Acute prolonged motor aura resembling ischemic stroke after COVID - 19 vaccination (CoronaVac): the firstcase report

ABSTRACT

Objective: NA Background: Due to the COVID-19 pandemic, Thailand has started its vaccination program since February 2021. After the launch of the mass vaccination with CoronaVac, there were reports of patients who suffer unusual hemiparesis across the country. We report the first case of a patient who suffered transient focal neurological deficit mimicking stroke following CoronaVac vaccination. However, instead of an ischemic stroke, motor aura was suspected. Design/Methods: A 24 year-old Thai female presented with left hemiparesis fifteen minutes after receiving CoronaVac. She also had numbness of her left arm and legs, flashing lights, and headaches. On physical examination, her BMI was 32.8. Her vital signs were normal. She had moderate left hemiparesis (MRC grade III), numbness on her left face, arms, and legs. Her weakness continued for 5 days. Results: A brain CT scan was done showing no evidence of acute infarction. Acute treatment with aspirin was given. MRI in conjunction with MRA was performed in which no restricted diffusion was seen. A SPECT was performed to evaluate the function of the brain showing significant hypoperfusion of the right hemisphere. The patient gradually improved and was discharged. Conclusions: In this study, we present the first case of stroke mimic after CoronaVac vaccination. After negative imaging studies, stroke is unlikely to be the cause. Asymmetrical abnormal functional imaging study showing multifocal hypoperfusion on the right could represent the ongoing neurological deficits. Therefore, we believed that it might be due to cortical spreading depression, in which motor aura could be responsible. The uniqueness in our case is the prolongation of weakness that we think might be due reverberating spreading depression wave. The cause is unknown, but we proposed that aluminum found to enhance the vaccine that could disrupt the Glutamate - Nitric oxide - cGMP pathway leading to the prolongation of motor aura.