ABSTRACT
Objective: To discuss neuro-immunologic complications of mRNA vaccinations. Background(s): Neuro-immunologic complications are a known risk of various types of vaccines, but little is known about complications after mRNA vaccines. Method(s): We present a series of four patients from a single institution who developed severe neurologic complications after mRNA COVID-19 vaccinations. Result(s): Case One: A 31-year-old female developed arm paresthesias, leg weakness and urinary retention one week following her first dose. MRI demonstrated T2 hyperintensity at T5 and T8-T9 with enhancement. She received five days methylprednisolone and IVIG. She remains wheelchair bound with urinary retention. Case Two: A 31-year-old male developed paresthesias in legs and urinary retention four weeks following his second dose. A year prior, he contracted COVID-19 and had transient leg paresthesias. MRI demonstrated T2 hyperintensity from lower medulla to the conus. He received five days of intravenous methylprednisolone followed by oral prednisone. He remains symptomatic requiring gabapentin, baclofen and tamsulosin. Case Three: A 75-year-old female with hypertension, diabetes mellitus and Crohn's disease developed leg weakness, complicated by respiratory failure, three days after her first dose. Guillian- Barre Syndrome was diagnosed based on nerve conduction studies. She received PLEX followed by IVIG. She can now ambulate with a walker. Case Four: A 59-year-old healthy female developed urinary retention, saddle anesthesia and leg weakness four weeks following her second dose. MRI spine demonstrated patchy T2 hyperintensities throughout the pons, C- and T-spine. She continues to have gait imbalance and urinary incontinence. Other causes of transverse myelitis including neuromyelitis optica and myelin oligodendrocyte associated disease were ruled out in Case 1, 2 and 4. CSF analysis in all were compatible with neuro-inflammation. Conclusion(s): These cases raise concern that mRNA vaccinations may be associated with neurologic complications due to heightened immune reactivity. Further studies are needed to understand the risk associated with mRNA vaccinations.