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Brain magnetic resonance imaging (MRI) findings. FLAIR hyperintensity involving the frontal white matter, with the largest lesion on the left side (A: axial view, B: sagittal view) and the ipsilateral superior cerebellar peduncle (C: axial view, D: sagittal view). Abbreviations: FLAIR, Fluid attenuated inversion recovery.
Source publication
Several central and peripheral nervous system complications associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection have been recently described. An effective mass vaccination program is necessary to effectively reduce infection spread and, consequently, limit long-term sequelae, including those affecting the nervou...
Contexts in source publication
Context 1
... gait (scale for the assessment and rating of ataxia [SARA] score: 7). Meningeal signs were negative. Brain MRI showed an area of hyperintensity on fluid attenuated inversion recovery (FLAIR) sequences involving the left cerebellar peduncle, with modest mass effect on the fourth ventricle, which was not present on the previous MRI examination (Fig. 2). No contrast enhancement was observed and the lesion did not exhibit diffusion restriction. In addition, new supratentorial areas of hyperintensity on FLAIR sequences were observed, the largest in the left centrum semiovale (Fig. 2). No lesions in the corpus callosum were detected. Control EEG showed no abnormalities. CSF cell count, ...
Context 2
... peduncle, with modest mass effect on the fourth ventricle, which was not present on the previous MRI examination (Fig. 2). No contrast enhancement was observed and the lesion did not exhibit diffusion restriction. In addition, new supratentorial areas of hyperintensity on FLAIR sequences were observed, the largest in the left centrum semiovale (Fig. 2). No lesions in the corpus callosum were detected. Control EEG showed no abnormalities. CSF cell count, glucose, and protein levels were within reference ranges. Oligoclonal bands were searched in serum and CSF by isoelectric focusing, with negative results (type 1 pattern). Microbiological studies (including HSV, VZV, HHV6, EBV, CMV, ...
Context 3
... gait (scale for the assessment and rating of ataxia [SARA] score: 7). Meningeal signs were negative. Brain MRI showed an area of hyperintensity on fluid attenuated inversion recovery (FLAIR) sequences involving the left cerebellar peduncle, with modest mass effect on the fourth ventricle, which was not present on the previous MRI examination (Fig. 2). No contrast enhancement was observed and the lesion did not exhibit diffusion restriction. In addition, new supratentorial areas of hyperintensity on FLAIR sequences were observed, the largest in the left centrum semiovale (Fig. 2). No lesions in the corpus callosum were detected. Control EEG showed no abnormalities. CSF cell count, ...
Context 4
... peduncle, with modest mass effect on the fourth ventricle, which was not present on the previous MRI examination (Fig. 2). No contrast enhancement was observed and the lesion did not exhibit diffusion restriction. In addition, new supratentorial areas of hyperintensity on FLAIR sequences were observed, the largest in the left centrum semiovale (Fig. 2). No lesions in the corpus callosum were detected. Control EEG showed no abnormalities. CSF cell count, glucose, and protein levels were within reference ranges. Oligoclonal bands were searched in serum and CSF by isoelectric focusing, with negative results (type 1 pattern). Microbiological studies (including HSV, VZV, HHV6, EBV, CMV, ...
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There have been a growing number of acute disseminated encephalomyelitis cases following coronavirus disease-19 (COVID-19) infection. Given the rare occurrence, studies eliciting the clinical features, treatment response, and outcomes are still limited. In patients recovering from COVID-19, multifocal neurologic symptoms in the presence or absence...
Citations
... VITT is related to autoantibody generation against platelet factor four (PF4), with all the confirmed cases showing raised titers and the patients phenotypically demonstrating thrombosis in various sites. Other known, but relatively less common, adverse events are transverse myelitis, superior ophthalmic vein thrombosis, acute disseminated encephalomyelitis, multiple sclerosis, neuromyelitis optica, hemorrhagic stroke, and ischemic stroke, etc. 41,42,[58][59][60][61][62][63][64][65][66][67][68] ...
The World Health Organization has declared “with great hope” an end to COVID-19 as a public health emergency. The vaccination drive that started in December 2020 played a crucial role in controlling the pandemic. However, the pace at which COVID-19 vaccines were developed and deployed for general population use led to vaccine hesitancy, largely owing to concerns regarding the safety and efficacy of the vaccines. Radiology has been instrumental in demonstrating the extent of pulmonary involvement and identification of the complications of COVID-19, and the same holds true for vaccine-related complications. This review summarizes the existing body of radiological literature regarding the efficacy, adverse events, and imaging pitfalls that accompany the global rollout of various COVID-19 vaccines.
... The median interval between vaccination and symptom onset was 13 days (range: 0-75 days) [4]. Cases of acute transverse myelitis, as well as cases of acute disseminated encephalomyelitis have been described in the literature [5][6][7]. During post market surveillance, only a few cases of facial palsy following COVID-19 vaccination have been described [8,9]. ...
... Conversely, little has been done to gather information on central nervous system (CNS) adverse events of COVID-19 vaccination for which only isolated case reports and small case series exist (16)(17)(18)(19)(20)(21), despite the fact that detailed assessments of potential neurological adverse events associated with COVID-19 vaccines as well as infection are urgently needed. ...
... Dashed lines = reference values. (18,30)) immune-mediated complications of COVID-19 was much higher (11), especially in the first waves of the pandemic, likely reflecting a protective role of vaccines not only in reducing SARS-CoV-2 infections, hospitalizations, and deaths but also neuroimmune disorders triggered by the infection itself (8). ...
... In addition, vaccination might also trigger the exacerbation of pre-existing, subclinical, neuroimmune disorders (36), similarly to what it was observed for other adverse events triggered by nonspecific T cell activation, such as those of ICIs (40,41). Finally, a temporal coincidence of the 2 events (vaccination and CNS immunemediated disorders) cannot be completely excluded considering the high global vaccination rates (18,36). ...
Background
COVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination.
Methods
Multicenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis.
Results
Nineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2.
Conclusion
CNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment.
... diffuse theta and delta slowing and no posterior dominant rhythm49 ; significant generalised background slowing in the left hemisphere with sharp waves 52 ; increased widespread slow waves accompanied by sharp waves52 ; and intermittent slowing in the delta range, predominantly over the fronto-temporal regions56 ...
A number of different neurological complications have been reported following vaccination against the coronavirus disease 2019 (COVID‐19). Electroencephalogram (EEG) is one of the modalities used to evaluate the neurological complications of diseases. The aim of the present study was to identify the EEG changes in participants vaccinated against COVID‐19. PubMed, Scopus, Web of Science, medRxiv, and Google Scholar were searched up to 1 September 2022, with terms related to COVID‐19 vaccines, EEG, neurological signs/symptoms, or neurological disorders. All case reports and case series were included if the participants had received at least one dose of a COVID‐19 vaccine and a post vaccination EEG report was also reported. We used the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case reports and case series to appraise the methodological quality of the included studies. Thirty‐one studies were included, which were comprised of 24 case reports and seven case series and a total of 36 participants. Generalised slowing and non‐convulsive focal status epilepticus were the most common EEG findings post‐COVID‐19 vaccination. The most frequent symptoms were headache, fatigue, generalised weakness, and vomiting. In addition, the most common signs were encephalopathy, post‐ictal phases, and confusion. Encephalitis, acute disseminated encephalomyelitis, and post‐vaccinal encephalopathy were the most commonly diagnosed adverse events. Furthermore, most of the imaging studies appeared normal. The EEG reports mainly showed background slowing and epileptiform discharges, encephalitis, encephalopathies, and demyelinating disorders. Future studies with larger samples and more vaccine types may help to further unravel the potential neurological effects of COVID‐19 vaccinations on recipients.
... 9 Además, recientemente se ha encontrado asociación con la infección por SARS-COV-2 y post vacunación con la presentación de cuadros de encefalomielitis aguda diseminada. 10,11 ...
Resumen
Introducción
la encefalomielitis aguda diseminada es una enfermedad autoinmune y desmielinizante. Es rara en el adulto. Cuenta con tres variantes principales. Una de ellas es el síndrome de Weston Hurst, también conocido como leucoencefalitis hemorrágica aguda. El objetivo fue compartir la experiencia en el abordaje diagnóstico y terapéutico de esta rara enfermedad, así como hacer una revisión de la bibliografía actual, a fin de colaborar con el conocimiento de esta.
Caso clínico
mujer de 27 años con cuadro de infección respiratoria viral 2 semanas previas al desarrollo de síndrome neurológico caracterizado por parestesias, déficit motor, estatus epiléptico y encefalopatía aguda, el cual progresó a estado de coma y evidenció en resonancia magnética lesiones difusas hemorrágicas en sustancia blanca cerebral con desmielinización y edema periférico. Se inició tratamiento con esteroides por 5 días con mejora de síntomas, aunque persistió el déficit motor y sensitivo.
Conclusiones
la encefalomielitis aguda diseminada y la variante hemorrágica de esta son entidades raras, con una importante gama de diagnóstico diferencial, que deben ser identificadas y tratadas de forma rápida para evitar su letal o incapacitante desenlace.
... Yet in the meantime, vaccines may cause a vaccination-related attack by triggering a rogue autoimmune response. Clinical onset of CNS IDDs after COVID-19 vaccination were reported, such as MS [15,16], NMOSD, MOGAD [17], and other CNS IDDs [18][19][20]. Thus, it is necessary to assess the relapse rate subsequent to COVID-19 vaccinations administration in these relapsing autoimmune CNS demyelinating syndromes. ...
Objective
This study aims to evaluate the short-term safety of inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in Chinese patients with central nervous system inflammatory demyelinating diseases (CNS IDDs).
Methods
A web-based survey was conducted among patients with CNS IDDs from April 15 to 19, 2022 in China. In total, 645 patients with CNS IDDs were identified, including 425 patients with multiple sclerosis (MS), 194 with neuromyelitis optica spectrum disorder (NMOSD), and 26 with other CNS IDDs. The questionnaire consisted of demographic data, clinical records, history of SARS-CoV-2 vaccination, and vaccination-related symptoms within one month after vaccination. The demographic data, clinical information, and relapse rates between vaccinated and non-vaccinated patients were compared.
Results
Among 645 patients with CNS IDDs, 78 were vaccinated and 567 were non-vaccinated with the vaccination rate of 12.1 %. Compared to non-vaccinated group, a lower percentage of patients on DMDs therapy (41.0 % vs. 71.8 %, P < 0.001) and an increased proportion of patients with other vaccination in past 3 years (17.9 % vs. 4.8 %, P < 0.001) were observed in vaccinated group. Six patients experienced a relapse within 30 days of a vaccination. Additionally, vaccine-associated relapse rates in vaccinated patients did not significantly differ from these in non-vaccinated patients among 2020, 2021, and from January 1 to October 1, 2022.
Conclusions
No increased risk of vaccination-associated relapses among Chinese patients with CNS IDDs indicated that inactivated SARS-CoV-2 vaccines appear to be safe for this population.
... One patient with encephalopathy post-SARS-CoV-2 vaccination had elevated IL-6 in both serum and CSF, with elevated IL-8 only in the CSF [38]. Another patient who presented with rhomboencephalitis had elevated IL-8 in both serum and CSF, with elevated IL-10, IFN-g, and IL-6 in the CSF [39]. ...
Introduction
Neurological involvement can occur in patients with SARS-CoV-2 infections, resulting in coronavirus disease 2019 (COVID-19). Cytokine alterations are associated with neurological symptoms in COVID-19. We performed a review of cytokines in the cerebrospinal fluid (CSF) of patients with COVID-19.
Methods
Two reviewers independently searched PubMed for all relevant articles published prior to November 11, 2022. Active SARS-CoV-2 infection and CSF cytokine analyses were required for inclusion.
Results
Three-hundred forty-six patients with COVID-19 and 356 controls from 28 studies were included. SARS-CoV-2 PCR was positive in the CSF of 0.9% (3/337) of patients with COVID-19. Thirty-seven different cytokines were elevated in the CSF of patients with COVID-19 when compared to controls and the standards set forth by individual assays used in each study. Of the 37 cytokines, IL-6 and IL-8 were most commonly elevated. CSF IL-6 is elevated in 60%, and CSF IL-8 is elevated in 51% of patients with COVID-19.
Conclusion
Levels of several inflammatory cytokines are elevated in the CSF of patients with COVID-19, and SARS-CoV-2 PCR is often not isolated in the CSF of patients with COVID-19. Many patients with COVID-19 have neurological symptoms and given the cytokine elevations in the absence of detectable viral RNA in cerebrospinal fluid; further study of the CSF cytokine profiles and pathogenesis of neurological symptoms in COVID-19 is needed.
... Since the present patient's CSF showed a marked increase in IL-6, the involvement of a cytokine storm similar to COVID-19 might have caused severe cytokine-induced injury to the corpus callosum. In addition, genetic variants in Toll-like receptor 3 (although not confirmed in this case), which is important for the recognition of foreign RNA, might affect the risk of adverse events from an mRNA vaccine [15]. ...
Cytotoxic lesions of the corpus callosum (CLOCC) is a disease entity associated with reversible lesions of the corpus callosum on magnetic resonance imaging (MRI). CLOCC is caused by a variety of etiologies, but CLOCC after vaccination is extremely rare. Four prior cases of CLOCC after the first dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine have been reported; these were localized to the splenium and showed early clinical and neuroradiological recovery. We experienced an unusual case in which a heterogeneous COVID-19 booster vaccination caused rather severe CLOCC damage. A 74-year-old Japanese woman presented with ataxia, high fever, and hearing loss several days after her third vaccination against COVID-19. This booster was an mRNA-1273 while her first and second vaccinations were both BNT162b2 type. SARS-CoV-2 real-time reverse transcriptase polymerase chain reaction (RT-PCR) analysis was negative, but serum SARS-CoV-2 S-IgG antibodies were elevated. Her cerebrospinal fluid (CSF) showed an elevated cell count and high levels of protein and interleukin-6 (IL-6). Brain MRI showed CLOCC spreading throughout the body of the corpus callosum. After the exclusion of other potential causes, the diagnosis of vaccination-related CLOCC was made. Six months later, recovery of clinical and MRI findings remained incomplete. It was suggested that the patient's CLOCC might have been caused by the increase in CSF IL-6 due to an enhanced immune response from the heterogeneous vaccination, resulting in more severe damage to the corpus callosum than usual.
... В других случаях заболевание может развиваться после вакцинации от бешенства, кори, коклюша, столбняка, гриппа, гепатита В, дифтерии, краснухи, пневмококка, ветряной оспы, вируса папилломы человека, полиомиелита, SARS-CoV-2. Так, ОРЭМ иногда развивается через 8-21 день после вакцинации от бешенства [2,12,14,23]. ...
Acute disseminated encephalomyelitis is an acute autoimmune demyelinating disease that manifests as a widespread polyfocal asymmetric lesions of the central nervous system and, in some cases, optic nerves with the formation of corresponding neurological symptoms. This lecture presents basic information about acute disseminated encephalomyelitis with consideration of 5 clinical cases demonstrating the variety of manifestations of this disease in the practice of a neurologist.
Keywords: acute disseminated encephalomyelitis, myelin oligodendrocyte glycoprotein, multiple sclerosis, AQP-4
... Acute disseminated encephalomyelitis (ADEM) is an extremely rare complication of COVID-19 vaccination with few reports world wide. The link between ADEM and COVID-19 is well-established but only eight cases of suspected ADEM have been reported in association with COVID-19 vaccination [4][5][6][7][8][9][10][11]. ...
... The first case of ADEM was reported in China who developed neurological symptoms 2 weeks after the first dose of Sinovac and responded to intravenous immunoglobulin therapy [4]. Vogrig et al. reported a case of a 56-year-old female who developed progressive neurological deficits 2 weeks after vaccination with the "Pfizer" COVID-19 vaccine and was diagnosed as probable ADEM [5]. Shimizu [12]. ...
Background
Acute disseminated encephalomyelitis (ADEM) is an extremely rare complication of COVID-19 vaccination with very few reports worldwide. Concomitant peripheral nervous tissue involvement in ADEM is very uncommon.
Case presentation
We report the case of a 52 year aged lady who developed headache and focal neurological deficits after 10 days of COVID-19 vaccination. Her evaluation suggested ADEM with optic neuritis and mononeuritis multiplex. She responded to pulse methylprednisolone therapy.
Conclusions
COVID-19 vaccine may be associated with ADEM, optic neuritis and concurrent peripheral nervous system inflammation in rare instances.
