Persistent Symptoms After AZ Vaccine: When to Seek Neurology Care

Persistent symptoms one month after receiving the AZ vaccine?

Hello, Dr.
Jiang: I received the AZ vaccine on September 10, and that night I had a fever of 41.4 degrees Celsius.
However, the fever subsided by the morning of the following day.
Two weeks later, on September 13, I noticed that I was having difficulty expressing complete sentences and could only say simple words.
As of today, October 20, I have been experiencing headaches almost every day, with the most common pain radiating from the top of my head to the back of my skull.
I have taken pain relievers, but the pain persists without relief.
My colleagues have commented that my complexion looks pale.
Additionally, after noon on October 10, I had another headache, and when I measured my temperature at 7:30 PM, it was 37.8 degrees Celsius, but it dropped to 36.4 degrees Celsius half an hour later.
I had a health check-up at work on September 10, and I noticed that my blood test results were slightly low (the check-up was the day before I received the AZ vaccine).
During the period after the vaccination, I also noticed some black spots floating in my vision, which quickly disappeared; I'm not sure if this was related to floaters.
I frequently experience dizziness, and I'm unsure if this could be a symptom of a stroke, although my blood pressure remains within the normal range, and I have been eating a light diet.
Since these symptoms have persisted for over a month, I believe I need to go to a large hospital for an examination.
Which department should I consult?

Zhuang Xiaojie, 20~29 year old female. Ask Date: 2021/10/20

Dr. Jiang Junyi reply Neurology

Dear Ms.
Chuang,
You mentioned that "two weeks after September 13, I found that I seemed unable to express a complete sentence and could only say simple words." It may be necessary to consider the adverse reaction of thrombosis associated with the AZ vaccine, currently referred to as VITT (Vaccine-induced immune thrombotic thrombocytopenia).
The incidence rate is approximately 1 in 10,000 in Europe.
It typically occurs within 4 to 28 days.
Please be aware of symptoms such as: swelling in the lower limbs, shortness of breath, headache accompanied by blurred vision, and persistent abdominal pain lasting more than 24 hours.

Clinically, if cerebral venous sinus thrombosis is suspected, MRI is required for diagnosis.
For abdominal or pulmonary embolism, a CT scan with contrast is necessary, while deep vein thrombosis in the lower limbs can be assessed using vascular ultrasound.
Blood tests should include PT, aPTT, D-dimer (elevated more than four times), and fibrinogen (severely decreased).

I recommend that you consult with a neurologist or hematologist at a regional hospital or higher for further discussion and examination.
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health, peace, and joy.
Dr.
Jiang Junyi,
Department of Internal Medicine, Taoyuan Hospital

Reply Date: 2021/10/20

More Info

It sounds like you're experiencing a range of concerning symptoms following your AZ vaccine, and it's understandable to feel anxious about them. Given the complexity of your situation, it's crucial to approach this methodically.

Firstly, the symptoms you've described—persistent headaches, difficulty expressing complete sentences, visual disturbances, and dizziness—are significant and warrant further investigation. While some mild side effects such as headaches and fatigue can occur after vaccination, the persistence and severity of your symptoms raise a red flag that should not be ignored.

When to Seek Neurology Care
You should consider seeking care from a neurologist if you experience any of the following:
1. Persistent Headaches: If your headaches are frequent and unresponsive to over-the-counter pain relief, this is a sign that you should consult a specialist.

2. Cognitive Changes: Difficulty in expressing thoughts or forming complete sentences can indicate neurological issues. This symptom, especially if it has developed suddenly, should be evaluated by a neurologist.

3. Visual Disturbances: The presence of visual floaters or changes in vision, particularly if they are new or accompanied by other symptoms, should be assessed.

4. Dizziness and Balance Issues: Frequent dizziness, especially if it affects your balance or coordination, is another reason to seek neurological evaluation.

5. Duration of Symptoms: Since your symptoms have persisted for over a month, it is essential to seek medical advice rather than waiting for them to resolve on their own.

Recommended Steps
1. Schedule an Appointment with a Neurologist: Given your symptoms, a neurologist is the appropriate specialist to evaluate your condition. They can perform a thorough neurological examination and may recommend imaging studies, such as an MRI or CT scan, to rule out any serious underlying conditions.

2. Document Your Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider.

3. Blood Tests: Since you mentioned that your blood tests showed some low values, it might be beneficial to have these retested. Sometimes, deficiencies in vitamins (like B12) or other metabolic issues can contribute to neurological symptoms.

4. Stay Hydrated and Rest: While waiting for your appointment, ensure you are drinking enough fluids and getting adequate rest. This can help manage some of your symptoms.

5. Emergency Symptoms: If you experience any acute symptoms such as sudden weakness, severe headache, confusion, or changes in vision, seek emergency medical attention immediately.

Conclusion
Your symptoms are concerning and should be taken seriously. While it's possible that they could be related to the vaccine, they could also indicate other underlying health issues that need to be addressed. Consulting with a neurologist will provide you with the best chance of getting a proper diagnosis and treatment plan. Remember, your health is paramount, and seeking help is a proactive step in ensuring your well-being.

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