Patients after handling of brain aneurysm should be submitted to increased care throughout the period of vaccination against COVID-19

Abstract

Background: It is commonly believed that after successful clipping of unruptured cerebral aneurysms patients may be considered restored to normal life. Nonetheless, some 11% may develop stroke within a year of the procedure. Therefore the question arises as to whether this group of patients can be submitted to different medical procedures, including vaccination against COVID-19, which has been reported to incidentally elicit thromboembolic events, without the necessity of special precautions. Case presentation: A contribution to this debate was presented in the case-history of a 56-year-old woman who underwent clipping of 3 unruptured cerebral aneurysms and in whom CT 8 months postsurgery did not show any abnormalities. Fourteen months post procedure she developed headache,vomiting and hand numbness coincidentally with ChAdOx1 nCoV-19 vaccination. CT revealed a small hypodense region within the territory of the right middle cerebral artery (MCA). CT angiography demonstrated a gap in contrast enhancement of the MCA and of the left anterior cerebral artery (ACA), exactly at the sites corresponding to localization of the aneurysm clips. Conclusions: Following clipping of cerebral aneurysms, patients may be prone to developing stroke coincidental with anti-COVID-19 vaccination. They may require special care during the peri-vaccinate period.