Malignant cerebral infarction after ChAdOx1 nCov-19 vaccination: a catastrophic variant of vaccine-induced immune thrombotic thrombocytopenia

Abstract Vaccine-induced thrombotic thrombocytopenia with cerebral venous thrombosis is a syndrome recently described in young adults within two weeks from the first dose of ChAdOx1 nCoV-19 vaccine. Here we report cases malignant middle artery (MCA) infarct and 9-10 days following vaccination. The arrived our facility around same time but different geographical areas, potentially excluding epidemiological links; meanwhile, no abnormality was found respective vaccine batches. Patient 1 57-year-old woman who underwent decompressive craniectomy despite prior, successful mechanical thrombectomies. 2 55-year-old developed fatal bilateral MCA infarct. Both patients manifested pulmonary portal vein high level antibodies to platelet factor 4-polyanion complexes. None had ever received heparin past before stroke onset. Our observations rare arterial may contribute assessment possible adverse effects associated COVID-19