Transient ischemic attack after mRNA-based COVID-19 vaccination during pregnancy: A case report

doi:10.12998/wjcc.v10.i27.9929

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World Journal of Clinical Cases

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Case Report

World J Clin Cases. Sep 26, 2022; 10(27): 9929-9935
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9929

Transient ischemic attack after mRNA-based COVID-19 vaccination during pregnancy: A case report

Chi-Han Chang, Sheng-Po Kao, Dah-Ching Ding

Chi-Han Chang, Sheng-Po Kao, Dah-Ching Ding, Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan

Author contributions: Ding DC, Kao SP, and Chang CH designed the research study; Ding DC, Chang CH performed the research; Ding DC and Chang CH analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.

Informed consent statement: A written informed consent was obtained from the patient for publication of this case report.

Conflict-of-interest statement: The authors have nothing to disclose.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Dah-Ching Ding, PhD, Chief Physician, Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, 707, Sec. 3, Chung-Yang Road, Hualien 970, Taiwan. dah1003@yahoo.com.tw

Received: May 23, 2022
Peer-review started: May 23, 2022
First decision: July 12, 2022
Revised: July 19, 2022
Accepted: August 11, 2022
Article in press: August 11, 2022
Published online: September 26, 2022
Processing time: 116 Days and 2 Hours

Abstract

BACKGROUND

Thrombocytopenia with thrombosis syndrome has been reported after vaccination against severe acute respiratory syndrome coronavirus 2 with two mRNA vaccines. The syndrome is characterized by thrombosis, especially cerebral venous sinus thrombosis, and may lead to stroke. Pregnant women with stroke show higher rates of pregnancy loss and experience serious pregnancy complications. We present the case of a 24-year-old pregnant woman with a transient ischemic attack (TIA) that developed after vaccination with the Moderna mRNA-1273 vaccine (at 37 2/7 wk).

CASE SUMMARY

TIA occurred 13 d following the coronavirus disease vaccination. At 39 1/7 wk of pregnancy, the patient presented with sudden onset of right eye blurred vision with headache, dizziness with nausea, right-hand weakness, anomia, and alexia. The symptoms lasted 3 h; TIA was diagnosed. Blood test results revealed elevated D-dimer, cholesterol, and triglyceride levels. Brain magnetic resonance imaging showed no acute hemorrhagic or ischemic stroke. At pregnancy 37 6/7 wk, she was admitted for cesarean delivery to reduce subsequent risk of stroke during labor. Body mass index on admission was 19.8 kg/m². Magnetic resonance angiography and transesophageal echocardiography showed no abnormalities. The next day, a mature female baby weighing 2895 g and measuring 50 cm was delivered. Apgar scores were 8 and 9 in the first and fifth minutes. D-dimer levels decreased on postoperative day 4. After discharge, the autoimmune panel was within normal limits, including antinuclear and antiphospholipid antibodies.

CONCLUSION

TIA might be developed after the mRNA vaccines in pregnant women.

Keywords: Pregnancy; mRNA vaccine; COVID-19; Stroke; Transient ischemic attack; Case report

Core Tip: We reported the information of transient ischemic attack following coronavirus disease 2019 (COVID-19) mRNA vaccination in a pregnant woman. We also updated the information on vaccine-induced thrombosis caused by COVID-19 mRNA vaccination. Finally, since transient ischemic attack is a rare event associated with COVID-19 mRNA vaccination, vaccination should not be prohibited for pregnant women.