ABSTRACT
OBJECTIVE: There have been no reports suggesting a relationship between the COVID-19 mRNA vaccines that encodes the spike glycoprotein of SARS-CoV-2 and cerebrovascular disease. A case of repeated cardioembolic stroke after vaccination with the BNT162b2 (Pfizer) COVID-19 mRNA vaccine is presented. METHODS: Imaging and laboratory findings, treatment decisions, and the outcome of this case are presented. RESULTS: An 83-year-old Japanese woman developed right hemiplegia and motor aphasia three days after receiving her first dose of the BNT162b2 (Pfizer) COVID-19 mRNA vaccine. She had been taking rivaroxaban for persistent atrial fibrillation for 10 years, but had no symptomatic ischemic strokes. On magnetic resonance imaging (MRI) the left middle cerebral artery (MCA) was occluded. Intravenous recombinant tissue-plasminogen activator (rt-PA) therapy and mechanical thrombectomy were performed, and she recovered almost fully. However, three days after the second dose, she developed left hemiplegia and left hemispatial neglect. MRI showed occlusion of the right MCA. Only mechanical thrombectomy was performed again, but it could not be resumed due to the hard thrombus. DISCUSSION: In this case, it is difficult to exclude a causal relationship between the COVID-19 mRNA vaccine and ischemic stroke. This association needs to be carefully monitored.
Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Embolic Stroke/complications , Aged, 80 and over , BNT162 Vaccine , COVID-19 Vaccines/administration & dosage , Embolic Stroke/etiology , Embolic Stroke/therapy , Female , Hemiplegia , Humans , Ischemic Stroke , Magnetic Resonance Imaging , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/etiology , Thrombectomy , Tissue Plasminogen Activator , Vaccination/adverse effectsABSTRACT
BACKGROUND: The current coronavirus (COVID-19) pandemic is associated with severe pulmonary and cardiovascular complications. CASE PRESENTATION: This report describes a young patient with COVID-19 without any comorbidity presenting with severe cardiovascular complications, manifesting with pulmonary embolism, embolic stroke, and right heart failure. CONCLUSION: Management with short-term mechanical circulatory support, including different cannulation strategies, resulted in a successful outcome despite his critical cardiovascular status.