Two Cases of Neurological Complications After mRNA Vaccination for COVID-19
Neurology
; 98(18 SUPPL), 2022.
Article
in English
| EMBASE | ID: covidwho-1925368
ABSTRACT
Objective:
We present two patients with neurological complications following COVID-19 mRNA vaccination.Background:
Post-vaccinal myelitis and demyelination is well described. We investigated two patients presenting inflammatory demyelination following mRNA based vaccination against COVID-19. Design/Methods:
Patients were referred to the treating neurologist for a second opinion as possible cases of multiple sclerosis. Clinical neurological evaluation, MRI imaging of brain and spine as well as serum and cerebrospinal fluid (CSF) analysis was performed.Results:
In case 1, the patient developed left-side numbness and difficulty walking six weeks post-second dose of the Moderna mRNA COVID-19 vaccine. She was found to have an enhancing thoracic cord lesion on MRIs, and CSF ELISA studies showed highly elevated IgG levels against the spike protein receptor-binding domain (S1-RBD) of COVID 19. In case 2, the patient began to hiccup and vomit, developed diplopia, and right-side weakness and numbness around two days post-second dose of the Moderna vaccine. MRIs showed two lesions on her brain and a C4 enhancing lesion on her spinal cord. CSF showed oligoclonal bands. However, further analysis of her spinal fluid showed highly elevated IgG antibodies to the S1-RBD.Conclusions:
Initially, case 1 was diagnosed with transverse myelitis and possible multiple sclerosis, and case 2 with multiple sclerosis. Both patients likely would have received long-term immunosuppressive therapy had vaccine complications not been suspected. The presence of CSF antibodies to the S1-RBD protein suggests an immune response to the mRNA COVID-19 vaccinations crossing over to the CNS as the likely cause of these neurological complications. In patients developing acute neurological complaints in the period following vaccination, even with the presence of oligoclonal bands, CSF should be analyzed for reactivity against the S1-RBD. Further investigation is required to explain the mechanism of this response and subsequent complications. Both patients are clinically improving and will continue to be managed by a neurologist.
elasomeran; endogenous compound; immunoglobulin G; immunoglobulin G antibody; messenger RNA; oligoclonal band; virus spike protein; adult; case report; central nervous system; cerebrospinal fluid; cerebrospinal fluid analysis; clinical article; clinical evaluation; complication; conference abstract; coronavirus disease 2019; crossing over; demyelination; diplopia; enzyme linked immunosorbent assay; female; gene expression; hiccup; human; human tissue; hypesthesia; immune response; immunoglobulin blood level; immunosuppressive treatment; multiple sclerosis; myelitis; neuroimaging; neurologic disease; neurological complication; neurologist; nuclear magnetic resonance imaging; protein domain; receptor binding; spine; thoracic spinal cord; transverse myelitis; vaccination; vaccination reaction; walking difficulty; weakness
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Collection:
Databases of international organizations
Database:
EMBASE
Topics:
Vaccines
Language:
English
Journal:
Neurology
Year:
2022
Document Type:
Article
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