Clinical Case of the Occurrence of Stroke Followed by Death After Vaccine Against SARS-CoV-2
Authors:   City Hall of Barretos / Prefeitura Municipal de Barretos, Sao Paulo, Brazil., Ewerling Penna Priciane Bárbara , Moreno Penna Maria Cândida ,   Hospital for the injured, Regional Hospital of Cacoal / Hospital dos acidentados, Hospital Regional de Cacoal, Rondônia, Brazil., Domingues Douglas ,   Hospital for the injured, Regional Hospital of Cacoal / Hospital dos acidentados, Hospital Regional de Cacoal, Rondônia, Brazil., Penna Filho Fernando Ferreira ,   Barretos Eye Hospital / Hospital de olhos de Barretos, Sao Paulo, Brazil., Freitas Miranda Raffaello de ,   Miranda Clinic and Cândido Rondon Hospital- Clinic Center / Clínica Miranda e Hospital Cândido Rondon- Center Clínica, Cacoal, Rondônia, Brazil., Mustafa Eliana Migliorini ,   Domingo Braile Institute of Sao Jose do Rio Preto, Sao Paulo, Brazil., Zotarelli Filho Idiberto José ,   FACERES – Faculty of Medicine of Sao Jose do Rio Preto, Sao Paulo, Brazil.
Published: September 2021

Introduction: The current COVID-19 pandemic has involved developing vaccines to control the virulence of SARS-CoV-2. More than 4.1 million people have died from COVID-19.1 In response to this public health emergency, several vaccines against COVID-19 have been developed, with more than 3.7 billion doses administered worldwide. After the introduction of the adenovirus vector vaccine ChAdOx1, several cases of severe venous thrombosis with thrombocytopenia were reported worldwide. Objective: It was to present a case report of a 25-year-old female patient who presented extensive left intraparenchymal hematoma and rapid progression to brain death followed by death. Case report: A 25-year-old woman, CSS, was vaccinated against COVID-19 with the adenovirus ChAdOx1, 14 days after admission, evolved with a fever that started about 13 days ago, associated with holocranial, tight, moderate-intensity headache. On the day of admission, she was found by the torporous, unresponsive, and vomiting family, referred to the hospital emergency room. The patient was admitted to Glasgow 4 with evidence of anisocoria, with the left pupils larger than the right, rapidly progressing to mydriasis. Cranial computed tomography (CT) showed extensive left intraparenchymal hematoma, performing urgent decompressive craniectomy and placement of an intracranial pressure monitoring catheter. The cerebrospinal fluid exam did not show bacteria or fungi. CT angiography showed extensive thrombosis of the anterior portions of the superior sagittal sinus and probable thrombosis of the superficial drainage veins of the frontal regions. Skull CT revealed diffuse and bilateral ischemia. Laboratory tests showed mild thrombocytopenia and no change in the coagulogram. After one day, the patient evolved with worsening neurological status. Sedation was turned off to start the brain death protocol, which was confirmed twice. Finally, an electroencephalogram was performed with evidence of a straight-line tracing, without evidence of electrical brain activity. Final considerations: Several studies have been published regarding cerebral thrombosis, stroke, and thrombotic thrombocytopenic events. Thus, safe and effective vaccines against COVID-19 are an urgent need, as they can leave pathophysiological responses of hypercoagulability and thrombo inflammation associated with acute infection.