Acute Ischemic Stroke in the Context of SARS-CoV-2 Vaccination: A Systematic Review

Abstract

Background There have been reports suggesting an increased incidence of acute ischemic stroke among anti-SARS-CoV-2 vaccinees. We aimed to systematically review the literature to summarize the available evidence on the association between SARS-CoV-2 vaccination and acute ischemic stroke. Methods A systematic literature search on MEDLINE, LitCovid and LIVIVO databases was performed for eligible randomized controlled trials, observational studies, registries and case reports that reported on imaging-confirmed acute ischemic stroke in the context of any SARS-CoV-2 vaccination with BNT162b2, mRNA-1273, Ad26.COV2.S, ChAdOx1 or Gam-COVID-Vac. Literature search was limited to English and German languages and publication date before October 19, 2021. Results We identified a total of 395,105,670 individuals who underwent vaccination. We found 21 sources, including 2 cohort studies, 4 registry studies, 3 randomized clinical trials, and 12 case reports. Individuals included in these studies were at least 16 years old. Cari et al observed a higher likelihood of acute ischemic stroke in vaccinees aged 18–64 years, compared to Whiteley et al observing vaccinees older than 70 years when vaccinated. In addition, differences in the likelihood of acute ischemic stroke were found among the vaccines studied, although no overall increased stroke incidence was demonstrated with vaccination. Conclusion In this systematic review of the available literature, we found that the risk of acute ischemic stroke does not appear to be increased in vaccinated individuals who have received any of the currently licensed SARS-CoV-2 vaccines compared with the baseline incidence of stroke.

Neurological Adverse Reactions to SARS-CoV-2 Vaccines

“…SC2V-related cerebrovascular diseases include VST, ischemic stroke, ICH, SAB, pituitary apoplexy, RCVS, cerebral vasculitis, and Susac syndrome ( Table 2 ) [ 4 , 6 …”

Is a high chest CT severity score a risk factor for an increased incidence of long-term neuroimaging findings after COVID-19?

“…The long time interval in our study also included the vaccination program that started in the first half of 2021 in our country. Although complications especially ASIS and CVST have been reported post-COVID-19 vaccination, Rahming et al reported in their review that there was no significant increase in the overall incidence of stroke in the population of individuals administered COVID-19 vaccines 39 . According to our results, we thought that the main cause of positive neuroimaging in our patients who were COVID-19 positive before vaccination and who were vaccinated afterward was the infection itself.…”

A Narrative Review of Neurological Complications of SARS-CoV-2 Vaccination

“…Appearance of persistent or unusual neurological symptoms following SARS-CoV-2 vaccine should be urgently investigated for VITT. 25 In meta-analytic studies, acute ischemic stroke (AIS) was reported in 4.7 cases per 100,000 vaccinations, 26,27 which is comparable to its prevalence in the general population.…”