ABSTRACT
As COVID-19 vaccines became widely available, there have been reports of neurovascular complications. In this article, we aim to report a case of cerebral venous sinus thrombosis (CVST) induced by COVID-19 vaccination, with a literature review on similar cases as well as the potential pathophysiological mechanisms. Our case is a healthy male who developed headache, vomiting, photophobia and diplopia after receiving the Ad26.COV2.S vaccine. Fundus examination showed papilledema, and magnetic resonance imaging of the brain and cerebral veins showed CVST involving the superior sagittal sinus and right transverse sinus extending into the right jugular vein. Hypercoagulability workup was unremarkable, and the patient received immunotherapy and anticoagulation. Following this treatment, symptoms resolved, and he had no residual neurologic deficits. Developing neurologic manifestations, especially severe headaches with papilledema, after COVID-19 vaccination should warrant neuroimaging. Early recognition and management of CVST are essential for good clinical outcomes.
ABSTRACT
BACKGROUND: In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. METHODS: We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. RESULTS: We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. CONCLUSIONS: Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.
Subject(s)
Bell Palsy , COVID-19 , Guillain-Barre Syndrome , Electromyography , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Humans , Middle Aged , SARS-CoV-2ABSTRACT
The COVID-19 pandemic has created overwhelming circumstances not only in the medical field, but in other walks of life. SARS-CoV-2, the causative virus of COVID-19 [1], primarily affects the respiratory system leading to respiratory illnesses of varying severity ranging from mild flu-like symptoms to acute respiratory distress syndrome [2]. However, the clinical manifestations of COVID-19 are not limited to the respiratory system [3]. There is a growing body of literature showing the incidence of a varying clinical spectrum of neuropsychiatric manifestations in a significant proportion of COVID-19 patients [4]. With the variability in neuropsychiatric presentation of COVID- 19, multiple mechanisms have been proposed to explain the pathophysiology of these presentations [5]. In this case report, we present a 20-year-old female with no significant respiratory symptoms or previous history of psychotic episodes who manifested with acute psychosis as a significant complication of COVID-19.