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Título

CEREBRAL VENOUS THROMBOSIS SECONDARY TO MUTATION IN THE GENE PROTHROMBIN IN THE CONTEXT OF VACCINATION AGAINST COVID-19: A CASE REPORT

RESUMO

CASE PRESENTATION: A 15-year-old woman attended the medical office with a headache without improvement for weeks after 30 days of vaccination against coronavirus with the Ad26.COV2.S vaccine. Denied using contraceptives. Evolved with drowsiness, neck stiffness, abducens nerve paresis, low visual acuity, vomiting, ataxia and mild asymmetric tetraparesis. Optical Coherence Tomography (OCT) showed bilateral papilledema. Cerebral Magnetic Resonance (CMR) and CSF examination without alterations. Spinal manometry confirmed the Intracranial hypertension (ICH) (75cmH2O). A relief lumbar puncture was performed and acetazolamide was started. Arteriography showed venous thrombosis of the sigmoid and left transverse sinus. The investigation of the alteration of Leiden V factor, antithrombin III, C and S Protein, antiphospholipid antibodies was all normal. A positive result for the prothrombin gene 20210 mutation in heterozygosity was obtained. Full anticoagulation therapy was performed with 5 mg warfarin (INR between 2 and 3) and enoxaparin bridge, associated with topiramate 25 mg/day. Patient remains in outpatient follow-up, with no signs of disease recurrence. DISCUSSION: Cerebral venous thrombosis (CVT) is defined as the presence of a thrombus within a venous sinus, in a superficial or deep intracranial vein. CVT has a higher incidence in young women, with additional risk factors, such as pregnancy, puerperium and use of oral contraceptives². Headache is the most common symptom, but focal neurologic deficits, convulsion episodes and encephalopathies are also evidenced. The most suitable study technique of venous thrombi is CMR venography. The coagulogram may indicate the presence of conditions that help the pathogenesis of CVT and the research of the thrombophilic status and mutations is helpful. Lumbar puncture is important to rule out meningitis cases³. In addition, other conditions such as prior vaccination for COVID-19 as adenovirus vector-based vaccines are related to thrombotic episodes, through a mechanism called Vaccine-Induced Thrombocytopenic Thrombosis (VITT)4 . FINAL COMMENTS: It is noteworthy that CVT is an uncommon and reversible condition if diagnosed and reated properly. Its association with mutations in the 20210A gene of prothrombin is well established and in relation to vaccination it is important to recognize that the risk of CVT from COVID-19 exceeds that of vaccines.

Palavras Chave

Cerebral Venous Thrombosis, Prothrombin Gene 20210, COVID-19