Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID

Abstract More than 670 million cases of coronavirus disease 2019 (COVID‐19) have been recorded worldwide in the 3 years since the start of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. About 45% of survivors of COVID‐19 develop a syndrome known as long‐term COVID, in whi...

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Main Authors: Elizabeth Mendoza‐Portillo, Estefania Aleman‐Navarro, G. Aleph Prieto, Yvonne Rosenstein, Jose J. Lozano‐Nuevo, Araceli Perez‐Lopez
Format: Article
Language:English
Published: Wiley 2023-12-01
Series:Neuroprotection
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Online Access:https://doi.org/10.1002/nep3.24
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author Elizabeth Mendoza‐Portillo
Estefania Aleman‐Navarro
G. Aleph Prieto
Yvonne Rosenstein
Jose J. Lozano‐Nuevo
Araceli Perez‐Lopez
author_facet Elizabeth Mendoza‐Portillo
Estefania Aleman‐Navarro
G. Aleph Prieto
Yvonne Rosenstein
Jose J. Lozano‐Nuevo
Araceli Perez‐Lopez
author_sort Elizabeth Mendoza‐Portillo
collection DOAJ
description Abstract More than 670 million cases of coronavirus disease 2019 (COVID‐19) have been recorded worldwide in the 3 years since the start of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. About 45% of survivors of COVID‐19 develop a syndrome known as long‐term COVID, in which symptoms persist even months after the acute infection. About 76% of patients with long COVID experience neurological manifestations. Moreover, patients who have survived COVID‐19 have an increased risk of cerebral venous thrombosis. This case report describes a 41‐year‐old woman who developed neurological manifestations associated with jugular vein thrombosis 24 h after administration of the Oxford–AstraZeneca (ChAdOx1 nCoV‐19) vaccine (AstraZeneca‐Serum Institute of India). She had been infected with SARS‐CoV‐2 three months before vaccination. Although initially suspected to be a case of vaccine‐induced immune thrombotic thrombocytopenia (VITT) in view of her recent vaccination, the patient did not have any hallmarks of VITT, such as thrombocytopenia, an increased d‐dimer level, or antibodies against platelet factor‐4. Moreover, the neurological manifestations were associated with a high concentration of inflammatory cytokines, including interleukin (IL)‐6, IL‐17A, and IL‐21, and elevated neutrophil levels in cerebrospinal fluid, suggesting that inflammatory immune components had a role in the development of thrombotic events and pointing to an alternative diagnosis. In this case, the laboratory results indicated that the neurological manifestations associated with jugular vein thrombosis were not associated with VITT. Therefore, we propose that the thrombosis of the left jugular vein was a sequela of SARS‐CoV‐2 infection.
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spelling doaj-art-1d73db2ae4424dbe8d5351d73ddbd2622025-08-20T02:40:29ZengWileyNeuroprotection2770-72962770-730X2023-12-011217017510.1002/nep3.24Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVIDElizabeth Mendoza‐Portillo0Estefania Aleman‐Navarro1G. Aleph Prieto2Yvonne Rosenstein3Jose J. Lozano‐Nuevo4Araceli Perez‐Lopez5Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez Ciudad de México MéxicoInstituto de Biotecnología Universidad Nacional Autónoma de México (UNAM) Cuernavaca Morelos MéxicoInstituto de Neurobiología UNAM‐Juriquilla Querétaro MéxicoInstituto de Biotecnología Universidad Nacional Autónoma de México (UNAM) Cuernavaca Morelos MéxicoHospital General de Ticomán Secretaría de Salud de la Ciudad de México Ciudad de México MéxicoUnidad de Investigación en Biomedicina Facultad de Estudios Superiores Iztacala, UNAM Tlalneplantla Estado de México MéxicoAbstract More than 670 million cases of coronavirus disease 2019 (COVID‐19) have been recorded worldwide in the 3 years since the start of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic. About 45% of survivors of COVID‐19 develop a syndrome known as long‐term COVID, in which symptoms persist even months after the acute infection. About 76% of patients with long COVID experience neurological manifestations. Moreover, patients who have survived COVID‐19 have an increased risk of cerebral venous thrombosis. This case report describes a 41‐year‐old woman who developed neurological manifestations associated with jugular vein thrombosis 24 h after administration of the Oxford–AstraZeneca (ChAdOx1 nCoV‐19) vaccine (AstraZeneca‐Serum Institute of India). She had been infected with SARS‐CoV‐2 three months before vaccination. Although initially suspected to be a case of vaccine‐induced immune thrombotic thrombocytopenia (VITT) in view of her recent vaccination, the patient did not have any hallmarks of VITT, such as thrombocytopenia, an increased d‐dimer level, or antibodies against platelet factor‐4. Moreover, the neurological manifestations were associated with a high concentration of inflammatory cytokines, including interleukin (IL)‐6, IL‐17A, and IL‐21, and elevated neutrophil levels in cerebrospinal fluid, suggesting that inflammatory immune components had a role in the development of thrombotic events and pointing to an alternative diagnosis. In this case, the laboratory results indicated that the neurological manifestations associated with jugular vein thrombosis were not associated with VITT. Therefore, we propose that the thrombosis of the left jugular vein was a sequela of SARS‐CoV‐2 infection.https://doi.org/10.1002/nep3.24cerebral venous thrombosislong COVIDvaccine
spellingShingle Elizabeth Mendoza‐Portillo
Estefania Aleman‐Navarro
G. Aleph Prieto
Yvonne Rosenstein
Jose J. Lozano‐Nuevo
Araceli Perez‐Lopez
Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID
Neuroprotection
cerebral venous thrombosis
long COVID
vaccine
title Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID
title_full Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID
title_fullStr Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID
title_full_unstemmed Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID
title_short Neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long COVID
title_sort neurological manifestations with jugular vein thrombosis linked to an inflammatory profile may be a sequela of long covid
topic cerebral venous thrombosis
long COVID
vaccine
url https://doi.org/10.1002/nep3.24
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