Ischemic stroke after AstraZeneca (Covid-19) vaccination

Abstract

Vaccination against SARS-COV-2 is considered an effective preventive strategy to halt COVID-19 pandemic. Reports of thromboembolic events in vaccine recipients has jolted some of the European countries to pause the vaccination process temporarily. It is still unclear whether the events are actually due to the vaccines or it is just a coincidence. The gravity of events particularly in young and previously normal patients merits further research to reach some conclusion. Here we present a similar case who sustained ischemic stroke shortly after receiving the first dose of his vaccine.

Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review

“… Author(s) No. of cases Vaccine dose Age gender Past medical history/medication(s) Time from vaccination (days) Clinical presentation Imaging findings Lab findings Treatment/outcome ChAdOx1 nCoV-19 M. A. Alammar [ 114 ] 1 First 43 male obesity, hyperlipidemia 3 Right hemiparesis Left paraventricular parietal infarct Platelets count: NL antiplatelets and statins therapy/alive T. Al-Mayhani et al [ 28 ] 3 N/A ⁎ 35 female N/A 11 headache, left hemiparesis, right gaze preference and drowsiness occlusion of right MCA (M1 segment) + haemorrhagic transformation concurrent thrombosis: right portal vein thrombosis thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive decompressive hemicraniectomy, IVIG, fondaparinux and plasmapheresis/dead N/A ⁎ 37 female N/A 12 diffuse headache, left visual field loss, confusion and left arm weakness left and right ICA occlusion concurrent thrombosis: CVST, PE, thrombosis of left jugular, right hepatic and both iliac veins thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive IVIG, methylprednisolone, plasmapheresis and fondaparinux/alive N/A ⁎ 43 male N/A 21 dysphasia acute left frontal and insular infarct (MCA territory) + haemorrhagic transformation thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive platelet transfusion, IVIG, and fondaparinux/alive S. A. Assiri et al [ 80 ] 4 First 66 male Cardiomyopathy, DM, HTN, dyslipidemia, IHD, prior stroke/ASA 10 Motor, sensory, vision, aphasia, dysphagia Right MCA infarct Platelets count: NL, increased l...…”

Covid-19 vaccine (covishield) heralding Moyamoya angiopathy

“…Stroke following varicella and influenza vaccination has been described and it was contemplated that similar to their natural infections, these vaccines can lead to intracranial vasculopathy cerebral angiopathy leading to narrowing and occlusion of the vessels and resultant ischemic stroke. ( Alammar, 2021 ) A similar possible mechanism may be involved in the COVISHIELD vaccines, causing hypercoagulable state leading to thromboembolisms.…”

“…Vaccination against SARS-CoV-2 has been an important breakthrough to manage the COVID-19 pandemic. ( Alammar, 2021 ) However, as our experiences with the vaccine side effects continue to grow, several cerebrovascular events in close temporal association to vaccination are being reported. Post-vaccination…”

Stroke after COVID‐19 vaccination

“…6 However, arterial and venous thromboembolic events have been reported, and few cases of ischemic stroke have been linked mostly with not RNAbased COVID-19 vaccines. [7][8][9][10][11][12] Multifactorial pathways may contribute to the onset of cerebral thrombosis after COVID-19 vaccination. On first principles, we could not differentiate atherosclerotic thrombosis as opposed to immune-mediated primary inflammatory arterial thrombosis upon clinical, laboratory, and imaging findings.…”

“… 6 However, arterial and venous thromboembolic events have been reported, and few cases of ischemic stroke have been linked mostly with not RNA‐based COVID‐19 vaccines. 7 , 8 , 9 , 10 , 11 , 12 …”