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Case Reports
. 2022 Feb;31(2):106238.
doi: 10.1016/j.jstrokecerebrovasdis.2021.106238. Epub 2021 Nov 26.

Fulminant Reversible Cerebral Vasoconstriction Syndrome in Breakthrough COVID 19 Infection

Somdattaa Ray  1 , Vikram V Kamath  2 , Arjun Raju P  3 , Rajesh Kn  2 , Shalini N  4
Affiliations
Case Reports

Fulminant Reversible Cerebral Vasoconstriction Syndrome in Breakthrough COVID 19 Infection

Somdattaa Ray et al. J Stroke Cerebrovasc Dis. 2022 Feb.

Abstract

COVID 19 infection continues to afflict people worldwide. Neurological complications of COVID infection are common. We report a case of fulminant reversible cerebrovascular constriction syndrome (RCVS) in a patient with breakthrough COVID 19 infection who was fully vaccinated. A 64 year old lady, fully vaccinated 2 months back, presented with headache, drowsiness, partial seizures, visual impairment and quadriplegia. Her nasopharyngeal swab was tested positive for SARS COV2 on real time PCR assay. MRI brain FLAIR images showed multifocal hyperintensities with MR angiogram showing arterial vasoconstriction suggestive of RCVS. Despite initiation of nimodipine, patient's symptoms worsened and she succumbed to sepsis. RCVS following COVID infection has been reported to have a benign outcome. However, despite vaccination, fulminant RCVS following a breakthrough COVID infection was observed in our patient.

Keywords: Breakthrough infection; COVID 19; Fulminant; Post vaccination; RCVS.

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Conflict of interest statement

Declaration of Competing Interest None of the authors have any financial disclosure to make or have any conflict of interest.

Figures

Fig.. 1
Fig.. 1
MRI brain (A) and (B) FLAIR sequences show grey and white matter hyperintensities in parieto occipital, fronto parietal region. (C) Susceptibility weighted image sequence shows haemorrhagic transformation of the lesions. (D) and (E) Diffusion weighted image sequences show diffusion restriction of bilateral occipital, fronto parietal and left capsuloganglionic region. (F) Intracranial MR angiogram shows widespread arterial vasocontriction.
See this image and copyright information in PMC

References

    1. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, Kneen R, Defres S, Sejvar J, Solomon T. Neurological associations of COVID-19. Lancet Neurol. 2020 - PMC - PubMed
    1. Mansoor T, Alsarah AA, Mousavi H, Eliyas JK, Girotra T, Hussein O. COVID-19 associated reversible cerebral vasoconstriction syndrome successfully treated with nimodipine and aspirin. J Stroke Cerebrovasc Dis. 2021;30(7) - PMC - PubMed
    1. Dakay K, Kaur G, Gulko E, Santarelli J, Bowers C, Mayer SA, Gandhi CD, Al-Mufti F. Reversible cerebral vasoconstriction syndrome and dissection in the setting of COVID-19 infection. JStroke Cerebrovasc. Dis. 2020;29(9) - PMC - PubMed
    1. Singhal AB, Hajj-Ali RA, Topcuoglu MA, Fok J, Bena J, Yang D, Calabrese LH. Reversible cerebral vasoconstriction syndromes: analysis of 139 cases. Arch Neurol. 2011;68(8):1005–1012. - PubMed
    1. Miller TR, Shivashankar R, Mossa-Basha M, Gandhi D. Reversible cerebral vasoconstriction syndrome, part 1: epidemiology, pathogenesis, and clinical course. Am J Neuroradiol. 2015;36(8):1392–1399. - PMC - PubMed

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Supplementary concepts