Temporal Association Between Vertebral Artery Dissection and SARS-CoV-2 Infection and Vaccination: A Case Report

Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a broad range of neurologic and vascular complications have been described, including ischemic stroke and arterial thrombosis. We report the case of a 39-year-old previously healthy male active-duty US Navy submariner who developed a right vertebral artery dissection complicated by posterior circulation ischemic stroke following symptomatic COVID-19 infection and subsequent mRNA vaccination. Nine months after SARS-CoV-2 infection confirmed on antigen testing, and three weeks after completing the second dose of the Moderna mRNA-1273 vaccine, the patient presented with transient focal neurologic deficits and headache. Computed tomography angiography demonstrated dissection and proximal occlusion of the right vertebral artery with distal reconstitution via thyrocervical trunk collaterals. Magnetic resonance imaging revealed an acute right inferior cerebellar infarct in the posterior inferior cerebellar artery distribution. The patient was managed conservatively with dual antiplatelet therapy and statin therapy, with gradual symptom resolution following physical therapy. This case highlights a potential association between SARS-CoV-2 infection, vaccination, and delayed vascular pathology, possibly mediated by endothelial dysfunction and prothrombotic states. Clinicians should consider maintaining a heightened index of suspicion for vascular etiologies in patients presenting with neurologic symptoms following COVID-19 infection or vaccination, particularly in younger individuals without traditional risk factors.