Abstract:

Background and Purpose: Cavernous dural arteriovenous fistulas (cDAVFs) represent complex neurovascular lesions with potential for devastating complications. Recent reports suggest possible associations with COVID-19 vaccination. We report a case with a detailed analysis of clinical presentation, diagnostic challenges, and neurovascular management implications.

Methods: Case report with systematic analysis of clinical timeline, neuroimaging findings, and treatment outcomes in a 66-year-old woman who developed cDAVF following Pfizer-BioNTech COVID-19 vaccination.

Results: Patient presented with progressive headaches within days of first vaccination, with symptom escalation following second dose. Despite multiple healthcare encounters over 11 months, diagnosis was delayed due to atypical presentation and initial imaging misinterpretation. Laboratory analysis revealed subtle but significant inflammatory changes when interpreted against individual baseline values. Definitive angiographic diagnosis led to emergency neurosurgical intervention, but resulted in permanent vision loss due to ischemic optic neuropathy. The temporal relationship, absence of alternative risk factors, and biological plausibility support a causal association.

Conclusions: This case highlights critical considerations for stroke specialists: (1) recognition of cDAVF as a potential post-vaccination complication, (2) importance of individual baseline interpretation for inflammatory markers, and (3) need for enhanced clinical suspicion in patients presenting with progressive neurological symptoms post-vaccination. Early recognition and intervention are crucial to prevent irreversible neurovascular complications.

Keywords: Dural arteriovenous fistula, COVID-19 vaccine, stroke, neurovascular complications, cavernous sinus, diagnostic delay