Suspected COVID-19 mRNA Vaccine-Induced Postural Orthostatic Tachycardia Syndrome.

We present a case of a 15-year-old South Asian male who developed suspected postural orthostatic tachycardia syndrome (POTS) two weeks after receiving the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine booster, which was successfully managed with low-dose fludrocortisone and ivabradine. Clinicians should be aware of the Pfizer-BioNTech COVID-19 vaccine being implicated with the onset of POTS.

Neurological Conditions Following COVID-19 Vaccinations: Chance or Association?

Coronavirus disease 2019 (COVID-19) has been labeled a global pandemic with the first reported case of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurring in Wuhan, China in December 2019. To combat the alarming, increasing rate of those affected by the virus, vaccine development ensued. As mass vaccination initiatives against COVID-19 ensued, adverse reactions began emerging. This non-consecutive, population-based case series focuses on four vaccine-associated neurological adverse events across the central and peripheral nervous system detailing the diagnosis, treatment and subsequent follow-up management. These four patients presented to public and private hospitals in Trinidad and Tobago with new-onset neurological diseases soon after their first doses of a COVID-19 vaccine: two after the Pfizer-BioNTech vaccine (one case of new-onset seizures and one case of longitudinally extensive transverse myelitis) and two after the ChAdOx1 nCoV-19 vaccine (one case of Guillain-Barre syndrome and one case of meningitis-retention syndrome). The background incidence rates of neurological conditions in the population and the large numbers of persons being vaccinated means that some of these conditions will appear in the post-vaccination window by chance. Hence, establishing causal links is difficult. The close temporal relationship between vaccination and the presenting symptoms, the biological plausibility, and the extensive diagnostic workup to exclude other causes fulfill criteria provided by the World Health Organization for causality assessment of an adverse event following immunization on an individual level. On this basis, it was determined that these adverse events were likely due to the vaccines. However, establishing causal links on a population level requires large epidemiological studies and cannot be done on individual case reports alone. While physicians should be cognizant of even these rare adverse events of vaccines, it should be reiterated that the overall safety profile of vaccines is well established.

Facio-brachial dystonic seizures and autoimmune encephalitis – a post COVID-19 neurological presentation?

BackgroundFacio-brachial dystonic seizures (FBDS), which affects the ipsilateral face and arm, is a disorder in the watershed between epilepsy and movement disorders, and a transitional presentation of limbic encephalitis.It is rarely described in children.ObjectivesWe present an unusual case of presumed autoimmune encephalitis - with the only positive investigations being Anti-TPO antibodies and COVID-19 antibodies.Methods17-month-old male presenting with the following different, progressive event types:1) Clusters of focal motor seizures described as head and eyes deviating to the left and occasionally associated with stiffening of the upper limbs/entire body2) Focal dyscognitive seizures described as staring episodes associated with increased aggression then unresponsiveness with eyes deviating upwards to the right3) Clusters of facio-brachial dystonic seizures described as right eyelid and facial twitching with posturing upward movement of ipsilateral armThese events were associated with developmental regression mainly involving speech/language and behaviour change.This was preceded by upper respiratory tract symptoms 1-week prior.ResultsThis was associated with resistance to conventional AED’s (carbamazepine, phenytoin, clonazepam) but response to immunosuppression (steroids and IVIG).Initial EEG showed diffuse background slowing and independent right and left temporal sharp waves. This improved post immunomodulation.MRI brain was normal. CSF studies were normal (CSF acellular, protein 31 mg/dL)Autoimmune encephalitis panel by IIFT (NMDA, AMPA1, AMPA2, GLUR1/GLUR2, CASPR2, DPPX, LGI1, GABARB1/B2) negativeAnti-TPO Ab 72.1 (elevated), anti-thyroglobulin Ab and thyroglobulin negative (post methylprednsiolone pulse x2)COVID-19 IgM Ab 1.416, IgG 0.229;SARS-CoV-2 Nasopharygeal swab negativeHe was treated as presumed autoimmune/limbic encephalitis initially with steroids, followed by IVIG. Seizure frequency improved significantly 1-week post IVIG, however mild improvement in the developmental regression and altered behaviour. He continues on a tapering prednisolone dose over the next 4 months.ConclusionsThis case highlights the association of facio-brachial dystonic seizures and limbic encephalitis in a child.We have considered whether this can be attributed to Hashimoto’s encephalopathy as a post-inflammatory neurological manifestation of SARS-CoV-2.