A Case Series of Stroke following COVID-19 Vaccination—Is It Just an Association?

Abstract

In India two vaccines were initially recommended for vaccination; Covaxin in the 3rd phase trial and Covishield in the 4th phase for coronavirus disease 2019 (COVID-19). Covaxin was approved to be given only in tertiary care health centers and urban areas. An adverse event is any untoward medical problem in a patient after the administration of a new drug or vaccine that may or may not be related to that product. There are several case reports of stroke followingCOVID-19 vaccination. Here, we have reported five cases of ischemic stroke following COVID-19 vaccination presenting to the neuro-outpatient department or casualty. We have taken three patients who were vaccinated with Covishield and presented with acute neurological deficit within 24 hours of vaccination. All patients were COVID-19 reverse transcription-polymerase chain reaction negative. Computed tomography brain, magnetic resonance imaging brain, echocardiography, carotid Doppler study, and other routine blood investigations were done on all patients. All the three patients were male in the age group of 30 to 60 years. All were ischemic strokes. All patients had associated other risk factors for stroke. None of them had thrombocytopenia. The proposed mechanism is vaccine-induced immune thrombotic thrombocytopenia. One patient had a posterior circulation stroke. Two patients recovered and one patient was in critical condition and left against medical advice. We cannot conclude that the thrombotic events were due to the vaccine only as other risk factors were also present. Weighing the beneficial effect of vaccines these complications can be called mere associations. But since these can be serious adverse effects of vaccines, more and more studies are required to prove vaccines as the causative agent of thrombotic stroke.