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Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia.
Krzywicka, Katarzyna; Aguiar de Sousa, Diana; Cordonnier, Charlotte; Bode, Felix J; Field, Thalia S; Michalski, Dominik; Pelz, Johann; Skjelland, Mona; Wiedmann, Markus; Zimmermann, Julian; Wittstock, Matthias; Zanotti, Bruno; Ciccone, Alfonso; Bandettini di Poggio, Monica; Borhani-Haghighi, Afshin; Chatterton, Sophie; Aujayeb, Avinash; Devroye, Annemie; Dizonno, Vanessa; Geeraerts, Thomas; Giammello, Fabrizio; Günther, Albrecht; Ichaporia, Nasli R; Kleinig, Timothy; Kristoffersen, Espen S; Lemmens, Robin; De Maistre, Emmanuel; Mirzaasgari, Zahra; Payen, Jean-Francois; Putaala, Jukka; Petruzzellis, Marco; Raposo, Nicolas; Sadeghi-Hokmabadi, Elyar; Schoenenberger, Silvia; Umaiorubahan, Meenakshisundaram; Sylaja, Padmavathy N; van de Munckhof, Anita; Sánchez van Kammen, Mayte; Lindgren, Erik; Jood, Katarina; Scutelnic, Adrian; Heldner, Mirjam R; Poli, Sven; Kruip, Marieke J H A; Arauz, Antonio; Conforto, Adriana B; Aaron, Sanjith; Middeldorp, Saskia; Tatlisumak, Turgut; Arnold, Marcel.
Afiliación
  • Krzywicka K; Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
  • Aguiar de Sousa D; Stroke Centre, Lisbon Central University Hospital Center, Lisbon, Portugal.
  • Cordonnier C; CEEM and Institute of Anatomy, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
  • Bode FJ; INSERM, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, University of Lille, Lille, France.
  • Field TS; Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany.
  • Michalski D; Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
  • Pelz J; Department of Neurology, Leipzig University Hospital, Leipzig, Germany.
  • Skjelland M; Department of Neurology, Leipzig University Hospital, Leipzig, Germany.
  • Wiedmann M; Department of Neurology, Oslo University Hospital, Oslo, Norway.
  • Zimmermann J; Department of Surgery, Oslo University Hospital, Oslo, Norway.
  • Wittstock M; Department of Neurology, Universitätsklinikum Bonn, Bonn, Germany.
  • Zanotti B; Department of Neurology, University Hospital Rostock, Rostock, Germany.
  • Ciccone A; Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy.
  • Bandettini di Poggio M; Department of Neuroscience, Neurology with Neurosurgical Activity, C. Poma Hospital, ASST di Mantova, Mantua, Italy.
  • Borhani-Haghighi A; Department of Neuroscience, Policlinic San Martino Hospital, Genoa, Italy.
  • Chatterton S; Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
  • Aujayeb A; Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
  • Devroye A; Respiratory Department, Northumbria Healthcare NHS Foundation Trust, Cramlington, UK.
  • Dizonno V; Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
  • Geeraerts T; Vancouver Stroke Program, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.
  • Giammello F; Department of Anesthesiology and Critical Care, University Toulouse 3-Paul-Sabatier, University Hospital of Toulouse, Hôpital Pierre-Paul Riquet, CHU Toulouse-Purpan, Toulouse, France.
  • Günther A; Translational Molecular Medicine and Surgery, XXXVI Cycle, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
  • Ichaporia NR; Stroke Unit, Department of Clinical and Experimental Medicine, Polyclinic Hospital G. Martino, Messina, Italy.
  • Kleinig T; Department of Neurology, Jena University Hospital, Jena, Germany.
  • Kristoffersen ES; Department of Neurology, Jahangir Hospital, Pune, India.
  • Lemmens R; Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
  • De Maistre E; Department of Neurology, Akershus University Hospital, Oslo, Norway.
  • Mirzaasgari Z; Department of General Practice, University of Oslo, Oslo, Norway.
  • Payen JF; Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
  • Putaala J; Laboratoire d'Hématologie-Hémostase, Centre Hospitalier Universitaire Dijon, Dijon, France.
  • Petruzzellis M; Department of Neurology, Firoozgar Hospital, School of Medicine, Iran University of Medical Science, Tehran, Iran.
  • Raposo N; Department of Anaesthesia and Intensive Care, Grenoble Alpes University Hospital, and Grenoble Alpes University, Grenoble Institut des Neurosciences, INSERM U1216, Grenoble, France.
  • Sadeghi-Hokmabadi E; Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
  • Schoenenberger S; Department of Neurology, AOU Consorziale Policlinico di Bari, Bari, Italy.
  • Umaiorubahan M; Department of Neurology, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
  • Sylaja PN; Inserm, Toulouse NeuroImaging Center, Université de Toulouse, Toulouse, France.
  • van de Munckhof A; Department of Neurology, Imam-Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Sánchez van Kammen M; Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
  • Lindgren E; Department of Neurology, Sri Ramachandra Medical College, Chennai, India.
  • Jood K; Comprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
  • Scutelnic A; Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
  • Heldner MR; Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
  • Poli S; Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Kruip MJHA; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
  • Arauz A; Department of Neurology, Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
  • Conforto AB; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden.
  • Aaron S; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Middeldorp S; Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Tatlisumak T; Department of Neurology & Stroke, Eberhard-Karls University, Tuebingen, Germany.
  • Arnold M; Hertie Institute for Clinical Brain Research, Eberhard-Karls University, Tuebingen, Germany.
Eur J Neurol ; 30(5): 1335-1345, 2023 05.
Article en En | MEDLINE | ID: mdl-36773014
ABSTRACT
BACKGROUND AND

PURPOSE:

Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is an adverse drug reaction occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. CVST-VITT patients often present with large intracerebral haemorrhages and a high proportion undergoes decompressive surgery. Clinical characteristics, therapeutic management and outcomes of CVST-VITT patients who underwent decompressive surgery are described and predictors of in-hospital mortality in these patients are explored.

METHODS:

Data from an ongoing international registry of patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March 2021 and 10 May 2022, were used. Definite, probable and possible VITT cases, as defined by Pavord et al. (N Engl J Med 2021; 385 1680-1689), were included.

RESULTS:

Decompressive surgery was performed in 34/128 (27%) patients with CVST-VITT. In-hospital mortality was 22/34 (65%) in the surgical and 27/94 (29%) in the non-surgical group (p < 0.001). In all surgical cases, the cause of death was brain herniation. The highest mortality rates were found amongst patients with preoperative coma (17/18, 94% vs. 4/14, 29% in the non-comatose; p < 0.001) and bilaterally absent pupillary reflexes (7/7, 100% vs. 6/9, 67% with unilaterally reactive pupil, and 4/11, 36% with bilaterally reactive pupils; p = 0.023). Postoperative imaging revealed worsening of index haemorrhagic lesion in 19 (70%) patients and new haemorrhagic lesions in 16 (59%) patients. At a median follow-up of 6 months, 8/10 of surgical CVST-VITT who survived admission were functionally independent.

CONCLUSIONS:

Almost two-thirds of surgical CVST-VITT patients died during hospital admission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Trombosis de los Senos Intracraneales / Trombocitopenia / Púrpura Trombocitopénica Idiopática / Vacunas contra la COVID-19 / COVID-19 Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Eur J Neurol Asunto de la revista: NEUROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos
Texto completo
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Trombosis de los Senos Intracraneales / Trombocitopenia / Púrpura Trombocitopénica Idiopática / Vacunas contra la COVID-19 / COVID-19 Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Eur J Neurol Asunto de la revista: NEUROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos