Yangi Kivanc, Demir Doga D, Uzunkol Ajlan
Neurological Surgery, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, TUR.
Emergency Medicine, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, TUR.
Cureus. 2023 Apr 18;15(4):e37747. doi: 10.7759/cureus.37747. eCollection 2023 Apr.
The Coronavirus 2019 (COVID-19) pandemic has affected over 700 million people worldwide and caused nearly 7 million deaths. Vaccines currently developed or in development are the most effective tools for curbing the pandemic and mitigating its impacts. In Turkey, inoculation with the Pfizer-BioNTech COVID-19 vaccine (BNT162b2, also known as tozinameran) has been approved. We report a 56-year-old female patient with underlying essential hypertension who experienced intracranial hemorrhage after receiving her first dose of tozinameran. The patient underwent immediate surgical evacuation of the hematoma, during which a left middle cerebral artery bifurcation aneurysm was macroscopically identified and clipped. The patient was pronounced deceased on the second postoperative day. This is the second case of intracranial hemorrhage following tozinameran administration caused by a ruptured middle cerebral artery bifurcation aneurysm. Upon analyzing the case, there might be a connection between the vaccine's potential immune-triggering effect on hemodynamic patterns and the rupture of the previously unknown cerebral aneurysm. However, these severe complications do not justify avoiding vaccines; further studies are needed. This study emphasizes the need for increased vigilance in patients with underlying systemic comorbidities who have recently been vaccinated and to share our insights into the potential relationship between tozinameran and intracranial hemorrhage.
2019年冠状病毒病（COVID-19）大流行已影响全球超过7亿人，并导致近700万人死亡。目前已研发或正在研发的疫苗是遏制该大流行并减轻其影响的最有效工具。在土耳其，辉瑞-BioNTech新冠疫苗（BNT162b2，也称为托珠单抗）的接种已获批准。我们报告了一名56岁患有原发性高血压的女性患者，她在接种第一剂托珠单抗后发生了颅内出血。患者立即接受了血肿清除手术，术中肉眼识别并夹闭了左侧大脑中动脉分叉处动脉瘤。患者在术后第二天被宣布死亡。这是第二例因大脑中动脉分叉处动脉瘤破裂导致接种托珠单抗后发生颅内出血的病例。在分析该病例时，疫苗对血流动力学模式的潜在免疫触发作用与先前未知的脑动脉瘤破裂之间可能存在关联。然而，这些严重并发症并不能成为避免接种疫苗的理由；还需要进一步研究。本研究强调，对于近期接种疫苗的患有全身性基础合并症的患者，需要提高警惕，并分享我们对托珠单抗与颅内出血之间潜在关系的见解。
