Table 3.
Case no. | Diagnosis | Age | Sex | Risk factors | Symptoms | Vaccine type | Time to onset | Imaging findings | Treatment | Outcomes |
---|---|---|---|---|---|---|---|---|---|---|
1 | PRES | 76 | F | Hypertension, alcohol use disorder, shingles | Confusion, blurry vision, unsteady intermittent gait | COVID-19 mRNA (Moderna) | <24 h | T2/FLAIR hyperintensities in the parieto-occipital lobes | levetiracetam 750 mg twice daily | Residual cognitive decline 18 months later |
2 | PRES | 18 | F | None | Diffuse pain, pruritus, weakness of the hand, dysthesia | Measles | 8 h | T2/FLAIR hyperintensities in the occipital lobes | 1000 mg steroids for 3 days. MRA showed vasoconstriction of the posterior cerebral arteries | Improvement in T2/FLAIR hyperintensities and posterior circulation vasoconstriction after 3 days of treatment |
3 | RCVS | 30 | M | History of RCVS, Bipolar disorder | Thunderclap headache | COVID-19 mRNA (Pfizer) | 12 h | Normal CT head | Losartan 50 mg for 2 weeks | No symptoms at 2-week follow-up |
4 | RCVS | 38 | F | Migraine without aura, 10-pack smoking history | Sudden-onset blurred vision bilaterally followed by a focal headache over the right occipital projection | COVID-19 mRNA (Moderna) | 18 days | MRI showed an ischemic stroke on the territory of the right posterior cerebral artery. MRA shows discontinuation of the right P1 segment | Levetiracetam (1000 mg/d) and nimodipine (90 mg/d) for 5 weeks | Normal flow in both PCAs was documented on CTA after 7 days of nimodipine, suggesting vasospasm |
COVID-19, Coronavirus disease 2019; MRA, Magnetic resonance angiography; PRES, Posterior reversible encephalopathy syndrome; RCVS, Reversible cerebral vasoconstriction syndrome.