Fatal cerebral haemorrhage after COVID-19 vaccine

Abstract

Upon admission, reduced consciousness was confirmed, with a GCS (Glasgow Coma Scale) score of 10-11. She had expressive aphasia, but w follow instructions. There was no neck stiffness. The pupils were of equal size and reactive to light bilaterally. She had central left-sided fac and complete left-sided hemiparalysis. She was able to spontaneously move her right extremities, follow instructions and lift her right low request. She was also able to move her right upper extremity and squeeze her right hand. The plantar reflexes were inverted bilaterally. The NIHSS stroke scale was calculated to be 22. Blood pressure now measured 132/80 mm Hg, oxygen. The respiration rate was 12/min. and the body temperature 36.5° C. An ECG showed sinus bradycardia with a frequency of 48/min., degree atrioventricular (AV) block. The findings were interpreted as secondary to the cerebral pathology. Intracerebral haemorrhage was strongly suspected, and the stroke alarm was triggered. A CT of the head was requisitioned and showed a l temporoparietal region in the supply region to the middle cerebral artery, incipient oedema with displacement of midline structures and ventricle. Both subarachnoid blood and some fresh blood were found in the brain parenchyma (Figure 1), but there was no visible blood in showed no evidence of an aneurysm. Figure 1 CT of patient's head at a local hospital shows major parenchymal bleeding in the right hemisphere with breakthrough into the su d) sagially. There is a significant mass effect with midline displacement and incipient transtentorial herniation. Angiography (a) did not taken during the arterial contrast phase and is not suitable for ruling out cerebral venous thrombosis. The duty officer at the laboratory called while the patient was undergoing the CT examination and reported very low platelet levels in the findings of a major intracerebral haemorrhage and relatively pronounced thrombocytopenia, 1 g of tranexamic acid (Cyclocapron) was ad has whole blood, but does not have access to platelets for transfusion. Blood sample analyses upon admission showed several deviating test results (indicated in italics): b-Hb 14.5 g/dl (11.7-15.3), b-leukocytes 12.5 × 10 /L (2.0-7.5), b-lymphocytes 1.1 × 10 /L (1.5-4.0), b-monocytes 0.7 × 10 /L (0.2-0.8), b-platelets 37 × 10 /L (145-390), b-MCV 94 fL (86-102), b-MCH partial thromboplastin time 27 s (25-36), p-fibrinogen 2.2 g/L (1.7-4.0), p-FDP-D-dimer > 7.0 mg/L (0-0.5), s-CRP 8 mg/L (0-5) and s-haptoglobin 2.4 admission samples showed normal levels.