Rupture of Vertebral Artery Dissecting Aneurysm after mRNA Anti-COVID-19 Vaccination: A Report of Two Cases

Abstract

The coronavirus disease 2019 (COVID-19) pandemic continues to spread around the world, and widespread vaccination is considered the most effective way to end it. Although the efficacy of COVID-19 vaccines has been confirmed, their safety remains a concern. In this paper, we report two cases of ruptured vertebral artery dissecting aneurysm (VADA) immediately after messenger RNA (mRNA) anti-COVID-19 vaccination. In Case 1, a 60-year-old woman experienced sudden headache 3 weeks before her first dose of the Moderna mRNA-1273 COVID-19 vaccine. Magnetic resonance imaging showed dilatation of the right vertebral artery (VA) without intracranial hemorrhage. A day after the vaccination, she developed subarachnoid hemorrhage with pulmonary effusion due to a ruptured right VADA. She underwent endovascular internal trapping and parent artery occlusion under general anesthesia. In Case 2, a 72-year-old woman with a previous history of the left VA occlusion due to arterial dissection developed subarachnoid hemorrhage 7 days after the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine due to a ruptured right VADA and underwent stent-assisted coil embolization under general anesthesia. The postoperative courses of these two cases were uneventful. The accumulation of more cases and further study are warranted to clarify the relationship between COVID-19 mRNA vaccination and ruptured intracranial dissecting aneurysms.

Intracranial Hemorrhage After Pfizer-BioNTech (BNT162b2) mRNA COVID-19 Vaccination: A Case Report

“…To our knowledge, ten cases of intracranial hemorrhage after the Pfizer-BioNTech COVID-19 mRNA (BNT162b2) vaccine have been reported in the literature across four different studies [3,[6][7][8]. In one case, ruptured arteriovenous malformation caused intracranial hemorrhage [3].…”

“…Only one case was caused by a middle cerebral artery bifurcation aneurysm. In the other four cases, aneurysms were located at the internal carotid artery-posterior communicating artery, anterior communicating artery, and vertebral artery [ 7 , 8 ]. To our knowledge, this is the second case of intracranial hemorrhage following tozinameran injection caused by a ruptured middle cerebral artery bifurcation aneurysm.…”

“…Female predominance has been reported in all cases similar to ours. Additionally, two cases were vaccinated for their second doses of tozinameran, while the other two were vaccinated for their first doses [ 7 , 8 ]. Furthermore, ten fatal cases following tozinameran injection were reported in the literature; five out of ten were due to intracranial hemorrhage.…”

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

“…31,32 Dissection of vertebral artery was reported following the first dose of mRNA vaccines in two cases. 33 Fatality from ICH following SARS-CoV-2 vaccine has been reported as 0.11 per 1,000,000 doses with 21.4% fatality. 34 Hypertension and diabetes are the most common risk factors.…”

Comment on “Echocardiographic Evolution of Posterolateral Left Ventricular Aneurysm with Normal Coronary Arteries in Patient Recently COVID-19 Vaccinated”

“…For instance, if the patient has an underlying aneurysm, the immunological shift following the vaccination may cause the aneurysm to rupture. [ 4 ]…”