{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T11:10:27Z","timestamp":1767006627603,"version":"3.44.0"},"reference-count":7,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2021,10,1]],"date-time":"2021-10-01T00:00:00Z","timestamp":1633046400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,9,17]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:p>Cerebral venous sinus thrombosis (CVST) following novel coronavirus-2019 (nCoV-19) vaccination is a rare adverse effect. We report the first case of CVST associated with ChAdOx1 vaccination, with positive anti-platelet factor 4 (PF4) antibodies, from India. A 44-year-old woman developed a thunderclap headache 4\u2009days after the first dose of the adenoviral vector vaccine ChAdOx1 (Covishield). Physical examination was unremarkable barring mild neck stiffness with no focal neurological deficits. MRI identified right transverse sinus thrombosis. Laboratory tests revealed raised D-dimer and thrombocytopenia; anti-PF4 antibodies were subsequently identified, consistent with thrombosis with thrombocytopenia syndrome (TTS). She was treated with non-heparin anticoagulation and intravenous immunoglobulin and made an uneventful recovery. Early recognition of adenoviral vector vaccine-related TTS, which resembles heparin-induced thrombocytopenia syndrome, is important as heparin and heparin analogues are best avoided in the treatment.<\/jats:p>","DOI":"10.1136\/bcr-2021-246455","type":"journal-article","created":{"date-parts":[[2021,10,27]],"date-time":"2021-10-27T13:08:33Z","timestamp":1635340113000},"page":"e246455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Cerebral venous sinus thrombosis after ChAdOx1 vaccination: the first case of definite thrombosis with thrombocytopenia syndrome from India"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7032-4412","authenticated-orcid":false,"given":"Boby Varkey","family":"Maramattom","sequence":"first","affiliation":[{"name":"Neurology, Aster Medcity, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fathima Mihta","family":"Moidu","sequence":"additional","affiliation":[{"name":"Neurology, Aster Medcity, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sajira","family":"Varikkottil","sequence":"additional","affiliation":[{"name":"Neurology, Aster Medcity, Kochi, Kerala, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8696-7121","authenticated-orcid":false,"given":"Akheel A","family":"Syed","sequence":"additional","affiliation":[{"name":"Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK"},{"name":"Division of Diabetes, Endocrinology & Gastroenterology, The University of Manchester, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,10,27]]},"reference":[{"key":"2025082711525160000_14.10.e246455.1","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1002\/ana.26143","article-title":"Guillain-Barr\u00e9 syndrome following ChAdOx1-S\/nCoV-19 vaccine","volume":"90","author":"Maramattom","year":"2021","journal-title":"Ann Neurol"},{"key":"2025082711525160000_14.10.e246455.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2104840"},{"key":"2025082711525160000_14.10.e246455.3","doi-asserted-by":"crossref","first-page":"1964","DOI":"10.1056\/NEJMc2105869","article-title":"Thrombotic thrombocytopenia after Ad26.COV2.S vaccination","volume":"384","author":"Muir","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082711525160000_14.10.e246455.4","unstructured":"World Health Organization . Guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination to prevent coronavirus disease (COVID-19): interim guidance. Geneva: World Health Organization, 2021. Available: https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-TTS-2021.1 [Accessed 19 Jul 2021]."},{"key":"2025082711525160000_14.10.e246455.5","unstructured":"Bussel JB , Connors JM , Cines DB . Thrombosis with thrombocytopenia syndrome (also termed vaccine-induced thrombotic thrombocytopenia). Washington, DC: American Society of Hematology, 2021. https:\/\/www.hematology.org\/covid-19\/vaccine-induced-immune-thrombotic-thrombocytopenia"},{"key":"2025082711525160000_14.10.e246455.6","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12718"},{"key":"2025082711525160000_14.10.e246455.7","doi-asserted-by":"crossref","DOI":"10.1016\/j.dsx.2021.06.021","article-title":"Anti-PF4 antibody negative cerebral venous sinus thrombosis without thrombocytopenia following immunization with COVID-19 vaccine in an elderly non-comorbid Indian male, managed with conventional heparin-warfarin based anticoagulation","volume":"15","author":"Dutta","year":"2021","journal-title":"Diabetes Metab Syndr"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-246455","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:53:00Z","timestamp":1756320780000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-246455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10]]},"references-count":7,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,27]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/bcr-2021-246455"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-246455","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2021,10]]}}}