Fasciculations as initial symptom of IGLON5 antibody encephalopathy

IgLON5 antibody encephalopathy is a rare but increasingly recognized disorder with a variety of clinical signs, due to deposition of neuronal tau protein. Most patients display a characteristic sleep disorder with severe insomnia, NREM parasomnia and sleep disordered breathing (stridor, obstructive sleep apnoea) but clinical spectrum has steadily expanded with brainstem, autonomic and neuropsychiatric disorders and, more rarely, peripheral symptoms with membrane hyperexcitability. Antibodies are present in both serum and CSF and there is a strong correlation with human leukocyte antigen (HLA) DRB1*10:01 and HLA-DQB1*05:01. Majority of cases respond partially to immunotherapy. We report a clinical case of a 46-year-old male patient with IgLON5 antibody disease and insidious onset (June 2021) with stable course, in absence of associated antibodies (GAD, NMDAR, AMPA, GABA-A, GABA-B, mGluR1, mGluR2, mGluR5, DPPX, LGI1, CASPR2). First symptom the patient recognized was generalized fasciculations 24 h after SARS-COV2 vaccine (1st dose mRNA-Moderna), without muscle cramps nor weakness, followed by a sleep disorder (severe insomnia and obstructive sleep apnoea) and bulbar dysfunction. Nine months after, he presented mild parkinsonism signs, mild cognitive impairment and acute bilateral L5-S1 denervation in electromyography with HLA DRB1*03 (DR17) and DRB1*13. He was subsequently treated with methylprednisolone and monoclonal antibodies (Rituximab), with a dramatic improvement of fasciculations. A growing spectrum of clinical manifestations suggest that IgLON5-antibodies may play a minor but important role on peripheral nerves, as seen in very few cases in the literature[1],[2], thus a comprehensive investigation of peripheral and central nervous system should be done systematically. It should be discussed if the peripheral affection, that caused a hyperexcitability manifestation, was primarily or directly induced by IgLON5-antibodies. Whether the association between COVID- 19 vaccine (only 24 h before symptoms) and autoimmune manifestations is co-incidental or causal remains to be elucidated.

Multiple Cranial Neuropathies After COVID-19 Vaccination

Objective: To present a patient with acute-onset of multiple cranial neuropathies associated with recent COVID-19 vaccination. Background: Vaccine-associated neurologic adverse effects have been well-described over the decades;the influenza vaccine as well as others have been thought to precede Guillain-BarréSyndrome (GBS), Miller-Fisher Syndrome (MFS), and similar processes. Hyper-inflammatory responses have been frequently reported with SARS-CoV-2 infection and immunization, along with various neurologic pathologies. In this case report we describe a cranial polyneuropathy (3, 6, 7 and 12) associated with the COVID-19 vaccine. Design/Methods: Case Report with Video/Photos Results: A 52-year-old R-handed female presented with acute-onset, rapidly progressive deficits including left upper lid ptosis, left eye ophthalmoplegia, leftward tongue deviation, left facial paresis and dysarthria. History includes congenital left eye cataract s/p lens exchange, remote strabismus surgery and slight ptosis at baseline. She denied recent illness or injuries, though had completed single-dose vaccination for SARSCoV-2 11 days prior to symptom onset. Exam revealed new L eye esotropia with restriction in abduction and supraduction. Also noted was worsening of baseline ptosis, weak tongue protrusion with right-sided fasciculations and leftward deviation. Patient endorsed dysphagia and dysarthria. Workup consisted of three unexplanatory MRIs during week of symptom onset, lumbar puncture, evaluation by ENT and neuro-ophthalmology as well as other serum and CSF studies to investigate other autoimmune causes. Consent-obtained videos and photographs were taken for documentation/educational purposes. Follow-up visits revealed slow improvement starting three months after symptom onset. Conclusions: We outline a case of a female patient who presented with progressive, multiple cranial neuropathies with onset 11 days after single-dose SARS-CoV-2 vaccination. This constellation of symptoms in the setting of COVID-19 vaccination suggests propensity towards autoimmune neurologic processes. Further investigation is needed to determine the true incidence of similar polyneuropathies with the COVID-19 vaccine and to guide providers and patients to make informed decisions.

Benign Fasciculation Syndrome and Migraine Aura without Headache: Possible Rare Side Effects of the BNT162b2 mRNA Vaccine? A Case Report and a Potential Hypothesis.

The BNT162b2 (Pfizer BioNTech) mRNA vaccine is an effective vaccine against COVID-19 infection. Here, we report an adverse event following immunization (AEFI) in a 48-year-old female patient who presented with fasciculations, migraine auras without headaches and in an increased discomfort of previously present palpitations, as well as excitation and insomnia. Her fasciculations were intermittently present until the time this paper was written, starting from the 6th day post-vaccination; they changed localization and frequency, but most commonly they were generalized, affecting almost all muscle groups. The patient also suffered from two incidents of migraine auras with visual kaleidoscope-like phenomena without headaches a few months after the vaccination. These symptoms were considered to be AEFI and no causal relation with the vaccine could be proven.