Reversible Cerebral Vasoconstriction Syndrome (RCVS) After COVID-19 Vaccination: An Analysis of VAERS
Objective:
To search the Vaccine Adverse Event Reporting System (VAERS) identifying and characterizing cases of reversible cerebral vasoconstriction syndrome (RCVS) in individuals who received the COVID-19 vaccine.
Background:
Reversible cerebral vasoconstriction syndrome (RCVS) occurs due to reversible vasospasm of cerebral vessels and often has a "thunder-clap" onset similar to a subarachnoid hemorrhage. RCVS can occur in any age group and demographic however is most prevalent in middle-aged women. RCVS can occur spontaneously or in response to a secondary factor such as vasoactive drugs, herbal supplements (i.e. ginseng), or physical activity a common etiology being sexual intercourse.
Design/Methods:
VAERS was searched from the time of authorization of the approval of the first mRNA COVID-19 vaccine to September 30th, 2022. The database was queried to report "Reversible Cerebral Vasoconstriction Syndrome" (VAERS ID: 10073240). All COVID-19 vaccines were included.
Results:
A total of nine records were obtained. All records were manually reviewed and analyzed based on diagnostic criteria defined by Singhal et al., the RCVS2 score [≥5: a diagnosis of RCVS is highly likely, 3-4: diagnosis is equivocal, ≤2: a diagnosis of RCVS is highly unlikely]. Four cases were immediately excluded due to lack of objective data. 3/5 (60%) cases are seen in women. The most common presenting symptom being a thunder-clap headache defined as a headache with 10/10 intensity within 1-minute of onset. One patient reported recurrence of thunder-clap headaches 17 times over the course of 15 days. Mean age calculated 59.6 years-old (31-76). Mean RCVS2 score is 7 (5-9). Mean time to symptom onset from vaccination is 6.6 days (1-15). All individuals received the mRNA-1273 (4/5) or BNT162b2 (1/5) vaccine.
Conclusions:
The current study shows that RCVS can occur after COVID-19 vaccination. However, more data is needed to justify a causal relationship. Further studies determining the risk of intracranial arteriopathies (i.e. RCVS, PRES, RPLS) are needed.