Subarachnoid hemorrhage during injection of AstraZeneca vaccine against Covid disease ۱۹, case report

Introduction: COVID-۱۹ was reported on September ۲۰۱۹ in Wuhan, China for the first time. the most important step in fighting against COVID-۱۹ pandemic are vaccines for acute respiratory syndrome coronavirus ۲ (SARS CoV-۲). Non-traumatic Subarachnoid hemorrhage (SAH) is resulted by rupturing of an intracranial aneurysm in ۸۰% of patients.Cerebrovascular incidents are considered as uncommon complications of vaccination against COVID-۱۹. Subarachnoid haemorrhages (SAH), usually occur as a result of an underlying cerebral aneurism. According to elevated risk of haemorrhagic events due to COVID-۱۹ vaccines and highly fatal nature of cerebral haemorrhage (including SAH), it is critical to collect and investigate about their relativity, risk factors and preventing strategies. In this study, we have reported a subarachnoid heamorrhage incidence in a patient, shortly after receiving the first dose of COVID-۱۹ vaccine (AStraZeneca). This study was approved by the ethics committee of Birjand University of Medical Sciences (IR.BUMS.REC.۱۴۰۰.۱۳۹). Patient Report:Patient was a ۶۹ year old male with no remarkable risk factor, referred to our hospital with complaints of headache, nausea and vomiting. Patient had received his first dose of vaccine against COVID-۱۹ four days before symptoms started. Aggravated headache and nausea with elevated blood pressure (۱۸۰/۱۰۰) and drowsiness occurred at the second day of admission. Imaging from head CT scans were implying on acute hydrocephalus and elevated intracranial pressure (ICP) caused by subarachnoid haemorrhage. The condition had been treated by inserting an external ventricular drain (EVD); which was removed after one week and patient was discharged with no permanent deficit. We found no underlying vascular abnormality in primary and follow-up cerebral angiographies.Conclusion:There are reports of cerebral heamorrhages caused by COVID-۱۹ vaccination, mostly intra-parenchymal. In current study, we witnessed a type of cerebrovascular event that has not been reported frequently; therefor it would be more challenging to find it associated with COVID-۱۹ vaccine side effects, or consider it as a coincidence. Regarding to significance of mortality and morbidity of cerebrovascular events on one hand, and importance of vaccination against COVID-۱۹ -which is a relatively new topic in medicine- during the pandemic situation on the other hand, it is essential to collect as much information as possible to prevent unnecessary complications and achieve best results.

کلیدواژه ها:

COVID-۱۹ ، vaccine ، subarachnoid haemorrhage ، Astrazeneca