ABSTRACT
Background: Many central and peripheral nervous system complications, following COVID-19 vaccination, have been described. We report an unusual case of central demyelinating disorder, following the administration of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Case-report: The 28-year female developed sudden onset headache followed by weakness of the left upper and lower limbs, and gait ataxia. Neurological symptoms developed two weeks after administration of the first dose of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccine. Magnetic resonance imaging brain revealed T2/FLAIR hyperintense lesions involving bilateral subcortical white matter, splenium of the corpus callosum, and both cerebellar hemispheres. Few lesions showed blooming on gradient echo sequence suggestive of a hemorrhagic component. Post-contrast T1 images showed mild enhancement of demyelinating lesions. The patient was treated intravenously with methylprednisolone. After 12 weeks of follow-up, there was a substantial improvement in her symptoms. She became independent in all her activities of daily living. Conclusion(s): In conclusion, this is an unusual case of acute hemorrhagic leukoencephalitis following ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELDTM) vaccination.Copyright © 2022 The Author(s)
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Background Management of patients with multiple sclerosis (MS) and evidence of disease activity during treatment with cladribine tablets represents a challenging point. Objectives To report a patient with highly active multiple sclerosis (HAMS) who has been early switched from cladribine to alemtuzumab owing to tumultuous clinical and radiological activity Methods A single retrospective case report. Results. Treatment with alemtuzumab has led to a complete suppression of disease activity without any evidence of infections or acquired autoimmune diseases. Conclusion Our report suggests that an early switch from cladribine to alemtuzumab, may be safe and efficacious in selected HAMS cases.Copyright © 2022 The Authors
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Background: Acute disseminated encephalomyelitis (ADEM) is classically considered as a monophasic immune-mediated demyelinating disorder. A relapse can occur in children but extremely rare in adults. Case-report: A 57-year-old man presented with fulminant ADEM-like episode without proceeding viral illness. Neurological deficits rapidly developed associated with extensive demyelinating brain lesions with vasogenic edema. After the initiation of aggressive immunotherapy, his symptoms resolved, but he relapsed twice during 26-month observation period;one was a mild episode characterized by rapidly evolving MRI lesions without development of symptoms, and the other was a fulminant ADEM-like episode similar to the first one. The second fulminant episode occurred only 2 days after getting a flu shot despite no clinical or radiological relapse when he received COVID-19 vaccinations. The patient's symptoms and extensive brain MRI lesions improved after the initiation of aggressive immunotherapy at the early stage. No autoantibodies against neuronal surface (such as GABA A receptor) or glial surface antigens (aquaporin 4, or myelin oligodendrocyte glycoprotein) were identified in either serum or CSF. Conclusion(s): Extensive white matter lesions can occur without neuronal or glial surface antibodies, recurrent fulminant ADEM-like episode can develop even in an adult patient, and flu shot may provoke fulminant ADEM-like episode.Copyright © 2022
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Objective: This clinical case history details a woman who received the COVID-19 vaccine BNT162b2 and developed an acute, severe encephalopathy associated with new onset seizures within days of her first vaccination. Background: BNT162b2, an mRNA-LNP-vaccine, has been strategically purified and modified to suppress immunogenicity. It still possesses powerful intrinsic immune-stimulatory features that induce type-I INF production, which has been associated with both inflammation and potentially autoimmunity in several mRNA-vaccine phase-I/II clinical trials (HIVNCT02413645, influenza-NCT03076385, rabies-NCT02241135 and Zika virus-NCT03014089). Design/Methods: A 69-year-old woman who received her first dose of BNT162b2 five days prior, was found unresponsive. Within twenty-four hours of arrival, she developed focal seizures with secondary generalized, and remained in non-convulsive status epilepticus on longterm EEG monitoring until day 5 of admission despite three anti-seizure medications and a propofol drip. Brain MRI on day 3 of admission showed gyriform-pattern diffusion restriction in the right hemisphere and left frontoparietal region without features suggestive of an acute vascular event. Vascular imaging was normal. Cerebrospinal fluid examination revealed an elevated protein level (135 mg/dl), with negative findings for infections from bacteria, fungi, mycobacteria, HIV, syphilis, and viruses, including COVID-19 PCR, as well as paraneoplastic and autoimmune encephalitis panels. Serum COVID-19 IgG antibody was negative on post-immunization day 8. Results: There was no significant improvement following empiric methylprednisolone and meningitis antibiotic/antiviral treatment. She was discharged in a deeply comatose status on day 30 of hospital admission. Repeat MRI brain on day 14 showed similar findings to her previous scan with the addition of Wallerian degeneration in the right cerebral peduncle. Conclusions: In a patient who develops an acute encephalopathy with new onset of seizure within days of BNT162b2 vaccine, do consider mRNA-vaccine related encephalopathy in the differential diagnosis.
ABSTRACT
The cases of Guillain Barre Syndrome (GBS) have been reported following the coronavirus disease 2019 (COVID-19). Here, we describe a case that evolved from GBS to chronic inflammatory demyelinating polyneuropathy (CIDP) after COVID-19 in terms of contributing to the literature due to its different aspects. In the cerebrospinal fluid examination of the acute onset mixed type polyneuropathy case, albuminocytological dissociation was not detected. The patient was given a loading dose and monthly maintenance intravenous immunoglobulin (IVIG) for six months. Blood ferritin levels gradually decreased in parallel with clinical improvement. Four months after the IVIG treatment was terminated, the findings recurred and the CIDP was developed and IVIG treatment was continued. Long-term follow-up of post-COVID-19 GBS patients is important in terms of recurrence and chronicity. Ferritin level may be a biochemical marker in the clinical follow-up of these cases.