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Published on: November 17, 2010
Stroke Associated with COVID-19 Vaccines
Maryam Kakovan1, Samaneh Ghorbani Shirkouhi2, Mojtaba Zarei3
1School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Insights
COVID-19 vaccination has been linked to rare cases of stroke, particularly cerebral venous sinus thrombosis (CVST) in women under 60 who received the ChAdOx1 nCoV-19 vaccine. Management of these vaccine-associated strokes requires careful consideration due to potential complications.
Area of Science:
- Neurology
- Immunology
- Vaccinology
Background:
- Coronavirus disease 2019 (COVID-19) vaccines are crucial for pandemic control.
- Reports indicate an increase in stroke types, including ischemic, hemorrhagic, and cerebral venous sinus thrombosis (CVST), post-COVID-19 vaccination.
Purpose of the Study:
- To review reported cases of stroke associated with COVID-19 vaccines.
- To provide a clinical overview of vaccine-associated stroke.
Main Methods:
- Literature review focusing on recent studies.
- Analysis of clinical presentations, outcomes, and management strategies.
Main Results:
- Most affected individuals are women under 60 who received the ChAdOx1 nCoV-19 vaccine.
- Cerebral venous sinus thrombosis (CVST), sometimes with Vaccine-induced Thrombotic Thrombocytopenia (VITT), is frequently reported, with headache as a common symptom.
- CVST post-vaccination may present more severely than non-vaccine-associated CVST, and standard treatments like low molecular weight heparin may be contraindicated in VITT cases.
Conclusions:
- Clinical decision-making regarding vaccine-associated stroke is complicated by current data.
- Further research and clinical guidelines are needed for the diagnosis and management of stroke following COVID-19 vaccination.
Objectives:
Development of safe and effective vaccines against coronavirus disease 2019 (COVID-19) remains the cornerstone of controlling this pandemic. However, there are increasing reports of various types of stroke including ischemic stroke, and hemorrhagic stroke, as well as cerebral venous sinus thrombosis (CVST) after COVID-19 vaccination. This paper aims to review reports of stroke associated with COVID-19 vaccines and provide a coherent clinical picture of this condition.
Materials And Methods:
A literature review was performed with a focus on data from recent studies.
Results:
Most of such patients are women under 60 years of age and who had received ChAdOx1 nCoV-19 vaccine. Most studies reported CVST with or without secondary ischemic or hemorrhagic stroke, and some with Vaccine-induced Thrombotic Thrombocytopenia (VITT). The most common clinical symptom of CVST seen after COVID-19 vaccination was headache. The clinical course of CVST after COVID-19 vaccination may be more severe than CVST not associated with COVID vaccination. Management of CVST following COVID-19 vaccination is challenging and may differ from the standard treatment of CVST. Low molecular weight heparin is commonly used in the treatment of CVST; however, it may worsen outcomes in CVST associated with VITT. Furthermore, administration of intravenous immunoglobulin and high-dose glucocorticoids have been recommended with various success rates.
Conclusion:
These contradictory observations are a source of confusion in clinical decision-making and warrant further study and development of clinical guidelines. Clinicians should be aware of clinical presentation, diagnosis, and management of stroke associated with COVID-19 vaccination.
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