Multiple cerebral arterial dissections with a ruptured blister aneurysm after COVID-19 vaccination

Abstract

Although extensive clinical data have verified the safety and adverse effects of coronavirus disease 2019 (COVID-19) vaccines, unexpected neurovascular events have rarely been reported. This report presents an unusual case in which we inferred that spontaneous multiple cerebral arterial dissections with a ruptured blister aneurysm occurred after COVID-19 vaccination. A 34-year-old woman presented with a severe headache, confusion, and mild weakness in her left arm 18 days after having received the Pfizer-BioNTech COVID-19 vaccine. Digital subtraction angiography showed fusiform dilatation in the proximal part of the left vertebral artery and luminal irregularities and string signs in the distal V4 segment. Stroke after vaccination involving multiple cerebral arterial dissections and simultaneous rupture of a blister aneurysm is a very rare phenomenon. Although laboratory studies such as cytoplasmic anti-neutrophil cytoplasmic autoantibody, perinuclear anti-neutrophil cytoplasmic antibodies, anti-cardiolipin, rheumatoid factor and lupus anticoagulant were checked in order to screen the patient for vasculitis and fibromuscular dysplasia, none of them showed significant results. The Pfizer-BioNTech COVID-19 vaccine that the patient had received a few days ago was the only plausi-ble trigger. In conclusion, COVID-19 vaccination might lead to multiple cerebrovascular changes in a short period of time.