A Rare Case of Cerebral Venous Sinus Thrombosis Following the Second Dose of BNT162b2 mRNA COVID-19 Vaccine—Just a Coincidence? A Case Report

TL;DR

A 38-year-old man developed cerebral venous sinus thrombosis 13 days after his second dose of the BNT162b2 mRNA vaccine, raising questions about a possible link.

Contribution

Reports a rare case of CVST after the second dose of an mRNA vaccine, expanding understanding of potential vaccine-related adverse events.

Findings

CVST occurred 13 days after the second dose of the BNT162b2 vaccine in a 38-year-old male.

Follow-up imaging showed partial recanalization of the affected sinuses with no cerebral infarction.

No other possible causes were identified, suggesting a possible vaccine-triggered event.

Abstract

Background and Clinical Significance: The occurrence of cerebral venous sinus thrombosis (CVST), both with or without thrombocytopenia, following COVID-19 vaccination, is well documented and more common in recipients of vector vaccines. Cases of CVST following immunization with the COVID-19 messenger RNA (mRNA) vaccine are rare; most of these cases occur within 28 days of the first dose of the vaccine. Case Presentation: We present the case of a 38-year-old male with a history of two episodes of deep vein thrombosis in the lower limbs, but without a specific thrombophilic condition, who developed CVST 13 days after the second dose of the Pfizer/BioNTech BNT162b2 vaccine. He suffered from diffuse tension-type headache of progressively increasing intensity, and his objective neurological findings were normal. Magnetic resonance venography showed thrombosis of the transverse and right sigmoid sinuses, and magnetic resonance imaging (MRI) of the brain revealed no cerebral infarction. Two months later, a follow-up MR venography showed partial recanalization of the affected sinuses, and a brain MRI showed no infarction. Conclusions: Given the temporal sequence and the absence of other possible causes, we speculate that the second dose of the COVID-19 BNT162b2 vaccine may have triggered the development of CVST.

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