Table 1.
Summary reports of acute ischemic stroke following the COVID-19 vaccination with viral vector vaccines.
| Author(s) | No. of cases | Vaccine dose | Age gender | Past medical history/medication(s) | Time from vaccination (days) | Clinical presentation | Imaging findings | Lab findings | Treatment/outcome |
|---|---|---|---|---|---|---|---|---|---|
| ChAdOx1 nCoV-19 | |||||||||
| M. A. Alammar [114] | 1 | First | 43 male | obesity, hyperlipidemia | 3 | Right hemiparesis | Left paraventricular parietal infarct | Platelets count: NL | antiplatelets and statins therapy/alive |
| T. Al-Mayhani et al. [28] | 3 | N/A | ⁎ 35 female | N/A | 11 | headache, left hemiparesis, right gaze preference and drowsiness | occlusion of right MCA (M1 segment) + haemorrhagic transformation concurrent thrombosis: right portal vein thrombosis |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | decompressive hemicraniectomy, IVIG, fondaparinux and plasmapheresis/dead |
| N/A | ⁎ 37 female | N/A | 12 | diffuse headache, left visual field loss, confusion and left arm weakness | left and right ICA occlusion concurrent thrombosis: CVST, PE, thrombosis of left jugular, right hepatic and both iliac veins |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | IVIG, methylprednisolone, plasmapheresis and fondaparinux/alive | ||
| N/A | ⁎ 43 male | N/A | 21 | dysphasia | acute left frontal and insular infarct (MCA territory) + haemorrhagic transformation | thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | platelet transfusion, IVIG, and fondaparinux/alive | ||
| S. A. Assiri et al. [80] | 4 | First | 66 male | Cardiomyopathy, DM, HTN, dyslipidemia, IHD, prior stroke/ASA | 10 | Motor, sensory, vision, aphasia, dysphagia | Right MCA infarct | Platelets count: NL, increased level of D-dimer | rtPA/alive |
| First | 46 male | DM | 7 | Motor, sensory, Ataxia, dysarthria | Right MCA infarct | Platelets count: NL, increased level of D-dimer | ASA, Clopidogrel/alive | ||
| First | 56 male | DM, HTN, dyslipidemia, smoker | 2 | Ataxia, vertigo | Right lacunar thalamic stroke | Platelets count: NL, increased level of D-dimer | ASA/alive | ||
| First | 62 male | HTN, dyslipidemia, smoker | 4 | Motor, sensory, vision, dysarthria | Pontine infarction | Platelets count: NL, increased level of D-dimer | ASA, Clopidogrel/alive | ||
| A. Bayas et al. [115] | 1 | First | 55 female | none | 18 | right-sided hemiparesis, and aphasia, conjunctival congestion retro-orbital pain binocular diplopia at vertical and right lateral gaze, right-sided focal seizures | left parietal lobe, and MCA territory infarct concurrent thrombosis: superior ophthalmic vein thrombosis (SOVT) |
thrombocytopenia, anti-PF4 antibodies: negative | intravenous dexamethasone, levetiracetam, lacosamide, phenprocoumon/alive |
| G. Berlot et al. [116] | 1 | First | ⁎ 69 female | HTN, hysterectomy |
9 | headache, left hemiparesis | ICA and MCA occlusion, right hemispheric infarction concurrent thrombosis: descending aorta, celiac tripod, inferior mesenteric artery, and left pulmonary artery |
thrombocytopenia, increased level of D-dimer, anti-PF4 reduced fibrinogen antibodies: positive |
thromboaspiration, intravenous dexamethasone, IVIG, argatroban, mannitol, decompressive craniotomy/alive |
| R. A. Blauenfeldt et al. [117] | 1 | First | 60 female | HTN and Hashimoto thyroiditis | 9 | headache, left hemiparesis and eye deviation to the right | Right MCA territory infarct | thrombocytopenia, increased level of D-dimer | hydrocortisone, dalteparin, platelet concentrates, hemicraniectomy/dead |
| N. Ceschia et al. [118] | 1 | First | ⁎ 73 female | hypercholesterolemia, HTN, positive family history for thrombophilia | 14 | no neurologic sign or symptom | Right PCA infarct Concurrent thrombosis: CVST, thrombosis in right medial gastrocnemius veins, pulmonary, left renal vein, right superficial femoral artery |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | IVIG, dexamethasone, fondaparinux and then warfarin, thromboendoarterectomy of right tibial artery, bivalirudin/alive |
| D. G. Corrêa et al. [119] | 1 | First | 64 male | HTN | 2 | right superior and inferior limbs paresia | left nucleo-capsular infarct | Platelets count: NL | ASA/alive |
| G. Costentin et al. [111] | 1 | First | ⁎ 26 female | None/ocp | 8 | headache, right hemiplegia and aphasia | Left MCA and M1 segment occlusion concurrent thrombosis: PE and portal vein thrombosis | thrombocytopenia, anti-PF4 antibodies: positive, decreased level of fibrinogen | mechanical thrombectomy/N/A |
| M. De Michele et al. [110] | 2 | First | ⁎ 57 female | mild hypothyroidism, treated breast cancer | 9 | left hemiplegia, right gaze deviation, dysarthria, and left neglect | first a Right MCA infarction and then a malignant infarct due to re-occlusion of MCA Concurrent thrombosis: thrombosis of splanchnic vein, pulmonary arteries |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | platelet transfusion, mechanical thrombectomy, betamethasone, decompressive craniectomy, IVIG, plasma exchange, fondaparinux/N/A |
| First | ⁎ 55 female | mild hypothyroidism | 10 | transient aphasia and right hemiparesis, and then generalized seizures and coma | Right ICA and bilateral MCA infarct Concurrent thrombosis: thrombosis of portal vein, pulmonary arteries |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | IVIG, dexamethasone/dead | ||
| J. Kenda et al. [108] | 1 | First | ⁎ 51 female | hyperlipidemia | 7 | global aphasia, right sided hemiplegia and hemianopsia | occlusion of left M1 segment of MCA, minor ischemic changes in the left basal ganglia and insula + hemorrhagic transformation | thrombocytopenia, high level of D-dimer, anti-PF4 antibodies: positive | rtPA, mechanical thrombectomy, IVIG, fondaparinux and then ASA/alive |
| M. Mancuso et al. [29] | 1 | First | ⁎ 42 female | none | 9 | left hemiparesis | MCA and ACA occlusion, ischemia on the right middle temporal gyrus, insula and putamen + hemorrhagic transformation | thrombocytopenia, high level of D-dimer, anti-PF4 antibodies: positive | mechanical thrombectomy, intravenous dexamethasone, IVIG, fondaparinux, platelet infusion, decompressive hemicraniectomy/alive |
| M. Scully et al. [30] | 2 | First | ⁎ 39 female | none | 10 | N/A | MCA infarct | thrombocytopenia, high level of D-dimer, anti-PF4 antibodies: positive, increased level of fibrinogen | N/A/alive |
| First | ⁎ 21 male | none | 10 | N/A | MCA infarct | thrombocytopenia, high level of D-dimer, anti-PF4 antibodies: positive, decreased level of fibrinogen | N/A/alive | ||
| A. Wills et al. [120] | 1 | N/A | ⁎ 42 female | smoker | 14 | left hemiplegia | Left CCA and right ICA infarct, then MCA and ACA infarcts | thrombocytopenia, anti-PF4 antibodies: positive | enoxaparin, heparin/dead |
| M. Garnier et al. [112] | 1 | N/A | ⁎ 26 female | N/A | 8 | Right hemiplegia, aphasia, headache, nausea | Left MCA infarction, concurrent thrombosis: PE, portal thrombosis extending to the splenomesenteric trunk and ileal veins |
thrombocytopenia, anti-PF4 antibodies: positive, decreased level of fibrinogen | thrombectomy, corticosteroids, plasmatic exchange and anticoagulant/alive |
| A. Tiede [121] | 2 | First | ⁎ 61 female | N/A | 9 | Headache, dysarthria, left-sided hemiplegia, conjugated gaze palsy | Right MCA and ICA thrombosis, right MCA territory infarction + hemorrhagic transformation | thrombocytopenia, high level of D-dimer, anti-PF4 antibodies: positive | Argatroban, IVIG, dexamethasone/alive |
| First | ⁎ 67 female | N/A | 8 | headache | Cortical infarctions, concurrent thrombosis: aortic arch thrombi | thrombocytopenia, high level of D-dimer, anti-PF4 antibodies: positive | Argatroban, IVIG, dexamethasone/alive | ||
| U. Walter et al. [122] | 1 | First | ⁎ 31 male | smoker | 8 | acute headache, aphasia, and right hemiparesis | Left MCA thrombosis and territory infarction Concurrent thrombosis: parietal solid thrombus in the left carotid bulb |
Platelets count: NL, increased level of D-dimer, anti-PF4 antibodies: positive | rtpa, thrombectomy, ASA, danaparoid and then phenprocoumon/alive |
| K. Y. Park et al. [31] | 1 | N/A | ⁎ 69 female | CAD, hyperlipidemia/ASA, rivaroxaban | 13 | dysarthria | small infarctions both MCA territories | thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | Rivaroxaban/alive |
| M. George et al. [123] | 1 | N/A | 71 male | N/A | 3 | Seizures | left Temporoparietal Cortex infarct | increased D-dimer | Antiplatelets, Antiepileptics/N/A |
| E. Pang et al. [124] | 1 | First | ⁎ 51 female | DM, obesity, nephrectomy | 13 | headache, Asymmetric (right >left) quadriplegia and aphasia | ICA thrombosis, left hemispheric internal watershed infarcts Concurrent thrombosis: CVST |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | mechanical thrombectomy, IVIG, fondaparinux and then bivalirudin, methylprednisolone/alive |
| V. D'Agostino et al. [125] | 1 | N/A | 54 female | Meniere's disease | 12 | Left side signs, GCS 13 |
basilar thrombosis, infarction of right occipito-temporal, superior cerebellar, thalamic and internal capsula regions, pons, and mesencephalon. Concurrent thrombosis: left portal branch and right suprahepatic vein, aortic arch floating thrombus |
thrombocytopenia, increased level of D-dimer | N/A/Dead |
| A. Bourguignon et al. [126] | 1 | N/A | ⁎69 male | DM, HTN, Obstructive Sleep Apnea, prostate cancer | 12 | Headache, confusion and left hemiplegia | Right MCA infarction + hemorrhagic transformation Concurrent thrombosis: right internal carotid artery, CVST, right internal jugular vein, hepatic vein, and distal lower-limb vein; PE |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | Fondaparinux, IVIG, rivaroxaban, plasma exchange/alive |
| Ad26.COV2·S | |||||||||
| A. Charidimou et al. [127] | 1 | N/A | ⁎ 37 female | Migraine/ocp | 10 | headache, left hemiparesis, hemineglect and right gaze deviation | occlusion of Right ICA, M1 segment of right MCA and ACA, acute right MCA infarct + hemorrhagic transformation. Concurrent thrombosis: left brachial vein and bilateral cephalic vein, right common femoral vein |
thrombocytopenia, increased level of D-dimer, anti-PF4 antibodies: positive | mechanical thrombectomy, intravenous dexamethasone, IVIG, argatroban, decompressive hemicraniectomy/N/A |
NL: normal; N/A: not available; anti-PF4 antibody: anti-platelet factor 4 antibody; IVIg: intravenous immunoglobulin; CVST: cerebral venous sinus thrombosis; MCA: middle cerebral artery; ICA: internal carotid artery; DM: diabetes mellitus; HTN: hypertension; IHD: ischemic heart disease; CAD: coronary artery disease; rtPA: recombinant tissue plasminogen activator; ASA: acetylsalicylic acid (aspirin); PCA: posterior cerebral artery; PE: Pulmonary Thrombosis.
⁎
VITT Case.