Atypical Intracerebral Hemorrhage With a Fatal Outcome Following the ChAdOx1 nCoV-19 Vaccine

Intracerebral hemorrhage (ICH) is a severe form of stroke and is usually associated with established vascular risk factors. Neurological adverse events following ChAdOx1 nCoV-19 vaccination are uncommon, and isolated ICH occurring without thrombocytopenia or coagulation abnormalities is rarely observed. We report here the case of a 41-year-old woman, without cardiovascular risk factors or coagulation abnormalities and with no remarkable past medical history, admitted to our hospital with an afebrile altered level of consciousness that appeared 15 days after receiving her dose of ChAdOx1 nCoV-19 vaccine. She died two days after hospitalization (18 days after receiving the COVID-19 vaccine) due to ICH. This case is characterized by several atypical features, including fatal ICH occurring within a compatible timeframe following vaccination, in the absence of thrombocytopenia, coagulation abnormalities, or evidence of vaccine-induced immune thrombotic thrombocytopenia. It highlights the heterogeneity of neurological events occurring after vaccination and the importance of continued pharmacovigilance.