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Título

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

Resumo

CASE PRESENTATION: A 15-year-old woman came to the consultation with a progressive headache for 6 weeks, after 30 days of vaccination against the coronavirus with the Ad26.COV2 vaccine. S. She Denied use of contraceptives. She evolved with drowsiness, neck stiffness, abducens nerve paresis, low visual acuity (BAV), vomiting, ataxia and mild asymmetric tetraparesis. Optical Coherence Tomography (OCT) showed bilateral papilledema. Brain Magnetic Resonance (MRI) and CSF examination without alterations. Spinal manometry confirmed Intracranial Hypertension (ICH) (75cmH2O). A relief lumbar puncture was performed and acetazolamide was started. Arteriography showed Venous Thrombosis of the sigmoid sinus and left transverse. The investigation of alteration of factor V Leiden, antithrombin III, Protein C and S, antiphospholipid antibodies were normal. A positive result was obtained for the mutation of the prothrombin gene 20210A in heterozygosity. Full anticoagulation was performed with 5 mg warfarin (INR between 2 and 3) and bridging with enoxaparin, associated with topiramate 25 mg/day. The patient remains under 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, superficial intracranial vein 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, seizure episodes, and encephalopathies are also evidenced. Digital subtraction angiography is indicated for inconclusive cases. The coagulogram may indicate the presence of conditions that aid in the pathogenesis of CVT and the search for thrombophilic status and mutations is useful. Lumbar puncture is important to rule out meningitis³. In addition, other conditions such as previous vaccination for COVID-19 should be investigated, as vaccines based on adenovirus vectors are related to thrombotic episodes, through a mechanism called Vaccine-Induced Thrombocytopenic Thrombosis (VITT). FINAL COMMENTS: It is noteworthy that CVT is an uncommon and reversible condition if properly diagnosed and treated. Its association with mutations in the prothrombin gene 20210A is well established and in relation to vaccination it is important to recognize that the risk of CVT by COVID-19 in the general population outweighs the risk of vaccines.

Palavras Chave

Cerebral Venous Thrombosis; Prothrombin Gene 20210A; COVID-19.