Imaging of Neurologically Symptomatic Patients after AZD1222 (Astrazeneca®) Vaccination – a Multicenter Study of 28 Cases

BACKGROUND: A series of disseminated intravascular coagulation (DIC) cases with cerebral venous thromboses and cerebral hemorrhage after AstraZeneca® COVID-19 vaccination motivated the European Medical Agency (EMA) to review the safety profile of this vaccine anew. Vaccination has been temporarily suspended in several European countries, which is in the spotlight of public and media interest. We noticed a sudden increase in neuroradiological imaging requests to rule-out post-vaccination complications. METHODS: We retrospectively included patients presenting at the emergency department of four primary care hospitals in Germany for various neurological complaints after AstraZeneca® vaccination with subsequent neuroradiological imaging. Clinical records were reviewed for laboratory results and neurological symptoms at initial presentation. Imaging results were reported in consensus by two experienced radiologists at each center. FINDINGS: Twenty-eight consecutive patients were evaluated (16 female, mean age 36.6 ± 8.6 years). Most patients suffered from headache (89%), followed by fatigue and common cold symptoms (11%). Further neurological findings included visual, sensory and speech or language impairment (7% each), and dizziness (4%). Blood platelet levels were normal for all reported observations; in seven cases D-dimer was elevated. A neuroradiological assessment ruled-out cerebral venous thrombosis and cerebral hemorrhage by magnetic resonance imaging or computed tomography in all cases. INTERPRETATION: The risk of post-vaccination DIC or immune-mediated thrombocytopenia is overestimated, which results in overdiagnosis of primarily young, healthy individuals. DIC is a particular pathologic entity with systemic activation of coagulation, and any analogy to singular deep vein thrombosis seems inappropriate. We propose a workflow by up-to-date evidence for management of neurologically symptomatic patients after AstraZeneca® vaccination, to enable meaningful use of limited resources in accident & emergency departments.