Cerebral Venous Sinus Thrombosis After Pfizer-BioNTech COVID-19 (BNT162b2) Vaccination
A 61-year-old man
- 5 days after after receiving the 2nd dose of the #CovidVaccine (Pfizer-BioNTech): worsening headache & vomiting over the following 2 days ⇒ intracerebral hemorrhages & cerebral venous sinus thrombosisCerebral Venous Sinus Thrombosis After Pfizer-BioNTech COVID-19 (BNT162b2) Vaccination
A 61-year-old Chinese male with diabetes mellitus had received his first dose of the BNT162b2 vaccine on March 19, 2021. He reported soreness at the local injection site lasting for a few days, but did not experience fever, headache, or flu-like symptoms. He was asymptomatic before receiving his second dose of the BNT162b2 vaccine on April 10, 2021. Five days thereafter he complained of worsening generalized headache associated with persistent vomiting over the following 2 days, leading to his hospital presentation. He did not notice any double vision, facial droop, slurring of speech, focal limb weakness, or numbness, and there was no history of recent trauma, infection, dehydration, or constitutional symptoms. He was a nonsmoker and denied taking any other drugs apart from his diabetic medications. There was no family or personal history of prior venous thromboembolic disease. On clinical examination, he had a normal body mass index and was alert and rational. Cranial nerves, limb reflexes, and motor and sensory testing were unremarkable. There was a left extensor Babinski response. A computed tomography (CT) scan of the brain on admission revealed acute subarachnoid hemorrhage (SAH) along the left frontal lobe sulci (Fig. 1A).
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As the world continues its vaccination efforts, the occurrence of CVST should be kept in mind as a possible significant side effect. However, in line with recommendations7, 8 from various major committees, its rarity suggests that the benefits of COVID-19 vaccines still outweigh their risks. Worldwide monitoring and data collection would be highly prudent as we continue to administer mRNA and other vaccines in efforts to end the pandemic.
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