Cerebral venous sinus thrombosis after COVID-19 vaccination: a case report and literature review

Abstract

As COVID-19 vaccines became widely available, there have been reports of neurovascular complications. In this article, we aim to report a case of cerebral venous sinus thrombosis (CVST) induced by COVID-19 vaccination, with a literature review on similar cases as well as the potential pathophysiological mechanisms. Our case is a healthy male who developed headache, vomiting, photophobia and diplopia after receiving the Ad26.COV2.S vaccine. Fundus examination showed papilledema, and magnetic resonance imaging of the brain and cerebral veins showed CVST involving the superior sagittal sinus and right transverse sinus extending into the right jugular vein. Hypercoagulability workup was unremarkable, and the patient received immunotherapy and anticoagulation. Following this treatment, symptoms resolved, and he had no residual neurologic deficits. Developing neurologic manifestations, especially severe headaches with papilledema, after COVID-19 vaccination should warrant neuroimaging. Early recognition and management of CVST are essential for good clinical outcomes.

Post-COVID-19 Vaccination CNS Magnetic Resonance Imaging Findings: A Systematic Review

“…A noteworthy observation from our analysis is the occurrence of CVST following COVID-19 vaccination, which was reported in several studies [ 22 – 33 ]. The incidence of CVST was found to be higher in patients who received the ChAdOx1 vaccine (AstraZeneca) compared to those who received the mRNA-based vaccines (Pfizer-BioNTech and Moderna) or Ad26.COV2.S (Janssen) vaccine.…”

“…Te clinical presentation of CVST varied among the included studies, with the most common symptoms being headache, fever, and vomiting [22][23][24][25][26][27][28][29][30][31][32][33]. In some cases, more severe neurological manifestations such as altered mental status (AMS), visual disturbances, and seizures were reported [31][32][33].…”

“…Te clinical presentation of CVST varied among the included studies, with the most common symptoms being headache, fever, and vomiting [22][23][24][25][26][27][28][29][30][31][32][33]. In some cases, more severe neurological manifestations such as altered mental status (AMS), visual disturbances, and seizures were reported [31][32][33]. MRI fndings in patients with CVST included hyperintensity on T2-weighted (T2-w) and fuid-attenuated inversion recovery (FLAIR) images, as well as restricted difusion on difusion-weighted imaging (DWI) sequences, indicating acute ischemic lesions [22,23,25,26,31].…”