Large hemorrhagic stroke after ChAdOx1 nCoV‐19 vaccination: A case report

Abstract

Background The anti‐COVID‐19 vaccines are new, and we should be alert of potential adverse effects of them. Aims of the Study To report a case of a large hemorrhagic stroke 5 days after ChAdOx1 nCoV‐19 vaccination. Methods Clinical, imaging, and laboratory data of a patient with stroke admitted to our emergency department. Results A woman, 57 years old, took the first dose of the ChAdOx1 nCoV‐19 vaccine and shortly thereafter presented mild systemic symptoms and started on aspirin. On day 5, she had a sudden onset of sweating and paleness, which has followed by left hemiparesis, vomiting, and somnolence. Computed tomography showed a large right deep frontal lobe parenchymal hematoma with the inundation of the entire ventricular system. Platelets count, fibrinogen, prothrombin time, and D‐dimer were normal. Digital subtraction angiography did not show any signs of thrombosis or aneurysms in brain circulation. Conclusions Clinicians should be aware of cerebrovascular adverse effects of ChAdOx1 nCoV‐19, including out‐of‐context of vaccine‐induced immune thrombotic thrombocytopenia.

Stroke Associated with COVID-19 Vaccines

“…ICH and subarachnoid hemorrhage (SAH) can occur after COVID-19 vaccination, which can be primary or secondary to venous thrombosis (23,(71)(72)(73)(74)(75)(76). While ICH after COVID-19 vaccination can occur in the context of VITT, Silva et al (75) described primary hemorrhagic stroke following ChAdOx1 nCoV-19 vaccination in a patient without thrombocytopenia, coagulation disorder, or coagulation risk factors. Arguments for such a causal relation is that arterial hypertension (77) and ICH (23,78) are complications of COVID-19 vaccination.…”

Thromboembolic events and hemorrhagic stroke after mRNA (BNT162b2) and inactivated (CoronaVac) covid-19 vaccination: A self-controlled case series study

“… 4 Some case reports also showed occurrence of hemorrhagic stroke subsequent to Vaxzevria vaccination together with or without thrombocytopenia and ischemic stroke. 5 , 6 …”

Accelerated Hypertension and Intracerebral Haemorrhage Following First Dose of ChAdOx1-nCOV-19 Vaccination

“…They raised the concern of primary intracerebral hemorrhage post-COVID-19 vaccination besides, out of the context VITT. [ 6 ] Our patient also presented with primary intracerebral hemorrhage, and sudden rise in blood pressure was documented in post-vaccination period. Possible association of accelerated hypertension following vaccine administration is described owing to the vaccine component polyethylene glycol, however, it seems unlikely in our case because ChAdOx1-nCOV-19 (Covishield™) lacks this component.…”

“…[ 2 3 4 5 ] Recently, cases with accelerated hypertension and intracerebral hemorrhage without thrombocytopenia have also been reported. [ 6 7 ] We, herein, report a case of primary intracerebral hemorrhage with accelerated hypertension within 8 hours of the first dose of COVID-19 vaccination.…”