Chida Kohei, Takahashi Tatsuhiko, Igarashi Suguru, Fujimoto Kentaro, Ogasawara Yasushi, Fujiwara Shunrou, Koji Takahiro, Kubo Yoshitaka, Ogasawara Kuniaki
Department of Neurosurgery, Iwate Medical University, Shiwa, Iwate, Japan.
NMC Case Rep J. 2022 Apr 28;9:95-100. doi: 10.2176/jns-nmc.2022-0012. eCollection 2022.
The coronavirus disease 2019 (COVID-19) pandemic continues to spread around the world, and widespread vaccination is considered the most effective way to end it. Although the efficacy of COVID-19 vaccines has been confirmed, their safety remains a concern. In this paper, we report two cases of ruptured vertebral artery dissecting aneurysm (VADA) immediately after messenger RNA (mRNA) anti-COVID-19 vaccination. In Case 1, a 60-year-old woman experienced sudden headache 3 weeks before her first dose of the Moderna mRNA-1273 COVID-19 vaccine. Magnetic resonance imaging showed dilatation of the right vertebral artery (VA) without intracranial hemorrhage. A day after the vaccination, she developed subarachnoid hemorrhage with pulmonary effusion due to a ruptured right VADA. She underwent endovascular internal trapping and parent artery occlusion under general anesthesia. In Case 2, a 72-year-old woman with a previous history of the left VA occlusion due to arterial dissection developed subarachnoid hemorrhage 7 days after the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine due to a ruptured right VADA and underwent stent-assisted coil embolization under general anesthesia. The postoperative courses of these two cases were uneventful. The accumulation of more cases and further study are warranted to clarify the relationship between COVID-19 mRNA vaccination and ruptured intracranial dissecting aneurysms.
2019冠状病毒病（COVID-19）大流行仍在全球蔓延，广泛接种疫苗被认为是终结疫情的最有效方式。尽管COVID-19疫苗的有效性已得到证实，但其安全性仍令人担忧。在本文中，我们报告了两例信使核糖核酸（mRNA）抗COVID-19疫苗接种后立即发生椎动脉夹层动脉瘤（VADA）破裂的病例。病例1中，一名60岁女性在接种第一剂莫德纳mRNA-1273 COVID-19疫苗前3周突发头痛。磁共振成像显示右侧椎动脉（VA）扩张，无颅内出血。接种疫苗一天后，她因右侧VADA破裂出现蛛网膜下腔出血并伴有胸腔积液。她在全身麻醉下接受了血管内内置圈套和供血动脉闭塞术。病例2中，一名72岁女性既往有因动脉夹层导致左侧VA闭塞的病史，在接种第一剂辉瑞-BioNTech BNT162b2 COVID-19 mRNA疫苗7天后，因右侧VADA破裂出现蛛网膜下腔出血，并在全身麻醉下接受了支架辅助弹簧圈栓塞术。这两例患者术后恢复顺利。需要积累更多病例并进行进一步研究，以阐明COVID-19 mRNA疫苗接种与颅内夹层动脉瘤破裂之间的关系。
