Psychological Treatment of Persistent Genital Arousal Disorder/Genitopelvic Dysesthesia Using an Integrative Approach.

Persistent genital arousal disorder/genitopelvic dysesthesia (PGAD/GPD) is characterized by persistent, unwanted physiological genital arousal (i.e., sensitivity, fullness, and/or swelling) in the absence of sexual excitement or desire which can persist for hours to days and causes significant impairment in psychosocial well-being (e.g., distress) and daily functioning. The etiology and course of PGAD/GPD is still relatively unknown and, unsurprisingly, there are not yet clear evidence-based treatment recommendations for those suffering from PGAD/GPD. We present the case of a 58-year-old woman with acquired persistent genital arousal disorder, which began in March 2020; she believed she developed PGAD/GPD due to a period of significant distress and anxiety related to the COVID-19 pandemic. After seeking medical diagnosis and treatment from multiple healthcare providers and trying a combination of pharmacological and medical treatment modalities, she presented for psychological treatment. An integrative therapy approach (3 assessment sessions, 11 treatment sessions), which included cognitive behavior therapy, distress tolerance and emotion regulation skills from dialectical behavior therapy, and mindfulness practice, was utilized. The patient reported improvements anecdotally (e.g., decreased impact on occupational and social functioning, greater self-compassion, less frequent and shorter duration of PGAD/GPD flare-ups, improved ability to cope with PGAD/GPD symptoms, and decreased need for sleeping medication) and on self-report measures (e.g., lower PGAD/GPD catastrophizing, lower anxiety and depression, and greater overall quality of life).We report the use of an integrative (i.e., psychoeducational, cognitive behavioral, dialectical behavioral, and mindfulness-based) intervention, which may be an effective psychological treatment for PGAD/GPD.

The safety of plasma apheresis from donors recovering from COVID-19 infection in Japan.

PURPOSE: Since 2020, the novel coronavirus infection (COVID-19) has spread globally. A few studies have investigated the safety of COVID-19 convalescent plasma (CCP) apheresis from COVID-19. This study was the first retrospective observational study of CCP in Japan. METHODS: We recruit donors from April 2020 to November 2021 and plasmapheresis in our center (NCGM: national center for global health and medicine). We set the primary endpoint as the Donors Adverse Event (DAE) occurrence at the time of the CCP collection. Variable selection was used to explore the determinants of DAE. RESULTS: Mean and SD age was 50.5 (10.6) years old. Seventy-three (42.2 %) were female, and 87 (33.3 %) were multiple-times donors. Twelve (6.97 % by donors and 4.6 % in total collections) adverse events occurred. The DAEs were VVR (Vaso Vagal Reaction), paresthesia, hypotension, agitation, dizziness, malaise, and hearing impairment/paresthesia. Half of them were VVR during apheresis. DAE occurred only in first-time donors and more in severe illnesses such as using ventilation and ECMO. From the donor characteristics and variable selection, the risk factors are as follows: younger age, female, the severity of disease at the time of the disease, and lower SBP before initiation. Our DAE incidence did not differ from previous studies. DAEs were more likely to occur in CCP apheresis than in healthy donors. CONCLUSION: We confirm the safety of CCP apheresis in this study, although DAEs were more than healthy donors. More caution should be exercised in the plasma collection for future outbreaks of emerging infectious diseases.

A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient's condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren's syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient's autoimmune reactions.

A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome.

BACKGROUND Guillain-Barre syndrome (GBS) is an autoimmune condition that presents as weakness, numbness, paresthesia, and areflexia. GBS may occur following infection or vaccination. The pathogenesis of GBS is characterized by inflammatory infiltrates and segmental demyelination. The mechanism of GBS following COVID-19 vaccination is hypothesized to arise from an autoimmune-mediated mechanism leading to an increase in inflammatory cytokines. While there were no reported cases of GBS during the mRNA COVID-19 vaccination clinical trials, there have been a few case reports of GBS following COVID-19 vaccination. CASE REPORT We report a case of symmetric weakness and paresthesia that began 3 days after the patient received his first dose of the Moderna COVID-19 vaccine. Cerebrospinal fluid (CSF) studies demonstrated albuminocytologic dissociation. The combination of the patient's CSF findings and clinical symptoms was concerning for Guillain-Barre syndrome. Given the clinical findings 3 days following COVID-19 vaccination, there was a high concern for COVID-19 vaccine-induced GBS. The patient was treated with IVIG followed by plasmapheresis but failed to show significant improvement from either treatment. CONCLUSIONS Our case report demonstrates occurrence of GBS soon after the patient received the COVID-19 Moderna vaccine. Although rare, there is some evidence to support an association between COVID-19 vaccination and GBS, but this is generally limited to case reports and case series. Clinicians, however, should remain vigilant to mitigate potential risks, such as autonomic dysfunction, respiratory failure, permanent disability, and death in patients who develop GBS after vaccination.

"Side effects of Vero cell vaccination against Covid-19 among medical students of Nepalgunj Medical College"-A Post Vaccination survey (preprint)

Background: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) is a highly transmissible virus causing Coronavirus disease (COVID-19). Its key symptoms include fever, dry cough, and shortness of breath. Vaccine plays a significant role in controlling infectious disease, and reduction of the use of health service leaving more resources for the treatment of other diseases.2 Vero Cell is an inactivated vaccine against COVID-19 manufactured by Sinopharm Company of China and recommended for people above 18 years by the World Health Organization. It is administered in two doses of 0.5 ml, 14-28 days apart. Methods and findings: A prospective cross-sectional study was conducted among undergraduate medical students and intern doctors of Nepalgunj Medical College after receiving ethical approval from the institutional review committee of this college. Demographic features of the study population and the frequency and percentages of side effects among the population who received the vaccines were calculated along with the duration of symptoms. All undergraduate medical students and intern doctors of Nepalgunj Medical College who received two doses of the Vero Cell vaccine against COVID-19 were involved in the study. Those who failed to give written consent and those who were not willing to receive both doses of vaccine were excluded. Data were collected using a self-administered structured questionnaire. The eligible participants were provided with the questionnaire twice, after administration of each dose of vaccine. Collected data were entered in structured Pro-forma and analyzed statistically in Microsoft Excel 2019 MSO (Version 2021). About 75% of the participants had one or more symptoms after the first dose of the vaccine, which reduced to 62% after the second dose. Symptoms were more in males after the first dose (76% vs. 72%), but the reverse was seen after the second dose (54% vs. 77%). Pain at the injection site was the most commonly reported side effect (27%) followed by myalgia (20%). No individuals receiving both doses of vaccine had diarrhea, difficulty in breathing, tingling sensation, or anaphylactic reaction. A higher percentage of females experienced pain at the injection site after the second dose over the first than males. However, males experienced fatigue more than females after every dose. Pain at the injection site and Myalgia were common symptoms to start early, within 12 hours post-vaccination. However, fatigue was seen maximally 24 hrs post-vaccination. Fever was seen in 7% of participants within 12 hours of vaccination. Cough and sore throat as side effects persisted up to 2 weeks after vaccination. The main limitation of the study is the low sample size. Conclusions: Pain at the injection site was the most common AEFI followed by Myalgia with other insignificant effects. There were no life-threatening side effects. A larger study on the general population including all age groups is highly recommended to detect all spectrum of side effects.

Clinical Characteristics of Hospital Follow-up for Patients Hospitalized from SARS CoV-2 (COVID 19) in an Academic Outpatient Internal Medicine Clinic.

BACKGROUND: As of July 2022, there have been more than 91.3 million cases of COVID-19 and nearly 1.03 million deaths in the United States alone. In addition, many people who survived COVID-19 had long-term symptoms, such as fatigue, dyspnea, loss of smell and taste, depression, and anxiety. OBJECTIVES: The purpose of our study is to evaluate the status of COVID-19 patients who were previously hospitalized. METHODS: We conducted a single-center retrospective cohort study at Texas Tech University Health Sciences Center and its affiliated University Medical Center under IRB of L21-144. We included all patients hospitalized for COVID-19 and followed up in our Internal Medicine Clinic at any time between April 1, 2020, and April 1, 2021, and reviewed follow-up data for these patients after discharge. RESULTS: A total of 128 patients were included; 59 (46%) were men, and 69 (54%) were women with an average age of 59.7 ± 14.8 years. Most of the patients (n = 78, 60.9%) identified their race as Hispanic or Latino origin; the next largest group was Caucasian (n = 29, 22.65%). The average number of days until post-hospitalization follow-up was 36 ± 38 days. The 50% of the patients (n = 64) used telemedicine for follow-up visits. Important comorbidities in these patients included diabetes (n = 84, 65.6%) and hypertension (n = 94, 73.4%). Thirty-four patients (26.6%) reported respiratory symptoms at their follow-up appointments, 24 patients (18.8%) reported constitutional symptoms, 12 patients (9.4%) reported GI symptoms, and 25 patients (19.5%) reported other symptoms, such as paresthesia, lower extremity edema, or psychological symptoms. After hospital discharge, 54 patients had follow-up chest x-rays, and 41 (75.9%) still had abnormal findings consistent with COVID-19 imaging characteristics. Follow-up laboratory tests identified 44 patients (77.2%, 57 tested) with elevated D-dimer levels, 44 patients (78.6%, 56 tested) with high ferritin levels, and 21patients (35.6%, 59 tested) with elevated troponin T HS levels. CONCLUSION: Long-lasting COVID-19 symptoms in these patients included respiratory symptoms (26.6%), constitutional symptoms (18.8%), GI symptoms (9.4%), and other symptoms, such as paresthesia, lower extremity edema, or psychological symptoms (19.5%). The rate of telehealth follow-up was 50%. Many patients had elevated inflammatory markers that will need follow up to determine the clinical implications.

Vaso-occlusive Pain Crisis Mimicking Mandibular Abscess in an Adolescent with Sickle Cell Disease.

In people with sickle cell disease (SCD), oral abscesses are concerning clinical conditions and carry a high risk of postoperative sickle cell complications. We present an unusual case of a 14-year-old girl with SCD whose initial presentation of facial swelling, headaches, jaw pain, and paresthesia mimicked an odontogenic abscess. She was diagnosed with vaso-occlusive crisis in the mandibular bone and successfully managed noninvasively. This is among the youngest cases of paresthesia in the lower lip in SCD, which provided a clue that postponing invasive aspiration or biopsy was possible under empiric antibiotics and close observation.

Bilateral facial palsy with paresthesias, variant of Guillain-Barré syndrome following COVID-19 vaccine: A case series of 9 patients.

Several cases of Guillain-Barré Syndrome (GBS) associated with COVID-19 vaccination have been reported, including the rare subtype known as Bilateral Facial Palsy with paresthesias (BFP). To date, it is not known whether a causal relationship may exist between the two. We report 9 cases of BFP in patients vaccinated against COVID-19 in the previous month. Nerve conduction studies revealed demyelinating polyneuropathy in 4 patients, and 5 presented bilateral, focal facial nerve involvement, exclusively. Ganglioside antibody panel was positive in 4 patients (anti-GM1=2, anti-GD1a=1 and anti-sulfatide=1). Seven patients received intravenous immunoglobulin treatment, one plasma exchange, and one patient died from sudden cardiac arrest following arrhythmia before treatment could be administered. Rates of BFP following COVID-19 vaccination, did not differ from those reported in previous series. Epidemiological studies are essential to determine whether a causal relationship may exist between this rare form of GBS and COVID-19 vaccination.

Loss of Taste as an Initial Symptom of a "Facial Diplegia and Paresthesia" Variant of Guillain-Barré Syndrome.

Loss of taste is a relatively common symptom of coronavirus disease 2019 (COVID-19) and has also been considered a rare Guillain-Barré syndrome (GBS) symptom. We herein report a case of a facial diplegia and paresthesia (FDP) variant of GBS that initially presented as a loss of taste occurring two weeks after COVID-19 mRNA vaccination. The patient recovered completely after intravenous immunoglobulin therapy. Clinicians should consider the possibility of post-vaccination FDP manifesting as facial palsy and should be aware that GBS, including the FDP variant, can initially present as an isolated loss of taste.

Bilateral facial palsy after COVID-19 vaccination.

Guillain-Barrè syndrome (GBS) is an acute immune-mediated neuropathy, possibly triggered by a recent infection or vaccination, and driven by an immune attack targeting the peripheral nervous system. GBS typically leads to ascending limb weakness, often with sensory and cranial nerve involvement 1-2 weeks after immune stimulation, but emergency and neurology physicians should be aware of its important clinical heterogeneity. In rare cases, bilateral facial nerve palsy can be the main clinical manifestation, as the case of the variant formerly known as bilateral facial weakness with paresthesias. An increasing number of case reports of GBS in patients receiving COVID-19 vaccination have been reported both during the pre-clinical phase and after large-scale authorities' approval. We report two cases of bifacial palsy with paresthesias, a rare variant of GBS, both occurring after the first dose of COVID-19 vaccine Vaxzevria™ (formerly COVID-19 vaccine AstraZeneca), showing a favorable outcome after high-dose immunoglobulin therapy, and discuss the literature of GBS post-COVID-19 vaccination.

Neuromuscular complications after COVID-19 vaccination: a series of eight patients.

BACKGROUND: Several neurologic complications have been reported in close temporal association with both severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and following vaccination against SARS-CoV-2. Specifically, several cases of Guillain-Barré syndrome (GBS) have been reported in temporal relationship with COVID-19 vaccination, with two small case series describing a specific phenotype with bifacial weakness and paresthesia in the limbs. METHODS: We retrospectively collected patients who developed a new-onset neuromuscular disorder in the first 6 weeks after receiving a COVID-19 vaccine (either first or second dose). The patients were collected from one tertiary care centre and one secondary care centre from February to July 2021. RESULTS: We report eight patients who developed phenotypically diverse neuromuscular disorders in the weeks following COVID-19 vaccination, with a presumed immune-mediated etiology. In our case series, we report three patients with classical GBS, one patient with bifacial weakness with paresthesia variant of GBS, two patients with subacute-onset chronic inflammatory demyelinating polyneuropathy (CIDP), one patient with brachial plexopathy and one patient with subacute axonal sensorimotor polyneuropathy. CONCLUSIONS: New-onset neuromuscular disorders with onset in the weeks after COVID-19 vaccination can include diverse phenotypes. A causal relationship between these disorders and the vaccine cannot be proven at present, and further epidemiological studies are needed to further investigate this association.

Neuropathic symptoms with SARS-CoV-2 vaccination (preprint)

Background and Objectives: Various peripheral neuropathies, particularly those with sensory and autonomic dysfunction may occur during or shortly after acute COVID-19 illnesses. These appear most likely to reflect immune dysregulation. If similar manifestations can occur with the vaccination remains unknown. Results: In an observational study, we studied 23 patients (92% female; median age 40years) reporting new neuropathic symptoms beginning within 1 month after SARS-CoV-2 vaccination. 100% reported sensory symptoms comprising severe face and/or limb paresthesias, and 61% had orthostasis, heat intolerance and palpitations. Autonomic testing in 12 identified seven with reduced distal sweat production and six with positional orthostatic tachycardia syndrome. Among 16 with lower-leg skin biopsies, 31% had diagnostic/subthreshold epidermal neurite densities ([≤]5%), 13% were borderline (5.01-10%) and 19% showed abnormal axonal swelling. Biopsies from randomly selected five patients that were evaluated for immune complexes showed deposition of complement C4d in endothelial cells. Electrodiagnostic test results were normal in 94% (16/17). Together, 52% (12/23) of patients had objective evidence of small-fiber peripheral neuropathy. 58% patients (7/12) treated with oral corticosteroids had complete or near-complete improvement after two weeks as compared to 9% (1/11) of patients who did not receive immunotherapy having full recovery at 12 weeks. At 5-9 months post-symptom onset, 3 non-recovering patients received intravenous immunoglobulin with symptom resolution within two weeks. Conclusions: This observational study suggests that a variety of neuropathic symptoms may manifest after SARS-CoV-2 vaccinations and in some patients might be an immune-mediated process.

Acute transverse myelitis progressing to permanent quadriplegia following COVID-19 infection.

As of January 2022, there have been over 350 million confirmed cases of COVID-19 in the world. The most common symptoms in those infected are fever, cough, malaise, and myalgia, however pulmonary, hematologic, gastrointestinal, renal, and neurologic complications have also been reported. Acute transverse myelitis (ATM) is an uncommon neurological syndrome characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory and autonomic impairment, and even paralysis. Etiologies are often unclear; however, potential causes include infection, neoplastic, drug or toxin induced, autoimmune, and acquired. Treatment for ATM primarily consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. ATM has rarely been reported as a complication of COVID-19 infections. A 43-year-old female presented to the emergency department for evaluation of progressive numbness and tingling in her legs ten days after developing upper respiratory symptoms from a COVID-19 infection. Physical examination and magnetic resonance imaging confirmed a diagnosis of ATM. During her hospital course, she experienced rapid progression of her paresthesias and developed complete loss of motor function in her upper and lower extremities. Within 48 hours after emergency department arrival, she required intubation due to worsening diaphragmatic and chest wall paralysis. Her treatment included a long-term steroid regimen and plasmapheresis, and unfortunately, she did not have any neurologic recovery. We present a very rare case of ATM progressing to complete quadriplegia following COVID-19 infection.

Post-COVID-19 bifacial weakness and paraesthesia: a case report.

OBJECTIVES: We present a patient with bifacial weakness and paraesthesia subtype of Guillain-Barré syndrome (GBS), which occurred 1 month after a SARS-CoV-2 infection. While GBS as complication of SARS-CoV-2 infection has been described many times, only a few cases of post-COVID-19 bifacial weakness and paraesthesia are known to date. RESULTS: A 59-year-old man presented with thoracoradicular pain, paraesthesias of hands and feet, as well as progressive bilateral facial palsy. Neurological examination revealed a hyporeflexia of his lower limbs and hypoaesthesia of his hands and feet. Clinical and electrophysiological findings as well as CSF analysis were consistent with bifacial weakness and paraesthesia. The patient's condition improved promptly after 5 days of intravenous immunoglobulin therapy. DISCUSSION: We suspect bifacial weakness and paraesthesia to be a possible post-infectious complication of COVID-19. Hence, it is a differential diagnosis of facial nerve palsy in association with SARS-CoV-2 infection. Considering the rarity of GBS and bifacial weakness and paraesthesia, it appears unlikely that bigger trials elucidating the causal relation between them and SARS-CoV-2 infection will be available in the future.

Scalp dysesthesia: a neuropathic phenomenon.

Scalp dysesthesia is an abnormal sensation of the scalp in the absence of cutaneous disease. It is characterized by a burning and/or itching sensation and can be related to a variety of neurogenic or psychogenic causes. This condition is extremely bothersome and is also common- especially among the geriatric population, in women, in patients with diabetes mellitus, and patients with psychiatric history. However, despite its prevalence in many populations, there are limited data about its causes and characteristics. Given its limited cutaneous manifestations, it is also easily misdiagnosed and an underrecognized cause of scalp pruritus in the dermatological community. Therefore, education on scalp dysesthesia is paramount to helping physicians identify and provide appropriate treatment for these patients. This review focuses predominantly on the neurogenic causes (with a brief review of psychogenic itch) of scalp dysesthesia and the therapeutics that have been found to be effective for this condition. Neurogenic causes of scalp dysesthesia occur with damage to the central or peripheral pathways of itch sensation, resulting in modification and heightened sensitivity of nerves that result in abnormal sensations in the absence of or out of proportion to external stimuli. A comprehensive review of etiologies is provided here, ranging from lesions to the central nervous system caused by cervical spine disease, trigeminal trophic syndrome, tumor, stroke, and multiple sclerosis, to small-fiber neuropathies caused by diabetes, brow lifts, keloid, and burn scarring. Recently, there have also been reports of scalp dysesthesias associated with post-infectious COVID-19. Treatment options tailored toward disease severity and different causes of disease will also be discussed. By elucidating the different mechanisms and therapeutic treatments of scalp dysesthesia, we hope to provide clinicians with the tools to identify and treat this condition as well as encourage further research into its etiologies and therapeutics.

[Isolated facial diplegia as an atypical variant of Guillain-Barre syndrome after suspected SARS-CoV-2 infection] / Diplejía facial aislada como variante atípica del síndrome de Guillain-Barré tras sospecha de infección por SARS-CoV-2.

Introduction: Since the SARS-CoV-2 pandemics began, multiple cases of Guillain-Barre syndrome secondary to COVID-19 have been described. Its typical presentation consists of the triad of paresthesia, ascending muscle weakness and areflexia, although there are several regional variants such as facial diplegia. Case presentation: Two weeks after a contact with a confirmed case of COVID-19, a 35-year-old woman presents with viral myopericarditis. Laboratory studies for autoimmune diseases come back negative, as well as multiple viral serologies. She presents anti-SARS-CoV-2 IgG, with negative PCR. A week after discharge she presents with palsy of both facial nerves, without other neurological abnormalities. She undergoes examination with cranial CT without findings, and an EMG which shows bilateral alteration of facial nerves. She refuses the performance of a lumbar puncture. Discussion: Facial diplegia can occur because of several illnesses, such as meningeal or brainstem tumors, infectious agents, Guillain-Barre syndrome, autoimmune diseases, trauma, metabolic causes or congenital causes. In our patient, having discarded other etiologies with imaging and analytical studies, the most probable cause is the Guillain-Barre syndrome. It is possibly secondary to SARS-CoV-2 infection given the presence of anti-SARS-CoV-2 IgG antibodies after contact with a confirmed case. Conclusion: This case supports the hypothesis that COVID-19 may trigger the Guillain-Barre syndrome, specifically as facial diplegia, which is an atypical variant that should be known to be early diagnosed and treated as part of this syndrome.

Introducción: Desde que se inició la pandemia por el SARS-CoV-2, se han descrito numerosos casos de síndrome de Guillain-Barré secundario a la COVID-19. Su presentación típica es la triada de parestesias, debilidad muscular ascendente y arreflexia, aunque hay diversas variantes regionales como la diplejía facial. Presentación del caso: Mujer de 35 años que, dos semanas después de un contacto estrecho con un caso confirmado de COVID-19, ingresa por miopericarditis probablemente viral, con estudio de autoinmunidad negativo, múltiples serologías virales negativas y positividad para IgG anti-SARS-CoV-2 con PCR negativa. Una semana tras el alta presenta paresia de ambos nervios faciales sin otras alteraciones neurológicas. Se realiza TAC craneal sin hallazgos y EMG que evidencia afectación bilateral de los nervios faciales. La paciente rechaza realización de punción lumbar Discusión: La diplejía facial puede ocurrir en el contexto de diversas patologías, como tumores meníngeos o troncoencefálicos, agentes infecciosos, síndrome de Guillain-Barré, patologías autoinmunes, traumatismos, causas metabólicas o causas congénitas. En el caso descrito tras descartar mediante pruebas de imagen y analíticamente el resto de etiologías, y dada la presentación clínica, permanece como causa más probable el síndrome de Guillain-Barré, posiblemente secundario a infección por SARS-CoV-2 dada la positividad de IgG anti-SARS-CoV-2 tras un contacto con un caso confirmado. Conclusión: Este caso apoya la hipótesis de que la COVID-19 puede desencadenar el síndrome de Guillain-Barré, específicamente en forma de diplejía facial, una variante atípica que se debe conocer para su identificación y manejo precoz como parte de este síndrome.

Disproportionality analysis of adverse neurological and psychiatric reactions with the ChAdOx1 (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in the United Kingdom (preprint)

ObjectiveThe information on neurologic or psychiatric adverse reactions to the COVID-19 vaccines is limited. Our objective was to examine the odds of neurological and psychiatric adverse reactions to BNT162b2 (Pfizer-BioNTech) and ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccines. MethodsWe analyzed all Adverse Vaccine Reaction reports to the United Kingdom Medicines and Healthcare products Regulatory Agency between December 9, 2020 and June 30, 2021 that mentioned the BNT162b2 or ChAdOx1 vaccines. We compared the rates of adverse neurological and psychiatric reactions with ChAdOx1 to those with BNT162b2. P-values were obtained by a Bonferroni-adjusted Z-test for proportions. ResultsAs of June 30, 2021, 53.2 M doses of ChAdOx1 and 46.1 M doses of BNT162b2 had been administered. We extracted information from 300,518 distinct reports. The number of individual adverse neurologic or psychiatric reaction reports were less than 200/M doses administered, except headache which was reported in 1,550 and 395 cases/M doses of ChAdOx1 and BNT162b2, respectively. Compared to BNT162b2, cerebral hemorrhagic or thrombotic events, headaches and migraines, Guillain-Barre syndrome and paresthesias, tremor and freezing, delirium, hallucinations, nervousness, poor sleep quality, and postural dizziness were more frequently reported with ChAdOx1. Reactions more frequently reported with BNT162b2 than ChAdOx1 were Bells palsy, facial paralysis, dysgeusia, anxiety, and presyncope or syncope. ConclusionSignificant differences in the neurologic and psychiatric adverse event profiles of the ChAdOx1 and BNT162b2 vaccines may exist, emphasizing the need for additional research. The beneficial and protective effects of the COVID-19 vaccines far outweigh the low potential risk of neurologic and psychiatric reactions.