case-by-case basis. As vaccination programs accelerate across the world, neurosurgeons are likely to be increasingly involved in managing intracranial hypertension in patients with VITT-related sinus thromboses.
((Eltayeb M, Jayakumar N, Coulter I, Johnson C, Crossman J. Decompressive
craniectomy for intracranial hypertension in vaccine-induced immune thrombotic
thrombocytopaenia: a case series. Br J Neurosurg. 2022 Aug 25:1-4. doi:
10.1080/02688697.2022.2115007. Epub ahead of print. PMID: 36004613.)).
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[[Cerebral venous sinus thrombosis]] (CVT) prior to the [[COVID]] [[pandemic]] was rare, responsible for 0.5 of all [[stroke]]s, at the onset of the [[pandemic]] on the East Coast, overall cross-sectional imaging volumes declined due to maintaining [[ventilation]], high levels of care and limiting disease spread, although [[COVID-19]] patients have a 30-60 times greater risk of CVT compared to the general population, and [[vaccination]] is currently the best option to mitigate severe disease. In early [[2021]], reports of adenoviral vector COVID vaccines causing CTV and Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT), led to a 39.65% increase in cross-sectional [[venography]], however, in this study unvaccinated patients in 2021 had a higher incidence of CVT (10.1%), compared to the vaccinated patients (4.5%). Clinicians should be aware that VITT CVT may present with a headache 5-30 days post-vaccination with thrombosis best diagnosed on CTV or MRV. If thrombosis is present with [[thrombocytopenia]], platelets <150 × 109, elevated [[D-Dimer]] >4000 FEU, and positive anti-[[PF4]] ELISA assay, the diagnosis is definitive. VITT CVT resembles spontaneous autoimmune [[heparin-induced thrombocytopenia]] (HIT) and is postulated to occur from [[platelet factor 4]] (PF4) binding to vaccine adenoviral vectors forming a novel [[antigen]], anti-PF4 memory B-cells, and anti-PF4 (VITT) antibodies.
((Franceschi AM, Petrover DR, McMahon TM, Libman RB, Giliberto L, Clouston SAP,
Castillo M, Kirsch C. Retrospective review COVID-19 vaccine induced thrombotic
thrombocytopenia and cerebral venous thrombosis-what can we learn from the
immune response. Clin Imaging. 2022 Jul 15;90:63-70. doi:
10.1016/j.clinimag.2022.06.020. Epub ahead of print. PMID: 35926315; PMCID:
PMC9283127.)).

===== Case reports =====
A 65-year-old man who developed cognitive deficits and memory impairments following his first dose of Oxford AstraZeneca vaccine (Covishield). The onset of acute cognitive deficits and memory impairments could be another complication of COVID-19 vaccination that physicians and neurologists need to be warned of. Monitoring the safety of COVID-19 vaccines and describing the side effects associated with them is essential to improve safety profiles and enhance public trust
((Chaurasia B, Chavda V, Lu B, Garg K, Montemurro N. Cognitive deficits and memory impairments after COVID-19 (Covishield) vaccination. Brain Behav Immun Health. 2022 Jul;22:100463. doi: 10.1016/j.bbih.2022.100463. Epub 2022 Apr 23. PMID: 35496775; PMCID: PMC9034829.)).