Intensive Care Med (2021) 47:790–791
https://doi.org/10.1007/s00134-021-06425-y

IMAGING IN INTENSIVE CARE MEDICINE

Fatal cerebral venous sinus thrombosis after 
COVID‑19 vaccination
Matthieu Jamme1,2* 

, Elie Mosnino1, Jan Hayon1 and Guillaume Franchineau1,3

© 2021 Springer-Verlag GmbH Germany, part of Springer Nature

A 69-year-old woman with arterial hypertension treated 
daily  by  hydrochlorothiazide  and  angiotensin  receptor 
antagonist  received  a  first  dose  of  Oxford–AstraZeneca 
vaccine.

Eleven days after the vaccination, the patient developed 
headache  associated  with  behavioral  symptoms.  At  day 
13, her daughter found her unconscious. Physical exami-
nation  revealed  a  coma  Glasgow  4/15,  right  mydriasis, 

Fig. 1  Cerebral venous thrombosis with bilateral frontal intraparenchymatous hemorrhage. A T2 FLAIR sequencing revealed bilateral left 
(80 
blood flow in sigmoids and superior sagittal sinus

 23 mm) intra parenchymatous frontal hemorraghe. B Venous phase contrast MRI study showed an absence of venous 

 53 mm) and right (56 

×

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*Correspondence:  matthieu.jamme@ght-yvelinesnord.fr 
1 Service de Réanimation polyvalente, Centre hospitalier intercommunal 
de Poissy Saint Germain en Laye (CHIPS), 10 rue du champ Gaillard, 
78300 Poissy, France
Full author information is available at the end of the article

791

bilateral Babinski reflex without hemodynamic instability 
or respiratory failure. She was intubated and transferred 
in our intensive care unit.

Immediate  CT  scan  followed  by  MRI  highlighted  a 
severe  bilateral  frontal  hemorrhage  with  brain  hernia-
tion  complicating  a  cerebral  venous  thrombosis  of  the 
left internal jugular vein, sigmoid sinus and superior sag-
ittal  sinus  (Fig.  1).  Moreover,  thoracic  CT  scan  showed 
concomitant  segmentary  pulmonary  embolism.  Blood 
analysis at admission revealed an isolated thrombopenia 
measured at 18G/L with positive anti-PF4 antibodies.

Evolution was dramatically poor in the next few hours 
with brain death, leading to an organ donation procedure.

Author details
1 Service de Réanimation polyvalente, Centre hospitalier intercommunal de 
Poissy Saint Germain en Laye (CHIPS), 10 rue du champ Gaillard, 78300 Poissy, 
France. 2 INSERM U1018, Centre de recherche en épidémiologie et santé des 

populations (CESP), Equipe “Rein et Cœur”, Université Paris Saclay, 16 avenue 
Paul Vaillant Couturier, 94800 Villejuif, France. 3 INSERMUMRS_1166-iCAN, 
Institute of Cardiometabolism and Nutrition, Sorbonne Universités, UPMC Univ 
Paris 06, 75651 Paris Cedex 13, France. 

Author contributions
MJ, EM, JH and GF wrote the manuscript.

Declarations

Conflicts of interest
The authors have no conflict of interest to declare.

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Received: 22 April 2021   Accepted: 27 April 2021
Published online: 13 May 2021