{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T17:25:51Z","timestamp":1764350751959,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,4,30]]},"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>mRNA vaccines including Pfizer BioNTech and Moderna have categorically been considered safe when it comes to preventing COVID-19. However, there is still a small associated risk of thromboembolic phenomenon including venous sinus thrombosis with it and our case report highlights one.<\/jats:p>\n               <jats:p>We describe a patient who developed severe progressive headache, tinnitus and visual disturbance symptoms post-Pfizer-SARS-CoV-2 vaccination. His medical history included essential tremors, hypertension, type 2 diabetes mellitus, chronic kidney disease stage 3, anxiety, depression and long-term catheterisation. Systemic examination revealed hypotonia, generalised reduced power and central diplopia along with peripheral visual field defect in the left eye. He was extensively investigated, the COVID-19 PCR test was negative and all routine blood tests were in the normal range except a marginally raised D-dimer of 779\u2009ng\/mL. CT head was unremarkable. He was also tested for myasthenia gravis; however, acetylcholine receptors antibodies were negative and nerve conduction studies were normal. Subsequent MRI of the brain with venography confirmed venous sinus thrombosis. A 24-hour Holter monitoring test did not reveal any cardiac rate or rhythm abnormality. He was treated with apixaban as per a neurologist\u2019s advice. His clinical condition started to improve and was later discharged from the hospital with an outpatient neurologist clinic follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2021-247493","type":"journal-article","created":{"date-parts":[[2022,5,23]],"date-time":"2022-05-23T07:40:46Z","timestamp":1653291646000},"page":"e247493","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Venous sinus thrombosis after the first dose of Pfizer BioNTech vaccine"],"prefix":"10.1136","volume":"15","author":[{"given":"Muhammad Imran Ahmad","family":"Qureshi","sequence":"first","affiliation":[{"name":"Acute Medicine\/GIM, Northampton General Hospital NHS Trust, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bilal","family":"Azam","sequence":"additional","affiliation":[{"name":"Acute Internal Medicine, Northampton General Hospital NHS Trust, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Aamir","family":"Waheed","sequence":"additional","affiliation":[{"name":"Acute Internal Medicine\/GIM, Northampton General Hospital NHS Trust, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afsheen","family":"Imran","sequence":"additional","affiliation":[{"name":"General Internal Medicine, Northampton General Hospital NHS Trust, Northampton, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"2025082701205459000_15.5.e247493.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2034577"},{"key":"2025082701205459000_15.5.e247493.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2035389"},{"key":"2025082701205459000_15.5.e247493.3","unstructured":"HAN Archive - 00442 [Internet]. Cdc.gov, 2021. Available: https:\/\/emergency.cdc.gov\/han\/2021\/han00442.asp [Accessed 16 Oct 2021]."},{"key":"2025082701205459000_15.5.e247493.4","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa2104840","article-title":"Thrombotic thrombocytopenia after ChAdOx1 nCov-19 vaccination","volume":"384","author":"Greinacher","year":"2021","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025082701205459000_15.5.e247493.5","doi-asserted-by":"publisher","DOI":"10.1097\/WNO.0000000000001122"},{"key":"2025082701205459000_15.5.e247493.6","doi-asserted-by":"publisher","DOI":"10.1159\/000509802"},{"key":"2025082701205459000_15.5.e247493.7","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.1056\/NEJMoa2104882","article-title":"Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination","volume":"384","author":"Schultz","year":"2021","journal-title":"N Engl J Med"},{"key":"2025082701205459000_15.5.e247493.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2105385"},{"key":"2025082701205459000_15.5.e247493.9","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":"2025082701205459000_15.5.e247493.10","doi-asserted-by":"crossref","first-page":"2448","DOI":"10.1001\/jama.2021.7517","article-title":"US case reports of cerebral venous sinus Thrombosis with thrombocytopenia after Ad26.COV2.S vaccination, March 2 to April 21, 2021","volume":"325","author":"See","year":"2021","journal-title":"JAMA"},{"key":"2025082701205459000_15.5.e247493.11","unstructured":"Thrombosis with thrombocytopenia syndrome - hematology.Org [Internet]. Hematology.org:443. Available: https:\/\/www.hematology.org:443\/covid-19\/vaccine-induced-immune-thrombotic-thrombocytopenia [Accessed 16 Oct 2021]."},{"key":"2025082701205459000_15.5.e247493.12","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1182\/blood.2020008248","article-title":"Direct activation of the alternative complement pathway by SARS-CoV-2 spike proteins is blocked by factor D inhibition","volume":"136","author":"Yu","year":"2020","journal-title":"Blood"},{"key":"2025082701205459000_15.5.e247493.13","doi-asserted-by":"crossref","DOI":"10.1016\/j.clim.2021.108665","article-title":"Do COVID-19 RNA-based vaccines put at risk of immune-mediated diseases? In reply to \"potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases\"","volume":"224","author":"Talotta","year":"2021","journal-title":"Clin Immunol"},{"key":"2025082701205459000_15.5.e247493.14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1009128"},{"key":"2025082701205459000_15.5.e247493.15","doi-asserted-by":"crossref","unstructured":"Taquet M . Cerebral venous thrombosis and portal vein thrombosis: A retrospective cohort study of 537,913 COVID-19 cases [Internet]. Open Science Framework, 2021. Available: https:\/\/osf.io\/h2mt7\/ [Accessed 16 Oct 2021].","DOI":"10.1101\/2021.04.27.21256153"},{"key":"2025082701205459000_15.5.e247493.16","doi-asserted-by":"crossref","unstructured":"Pawlowski C , Rinc\u00f3n-Hekking J , Awasthi S . Cerebral venous sinus thrombosis (CVST) is not significantly linked to COVID-19 vaccines or non-COVID vaccines in a large multi-state US health system. bioRxiv 2021.","DOI":"10.1101\/2021.04.20.21255806"},{"key":"2025082701205459000_15.5.e247493.17","doi-asserted-by":"publisher","DOI":"10.1002\/phar.1415"},{"key":"2025082701205459000_15.5.e247493.18","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1633"},{"key":"2025082701205459000_15.5.e247493.19","doi-asserted-by":"publisher","DOI":"10.1002\/cpt.81"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-247493","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T08:21:07Z","timestamp":1756282867000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-247493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,20]]},"published-print":{"date-parts":[[2022,5]]}},"alternative-id":["10.1136\/bcr-2021-247493"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-247493","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,5]]}}}