1 INTRODUCTION
Large-scale vaccination has emerged as a promising method to cease the COVID-19 pandemic. Although there are concerns about side and adverse effects of vaccination, there is a consensus that the benefits of approved vaccines outweigh those risks. One of the approved vaccines, ChAdOx1 nCoV-19 (by AstraZeneca/Oxford), is made by recombinant adenovirus technology, and adverse effects have been described, such as demyelinating disease,1 and vaccine-induced immune thrombotic thrombocytopenia (VITT), which may be associated with ischemic stroke,2 cerebral sinuses, and other atypical-sites thrombosis,3 mainly in young women. However, to the best of our knowledge, atypical hemorrhagic stroke following ChAdOx1 nCoV-19 vaccination, and not due to thrombocytopenia, was not reported so far.
2 CASE REPORT
A woman, 57 years old, previously healthy, without cardiovascular risk factors, and with no remarkable past medical history, took the first dose of ChAdOx1 nCoV-19 vaccine and shortly thereafter presented fever, headache, and myalgia. On day 3, she started on aspirin 100 mg/day for those symptoms and “prevention of thrombotic complications” of the vaccine. On day 5, she had a sudden onset of sweating and paleness, which has followed by left hemiparesis, vomiting, and somnolence. She came to the emergency room with a Glasgow Coma Scale of 7 and required orotracheal intubation; blood pressure was 160 × 90 mmHg. Computed tomography showed a large right deep frontal lobe parenchymal hematoma with the inundation of the entire ventricular system (Figures 1 and 2). Platelets count, fibrinogen, prothrombin time, and D-dimer were normal. Digital subtraction angiography did not show any signs of thrombosis or aneurysms in brain circulation. She underwent hematoma drainage and external ventricular drain, but intracranial pressure kept raising and she underwent decompressive craniectomy. We also did not find any signs of thrombosis in other sites. At the time of submitting this report (day 15), she is left hemiparetic, capable of obeying simple tasks, and on tracheostomy.
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