ABSTRACT
Encephalitis is the inflammation of the brain which is usually caused by viral infections, but it can be also due to other non-infectious agents. We report an interesting case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with Haemophilus influenzae co-infection in association with severe acute respiratory syndrome coronavirus 2, without pulmonary involvement or fever. © 2022 UPM Press. All rights reserved.
ABSTRACT
OBJECTIVE: To assess safety data of the inactivated COVID-19 vaccines in a real-world sample of people with autoimmune encephalitis (pwAE). METHODS: A cross-sectional study was performed between 1 March and 30 April 2022. We invited pwAE from our previous ONE-WC (Outcome of Autoimmune Encephalitis Study in Western China) registration study database, to attend neurological clinics, at West China Hospital to participate in a face-to-face survey using a custom-designed questionnaire for this study. The ONE-WC study began in October 2011 and prospectively enrolled pwAE from four large comprehensive neurological centers in Sichuan province, China. RESULTS: Of the 387 pwAE, 240 (62.0%) completed the questionnaire. Half the 240 participants (121, 50.4%) reported receiving at least one dose of COVID-19 vaccine, which in all but two patients received inactivated COVID-19 vaccine. Among vaccinated pwAE, the median age was 35 years (range 15-69) and 57.8% of them were women. The most frequent reasons that unvaccinated individuals reported for not receiving the COVID-19 vaccine were concern about vaccine-induced relapse of AE (50.4%) and advice from a physician to delay vaccination (21.0%). Small proportions of vaccinated individuals reported adverse events after the first dose (11.5%) or the second dose (10.2%), and none of the adverse events was serious. Across the entire sample, one individual reported relapsing within 30 days after the first dose and three individuals reported relapsing more than 120 days after the first dose. CONCLUSIONS: This real-world survey indicates an overall favorable safety profile of the inactivated COVID-19 vaccine for pwAE.
Subject(s)
Autoimmune Diseases of the Nervous System , COVID-19 , Humans , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Male , COVID-19 Vaccines , Cross-Sectional Studies , VaccinationABSTRACT
Encephalitis is the inflammation of the brain which is usually caused by viral infections, but it can be also due to other non-infectious agents. We report an interesting case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis with Haemophilus influenzae co-infection in association with severe acute respiratory syndrome coronavirus 2, without pulmonary involvement or fever. [ FROM AUTHOR]
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to be a global issue. While immunizations comprise an important line of defense, adverse effects may occur. We report two cases of autoimmune conditions affecting the nervous system, anti-N-Methyl-D-Aspartate-receptor (NMDAR) encephalitis and myasthenia gravis (MG), that developed in close association with COVID-19 vaccination. CASE REPORT: In our first case, a 29-year-old woman presents with recurrent seizures, auditory hallucinations, psychiatric symptoms, and autonomic abnormalities, with an onset of 1 day after receiving the second dose of inactivated SARS-CoV-2 whole virus vaccine. CSF analysis and electroencephalogram (EEG) were consistent with anti-NMDAR encephalitis. In our second case, a 23-year-old woman presents with ocular ptosis, diplopia, hoarseness, and fatigability, which first appeared 1-day after her first dose of inactivated SARS-CoV-2 whole virus vaccine. Electromyography (EMG) results established a definite diagnosis of MG. CONCLUSION(S): To the best of our knowledge, this is the first report of anti-NMDAR encephalitis and MG associated with inactivated SARS-CoV-2 whole virus vaccine. In both cases, COVID-19 vaccination appears to be the only remarkable feature of history. The authors postulate that COVID-19 vaccination may trigger underlying defects or induce failure of positive and negative selection, which may lead to autoreactivity and subsequent autoimmunity. However, further studies are required to confirm this possibility. Copyright © 2022, Scientific Foundation SPIROSKI. All rights reserved.
ABSTRACT
The dorsolateral prefrontal cortex (dlPFC) generates the mental representations that are the foundation of abstract thought, and provides top-down regulation of emotion through projections to the medial PFC and cingulate cortices. Physiological recordings from dlPFC Delay cells have shown that the generation of mental representations during working memory relies on NMDAR neurotransmission, with surprisingly little contribution from AMPAR. Systemic administration of low "antidepressant" doses of the NMDAR antagonist, ketamine, erodes these representations and reduces dlPFC Delay cell firing. In contrast to the dlPFC, V1 neuronal firing to visual stimuli depends on AMPAR, with much less contribution from NMDAR. Similarly, neurons in the dlPFC that respond to sensory events (cue cells, response feedback cells) rely on AMPAR, and systemic ketamine increases their firing. Insults to NMDAR transmission, and the impaired ability for dlPFC to generate mental representations, may contribute to cognitive deficits in schizophrenia, e.g., from genetic insults that weaken NMDAR transmission, or from blockade of NMDAR by kynurenic acid. Elevated levels of kynurenic acid in dlPFC may also contribute to cognitive deficits in other disorders with pronounced neuroinflammation (e.g., Alzheimer's disease), or peripheral infections where kynurenine can enter brain (e.g., delirium from sepsis, "brain fog" in COVID19). Much less is known about NMDAR actions in the primate cingulate cortices. However, NMDAR neurotransmission appears to process the affective and visceral responses to pain and other aversive experiences mediated by the cingulate cortices, which may contribute to sustained alterations in mood state. We hypothesize that the very rapid, antidepressant effects of intranasal ketamine may involve the disruption of NMDAR-generated aversive mood states by the anterior and subgenual cingulate cortices, providing a "foot in the door" to allow the subsequent return of top-down regulation by higher PFC areas. Thus, the detrimental vs. therapeutic effects of NMDAR blockade may be circuit dependent.