Table 2.
Summary reports of acute ischemic stroke following the COVID-19 vaccination with mRNA 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 |
|---|---|---|---|---|---|---|---|---|---|
| BNT 162b2 | |||||||||
| S. A. Assiri et al. [80] | 4 | First | 59 male | HTN, DM, dyslipidemia, smoker/clopidogrel | 12 | Sensory, Ataxia, Vertigo affection. Aphasia, dysphagia, dysarthria | PICA infarct | Platelets count: NL, increased level of D-dimer | ASA/alive |
| Second | 59 male | Dyslipidemia, hypercholesterolemia, smoker/ASA | 23 | Motor, Sensory, dysphagia, dysarthria | Right MCA thrombosis and infarction | Platelets count: NL, increased level of D-dimer | Thrombectomy/alive | ||
| Second | 80 female | Peripheral vascular neuropathy, dyslipidemia/warfarin | 7 | Motor, Sensory, Vision, Aphasia and dysphagia, dysarthria | Left MCA infarction, Left Internal Carotid Artery occlusion | Platelets count: NL, increased level of D-dimer | Thrombectomy/alive | ||
| First | 36 female | Asthmatic, hypercholesterolemia | 6 | Motor, Sensory, Aphasia and dysphagia | Left MCA thrombosis and infarction | Platelets count: NL, increased level of D-dimer | Thrombectomy/alive | ||
| G. Famularo [81] | 1 | Second | 87 female | ischemic heart disease, HTN, and hyperlipidemia/ASA | 1 | dysarthria, right gaze deviation, and complete left hemiplegia | Right MCA occlusion | Platelets count: NL | Clopidogrel/alive |
| R. Giovane et al. [128] | 1 | First | 62 male | HTN, DM, hyperlipidemia, ESRD, | 1 | left facial paralysis, dysarthria, slurred speech, anisocoria, left lower limb hemiballismus, left upper limb paralysis, horizontal nystagmus | bilateral thalamic infarction | thrombocytopenia, normal level of D-dimer, anti-PF4 antibodies: negative | ASA, Clopidogrel/alive |
| K. Yoshida et al. [129] | 1 | First | 83 female | AF/rivaroxaban | 3 (for both doses) | first stroke: right hemiplegia and motor aphasia, second stroke: left hemiplegia and left hemispatial neglect | first stroke: left insular cortex and corona radiata (occlusion of M1 segment of left MCA), second stroke: the right insular cortex, caudate, and corona radiata (occlusion of M1 segment of right MCA) then ischemic area spread to entire right MCA area | Platelets count: NL, increased level of D-dimer | first stroke: rtPA, mechanical thrombectomy, edoxaban,,, second stroke: mechanical thrombectomy/N/A |
| mRNA-1273 | |||||||||
| P.-H. Su et al. [48] | 1 | First | ⁎ 70 male | AF, COPD, HTN, Pancreatic cancer/rivaroxaban | 7 | left side weakness | scattered infarcts at the right thalamus, parietal cortex, medial temporal, parietal-occipital lobe, left centrum semiovale and posterior cerebral artery territory | thrombocytopenia, increased level of D-dimer, decreased level of fibrinogen, anti-PF4 antibodies: positive | intravenous dexamethasone, IVIG, plasma exchange/dead |
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); PICA: posterior inferior cerebellar artery; COPD: chronic obstructive pulmonary disease; AF: atrial fibrillation; ESRD: end-stage renal disease.
⁎
VITT Case.