An extensive basal ganglia hemorrhage in a preexisting neonatal asphyxiated lesion after mRNA-based SARS-CoV-2 vaccination: A fatal adult case of cerebral palsy

Objective

Neurological adverse reactions to SARS-CoV-2 vaccines include a wide variety of central nervous system (CNS) disorders; however, the cause-and-effect relationship is unclear. Herein, we present a fatal case of extensive basal ganglia bleeding after mRNA-based SARS-CoV-2 vaccination and discuss the pathophysiological mechanisms of brain hemorrhage.

Case presentation

A 66-year-old woman with cerebral palsy and a history of neonatal asphyxia suddenly presented with hypothermia and consciousness disturbance one day after the sixth dose of an mRNA-based SARS-CoV-2 vaccine (Moderna). Clinical investigations revealed a normal thrombocyte count, but stage 1 hypertension and mild prolongation of the prothrombin time and activated partial thromboplastin time. Urgent brain computed tomography (CT) revealed extensive left basal ganglia hemorrhage with global brain edema and downward herniation of the brainstem. The region of the large hematoma corresponded to the basal ganglia lesion which had been produced by neonatal asphyxia at birth. Because the neurosurgeons evaluated her state as inoperable, conservative therapy was continued, but the patient died on day 5 after the event.

Conclusion

We hypothesized that two pathophysiological mechanisms were responsible for the brain hemorrhage in this case: disruption of focal cerebrovascular autoregulation in preexisting neonatal asphyxiated lesions and disturbance of coagulation pathways after mRNA-based SARS-CoV-2 vaccination.