A 51-year-old female
- 7 days after the 1st dose of the #CovidVaccine: acute left middle cerebral artery occlusion (⇒ acute ischemic stroke)
- Standard ELISA detected high levels of anti-PF4 antibodies (⇒ autoimmune reaction)
Case from #Slovenia
Results
Female patient, age 51, previously treated for hyperlipidemia presented to neurology emergency 2 hours after acute onset of global aphasia, right sided hemiplegia and hemianopsia (National Institutes of Health Stroke Scale – NIHSS 20, modified Rankin Scale – mRS 5). Seven days before she received the first dose of the ChAdOx1 nCoV-19 vaccine. A day before admission she had been experiencing fatigue, chills and mildly increased temperature (37,1 °C). SARS-CoV-2 reverse-transcriptase-polymerase-chain-reaction assay of a nasopharyngeal swab was negative.
Due to high clinical suspicion of acute ischemic stroke in left MCA territory and onset of symptoms within the time window, the protocol for intravenous thrombolysis (IVT) with tissue plasminogen activator was started.
Head computed tomography (CT) showed just minor early ischemic changes in the left basal ganglia and insula, ASPECT (Alberta stroke programme early CT) score of 7. CT perfusion imaging revealed decreased perfusion of most of the left MCA territory with significant mismatch between infarct core and penumbra. Computed tomography angiography (CTA) revealed an occlusion of the proximal left M1 segment of MCA. Additionally, extreme tortuosity and chronic dissection of the proximal left internal carotid artery (ICA) with 10 mm pseudoaneurysm was present (Fig. 1).
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