Trigeminal neuralgia occurring after the third dose of Pfizer BioNTech COVID-19 vaccine. Complication or coincidence? An illustrative case report and literature review

The coronavirus disease 2019 pandemic is an ongoing concern for medical care worldwide. Since its emergence, multiple COVID-19 vaccines have been designed, allowing for more effective control of the pandemic. COVID-19 vaccines, like any other form of medical intervention, may cause adverse and unforeseen side effects, varying in frequency and severity. Determining a correlation between the occurring symptoms and the vaccination is often a challenging task, requiring multiple data sources and reported cases. So far, there have been multiple reports of trigeminal neuralgia developing after COVID-19 vaccination. A 36-year-old woman was admitted to the Emergency Ward due to chronic pain attacks in the left side of her face. The pain appeared two months ago, on the day following the vaccination using the third dose of the Pfizer BioNTech COVID-19 vaccine. At the Neurology Department she was diagnosed with trigeminal neuralgia. Based on the lack of any obvious causes, relation to the vaccination, and other similar reports, we assumed that the trigeminal neuralgia was a complication of the vaccination. Hospital treatment consisted of oxcarbazepine, dexamethasone and pregabalin. Treatment was successful, with transient episodes of exacerbation. Six months after the onset of the disorder the patient remains without pain. We believe that the presented case supports the possibility of trigeminal neuralgia occurring in relation to the Pfizer BioNTech COVID-19 vaccine administration. Additional reports may further contribute to establishing a certain link. Copyright © 2023 Termedia.

Challenging Case in Clinical Practice: Multimodal Management of Concurrent Structural and Virally Exacerbated Trigeminal Neuralgia

Introduction: Trigeminal neuralgia (TN) is among the most painful disorders of the orofacial region. Although TN has many possible etiologies, such as nerve compression, recently published evidence suggests that TN, or its exacerbations, may be the result of viral infections in the head and neck. This case presents clinical findings from a TN patient experiencing virally-induced exacerbations treated with intravenous (IV) magnesium sulfate and oral anti-inflammatories who was previously non-responsive to first-line pharmaceuticals. Methods: AM is a 51-year-old cis-female with a four-year history of TN caused by vascular encroachment of the trigeminal nerve and exacerbated by episodes of viral sinusitis and COVID-19. AM presented to the National University of Natural Medicine clinic in May 2019 and again in April 2022. After screening for contraindications, she was started on an IV Myer's push with an elevated dose of magnesium sulfate and oral anti-inflammatories: curcumin and omega-3. Results: Since her second presentation to our clinic in April 2022, the patient has undergone 11 treatments and reports significant benefit in pain and quality of life. Despite the initial MRI revealing vascular encroachment on her trigeminal nerve she experienced benefit from her treatment regimen and denied a neurosurgical consultation and repeat MRI. Conclusion: This study contributes to a growing body of literature suggesting that cranial neuralgias may be exacerbated by orofacial or upper-respiratory viral infections and that TN specifically may be well managed with IV nutrient therapy and oral anti-inflammatories. Given the paucity of successful treatment strategies, exploring cost-effective treatments with low side effect profiles is a worthwhile approach to improving clinical outcomes in patients with TN.

Access to pain medicines and follow-up consultation after radiofrequency ablation for trigeminal neuralgia during the COVID-19 pandemic.

Background: In the recent coronavirus disease 2019 (COVID-19) pandemic, follow-up of patients with trigeminal neuralgia post radio-frequency ablation (RFA) of the Gasserian ganglion was restricted because of closure of pain clinic services (PCSs) at our institution, travel restrictions, and fear of contracting COVID-19 infection by hospital visit. Periodic follow-ups are a must in this group of patients. Because the access to pain medications and consultations remained restricted, we tried identifying the factors predisposing to these difficulties in patients. Methods: We had contacted patients telephonically, who underwent RFA at our institution in the past 5 years as the PCS had not re-started to follow up with in-person consultation. Demographics, socio-economic factors, clinical factors, literacy status, distance to the health care system, and current health status were noted. Collected data were analyzed descriptively, and correlations were calculated between the predictors for difficulty in follow-up to access the medications and consultations. Results: Out of 121 patients who underwent RFA in the past 5 years, 73 were accessible on phone. Of these, 42.46% (31/73) patients had difficulty in accessing either medications or consultation. The literacy status of the patient was the strongest predictor (0.044) with a negative correlation (-1.216). Difficulty in accessing PCS was associated with a poor health status (p-0.032) and higher pain scores (0.066). Conclusion: Along with the clinical factors, we have to overlook other factors in predicting difficulty to access PCS in trigeminal neuralgia patients post the RFA status. Difficulty in access to pain medicines and/or consultations was associated with a poor health status and higher pain scores.

Central Nervous System Demyelination Following COVID-19 mRNA-Based Vaccination: Two Case Reports and Literature Review.

As the world embarks on mass vaccination against SARS-CoV2 to alleviate the spread of this highly contagious novel coronavirus, there are growing anecdotal reports on immune-related neurological complications following immunisation. Similarly, we encountered 2 cases of central nervous system demyelination at our centre with Comirnaty (BNT162b2), a mRNA-based COVID-19 vaccine. Our first patient had typical clinical-radiological manifestations of acute disseminated encephalomyelitis (ADEM) after his COVID-19 vaccination. This was the sixth reported case to date. Our second patient presented with an unusual complaint of trigeminal neuralgia, with an identifiable demyelinating lesion observed in the pons on neuroimaging. Both cases responded well to immunotherapy. However, larger prospective controlled studies and formal registries are much needed to ascertain a possible relationship between COVID-19 vaccines and acute central nervous system demyelination.

Cranial neuropathy in COVID-19: a case series and review of literature.

Neurological presentation of COVID-19 is increasingly being recognised. Cranial neuropathy in COVID-19 is an uncommon and under-diagnosed entity. We report a case series of 4 patients who presented with trigeminal neuropathy (two cases) and facial nerve palsy (two cases) which recovered with conservative treatment along with the review of the literature.

Retrosigmoid Craniectomy and Suprameatal Drilling-3-Dimensionally Printed Microneurosurgical Simulation: 2-Dimensional Operative Video.

Neurosurgical training is being challenged by rigorous work-hour restrictions and the COVID-19 pandemic.1 Now, more than ever, surgical simulation plays a pivotal role in resident education and psychomotor skill development. Three-dimensional (3D) printing technologies enable the construction of inexpensive, patient-specific, anatomically accurate physical models for a more convenient and realistic simulation of complex skull base approaches in a safe environment.2 All stages of the surgical procedure can be simulated, from positioning and exposure to deep microdissection, which has an unparalleled educational value. The complex approach-specific anatomy, narrow working angles, and pathoanatomic relationships can be readily explored from the surgeon's perspective or point of view.2,3 Furthermore, different thermoplastic polymers can be utilized to replicate the visual and tactile feedback of bone (cortical/cancellous), neurological, and vascular tissues.4 Retrosigmoid craniectomies are widely used in neurosurgery with various applications, including microvascular decompressions in patients with trigeminal neuralgia.5-7 Removal of the suprameatal tubercle (SMT) extends the retrosigmoid approach superiorly to the middle fossa and Meckel's cave, and anteriorly to the clivus.8,9 This maneuver may be necessary in patients with prominent SMTs obstructing the view of the trigeminal nerve and in patients with a more anterosuperior neurovascular conflict. This video illustrates a microsurgical training tool for learning and honing the technique of retrosigmoid craniectomy and suprameatal drilling using an affordable (29.00 USD) biomimetic 3D-printed simulator that closely recapitulates not only the anatomy but also the tactile feedback of drilling and manipulating neurological tissues (see Table and Graph 1; minute 07:11) as it happens at the time of surgery.

Trigeminal neuralgia as the sole neurological manifestation of COVID-19: A case report.

OBJECTIVE: To describe a case report of trigeminal neuralgia (TN) due to coronavirus disease-2019 (COVID-19). BACKGROUND: In March 2020, the World Health Organization declared COVID-19 as a pandemic. Respiratory system manifestations are dominant in this new disease. However, numerous case series and reviews have been published on the neurological manifestations, highlighting the potential neurotropism of the new coronavirus. METHODS: We describe a clinical case of TN during COVID-19 and we discuss the differential diagnosis and the potential pathogenic mechanism according to the literature. RESULTS: A 65-year-old man with general malaise and typical respiratory symptoms of COVID-19, who presented with paroxysmal lancinating pain in the right V1 trigeminal territory without other neurological symptoms. General blood test and neuroimaging study were normal. A rapid test showed positive IgG and IgM serologies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient was diagnosed with TN secondary to a viral infection by SARS-CoV-2. Facial pain resolved with the improvement of COVID-19. CONCLUSIONS: The new coronavirus SARS-CoV-2 is a possible etiology of secondary TN. Nevertheless, more studies are needed to elucidate the neuropathology of this viral infection.