Decompressive surgery in cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia

被引：2

作者：

Krzywicka, Katarzyna ^{[1
]}

de Sousa, Diana Aguiar ^{[2
,3
,4
]}

Cordonnier, Charlotte J. ^{[5
]}

Bode, Felix S. ^{[6
]}

Field, Thalia ^{[7
]}

Michalski, Dominik ^{[8
]}

Pelz, Johann ^{[8
]}

Skjelland, Mona ^{[9
]}

Wiedmann, Markus ^{[10
]}

Zimmermann, Julian ^{[6
]}

Wittstock, Matthias ^{[11
]}

Zanotti, Bruno ^{[12
]}

Ciccone, Alfonso ^{[12
]}

di Poggio, Monica Bandettini ^{[13
]}

Borhani-Haghighi, Afshin ^{[14
]}

Chatterton, Sophie ^{[15
]}

Aujayeb, Avinash ^{[16
]}

Devroye, Annemie ^{[17
]}

Dizonno, Vanessa ^{[7
]}

Geeraerts, Thomas ^{[18
]}

Giammello, Fabrizio ^{[19
,20
]}

Guenther, Albrecht R. ^{[21
]}

Ichaporia, Nasli ^{[22
]}

Kleinig, Timothy S. ^{[23
]}

Kristoffersen, Espen ^{[24
,25
]}

Lemmens, Robin ^{[17
]}

De Maistre, Emmanuel ^{[26
]}

Mirzaasgari, Zahra ^{[27
]}

Payen, Jean-Francois ^{[28
,29
]}

Putaala, Jukka ^{[30
,31
]}

Petruzzellis, Marco ^{[32
]}

Raposo, Nicolas ^{[33
,34
]}

Sadeghi-Hokmabadi, Elyar ^{[35
]}

Schoenenberger, Silvia ^{[36
]}

Umaiorubahan, Meenakshisundaram ^{[37
]}

Sylaja, Padmavathy N. ^{[38
]}

van de Munckhof, Anita ^{[1
]}

van Kammen, Mayte Sanchez ^{[1
]}

Lindgren, Erik ^{[39
,40
,41
]}

Jood, Katarina ^{[39
,40
,41
]}

Scutelnic, Adrian R. ^{[42
]}

Heldner, Mirjam ^{[42
]}

Poli, Sven ^{[43
,44
]}

Kruip, Marieke J. H. A. ^{[45
]}

Arauz, Antonio B. ^{[46
]}

Conforto, Adriana ^{[47
,48
]}

Aaron, Sanjith

Middeldorp, Saskia ^{[49
,50
,51
]}

Tatlisumak, Turgut ^{[39
,40
,41
]}

Arnold, Marcel M. ^{[42
]}

机构：

[1] Univ Amsterdam, Amsterdam Univ Med Ctr, Dept Neurol, Amsterdam, Netherlands

[2] Lisbon Cent Univ Hosp Ctr, Stroke Ctr, Lisbon, Portugal

[3] Univ Lisbon, Fac Med, CEEM, Lisbon, Portugal

[4] Univ Lisbon, Inst Anat, Fac Med, Lisbon, Portugal

[5] Univ Lille, INSERM, CHU Lille, U1172,LilNCog Lille Neurosci & Cognit, Lille, France

[6] Univ Klinikum Bonn, Dept Neurol, Bonn, Germany

[7] Univ British Columbia, Vancouver Stroke Program, Div Neurol, Vancouver, BC, Canada

[8] Leipzig Univ Hosp, Dept Neurol, Leipzig, Germany

[9] Oslo Univ Hosp, Dept Neurol, Oslo, Norway

[10] Oslo Univ Hosp, Dept Surg, Oslo, Norway

[11] Univ Hosp Rostock, Dept Neurol, Rostock, Germany

[12] C Poma Hosp, ASST Mantova, Neurol Neurosurg Act, Dept Neurosci, Mantua, Italy

[13] Policlin San Martino Hosp, Dept Neurosci, Genoa, Italy

[14] Shiraz Univ Med Sci, Clin Neurol Res Ctr, Shiraz, Iran

[15] Royal North Shore Hosp, Dept Neurol, Sydney, NSW, Australia

[16] Northumbria Healthcare NHS Fdn Trust, Resp Dept, Cramlington, England

[17] Univ Hosp Leuven, Dept Neurol, Leuven, Belgium

[18] Univ Toulouse 3 Paul Sabatier, Univ Hosp Toulouse, Hop Pierre Paul Riquet, Dept Anesthesiol & Crit Care,CHU Toulouse Purpan, Toulouse, France

[19] Univ Messina, Dept Biomed & Dent Sci & Morphofunct Imaging, Translat Mol Med & Surg, Cycle 36, Messina, Italy

[20] Polyclin Hosp G Martino, Dept Clin & Expt Med, Stroke Unit, Messina, Italy

[21] Jena Univ Hosp, Dept Neurol, Jena, Germany

[22] Jahangir Hosp, Dept Neurol, Pune, India

[23] Royal Adelaide Hosp, Dept Neurol, Adelaide, SA, Australia

[24] Akershus Univ Hosp, Dept Neurol, Oslo, Norway

[25] Univ Oslo, Dept Gen Practice, Oslo, Norway

[26] Ctr Hosp Univ Dijon, Lab Hematol Hemostase, Dijon, France

[27] Iran Univ Med Sci, Firoozgar Hosp, Sch Med, Dept Neurol, Tehran, Iran

[28] Grenoble Alpes Univ Hosp, Dept Anaesthesia & Intens Care, Grenoble, France

[29] Grenoble Alpes Univ, Grenoble Inst Neurosci, INSERM U1216, Grenoble, France

[30] Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland

[31] Univ Helsinki, Helsinki, Finland

[32] AOU Consorziale Policlin Bari, Dept Neurol, Bari, Italy

[33] Ctr Hosp Univ Toulouse, Hop Pierre Paul Riquet, Dept Neurol, Toulouse, France

[34] Univ Toulouse, Toulouse NeuroImaging Ctr, Inserm, Toulouse, France

[35] Tabriz Univ Med Sci, Imam Reza Hosp, Dept Neurol, Tabriz, Iran

[36] Heidelberg Univ Hosp, Dept Neurol, Heidelberg, Germany

[37] Sri Ramachandra Med Coll, Dept Neurol, Chennai, India

[38] Sree Chitra Tirunal Inst Med Sci & Technol, Dept Neurol, Comprehens Stroke Care Program, Trivandrum, India

[39] Univ Gothenburg, Sahlgrenska Univ Hosp, Dept Neurol, Gothenburg, Sweden

[40] Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden

[41] Inst Neurosci & Physiol, Dept Clin Neurosci, Gothenburg, Sweden

[42] Univ Bern, Bern Univ Hosp, Dept Neurol, Inselspital, Bern, Switzerland

[43] Eberhard Karls Univ Tubingen, Dept Neurol & Stroke, Tubingen, Germany

[44] Eberhard Karls Univ Tubingen, Hertie Inst Clin Brain Res, Tubingen, Germany

[45] Erasmus MC, Dept Hematol, Rotterdam, Netherlands

[46] Natl Inst Neurol & Surg Manuel Velasco Suarez, Mexico City, Mexico

[47] Univ Sao Paulo, Hosp Clin, Sao Paulo, Brazil

[48] Hosp Israelita Albert Einstein, Sao Paulo, Brazil

[49] Christian Med Coll & Hosp, Dept Neurol Sci, Neurol Unit, Vellore, Tamil Nadu, India

[50] Radboud Univ Nijmegen, Med Ctr, Dept Internal Med, Nijmegen, Netherlands

来源：

EUROPEAN JOURNAL OF NEUROLOGY | 2023年 / 30卷 / 05期

关键词：

brain death; cerebral venous thrombosis; coma; COVID-19; vaccinations; surgery; TRANSTENTORIAL HERNIATION; DIAGNOSIS;

D O I：

10.1111/ene.15735

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 ad-mission were functionally independent. Conclusions: Almost two-thirds of surgical CVST- VITT patients died during hospital ad-mission. Preoperative coma and bilateral absence of pupillary responses were associated with higher mortality rates. Survivors often achieved functional independence.

引用

页码：1335 / 1345

页数：11

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