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Bombardi LM, Almeida ACGD, Finsterer J, Scorza FA. Increased frequency and intensity of complicated migraine sans migraine after third BNT162b2 dose. Clinics (Sao Paulo) 2024; 79:100315. [PMID: 38479300 PMCID: PMC10950792 DOI: 10.1016/j.clinsp.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/19/2023] [Indexed: 03/23/2024] Open
Affiliation(s)
- Larissa M Bombardi
- Disciplina de Neurociência, Universiade Federal de São Paulo/Escola Paulista de Medicinal (UNIFESP/EPM), São Paulo, SP, Brazil
| | - Antonio-Carlos Guimaraes de Almeida
- Centro de Neurociências e Saúde da Mulher "Professor Geraldo Rodrigues de Lima", Escola Paulista de Medicina/Universidad Federal de São Paulo (EPM/UNIFESP), São Paulo, SP, Brazil
| | | | - Fulvio Alexandre Scorza
- Disciplina de Neurociência, Universiade Federal de São Paulo/Escola Paulista de Medicinal (UNIFESP/EPM), São Paulo, SP, Brazil
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Salai G, Ljubičić Đ, Novak R, Grgurević L. Benign fasciculation syndrome and migraine aura without headache as possible adverse events after BNT162b2 mRNA vaccination: a web-based survey. Croat Med J 2023; 64:430-435. [PMID: 38168524 PMCID: PMC10797237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
AIM To determine the characteristics of patients who experienced muscle fasciculations and migraine auras without headache after BNT162b2 immunization. METHODS In January 2022, we published a case report that described a 48-year-old female patient who experienced muscle twitching and migraine auras without headache following BNT162b2 immunization. A self-administered online survey was sent to people who had written to us and complained of similar symptoms described in the case report (N=20). RESULTS The survey was completed by 11 participants, of whom 10 reported muscle twitching following BNT162b2 immunization lasting a median of 14 (4-36.5) days. Five of these participants (50%) reported migraine auras without headache. Participants further reported on self-identified triggers that altered the intensity of their symptoms, such as anxiety or caffeine. Fifty percent of participants who got an acute SARS-CoV-2 infection (3/6) experienced increased muscle symptom intensity during the acute phase of the disease. CONCLUSION To the best of our knowledge, our survey is the first to summarize patients' experiences of these phenomena occurring after BNT162b2 immunization. It is important to note that no causal relationship between vaccination and these phenomena can be inferred.
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Affiliation(s)
| | | | | | - Lovorka Grgurević
- Grgurević, Department of Proteomics, University of Zagreb, School of Medicine, Šalata 2, 10000 Zagreb, Croatia,
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Ghaderi S, Mohammadi S, Heidari M, Sharif Jalali SS, Mohammadi M. Post-COVID-19 Vaccination CNS Magnetic Resonance Imaging Findings: A Systematic Review. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2023; 2023:1570830. [PMID: 37427078 PMCID: PMC10325882 DOI: 10.1155/2023/1570830] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/18/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023]
Abstract
Objective This systematic review aims to synthesize and analyze the available literature on central nervous system (CNS) magnetic resonance imaging (MRI) findings in individuals who have received COVID-19 vaccinations. Our objective is to enhance understanding of potential neurological side effects, inform clinical practice, and guide future research on the neurological implications of COVID-19 vaccination. Methods In this systematic review, we conducted a comprehensive search in PubMed, Scopus, and Web of Science from January 2020 to April 2023, using terms related to COVID-19 vaccination and CNS MRI findings. We evaluated the quality of the study, extracted relevant data, and included 89 eligible studies that covered various vaccines, demographics of patients, symptoms, and MRI findings to provide a thorough understanding of SARS-CoV-2 vaccination-related CNS problems. Results We investigated CNS MRI findings following COVID-19 vaccination across various vaccine types. Common diseases associated with post-vaccination CNS MRI findings included cerebral venous sinus thrombosis (CVST), vaccine-induced immune thrombotic thrombocytopenia (VITT), acute disseminated encephalomyelitis (ADEM), acute myelitis, autoimmune encephalitis (AE), and others. Patients presented with diverse onset symptoms and neurological manifestations. Abnormalities identified in CNS MRI findings included white matter (WM) hyperintensity. Our analysis offers a comprehensive overview of the current literature on post-vaccination CNS MRI findings. Discussion. We highlight a range of post-COVID-19 vaccination CNS MRI findings, including CVST, with a higher incidence in individuals receiving the ChAdOx1 (AstraZeneca) vaccine. Other notable observations include cases of ADEM, myelitis or transverse myelitis (TM), Guillain-Barré syndrome (GBS), and acute encephalopathy following COVID-19 vaccination. The incidence of these neurological complications is extremely rare, and the benefits of vaccination outweigh the risks. The reviewed studies were primarily case reports or case series, and thus large-scale epidemiological studies and controlled clinical trials are needed to better understand the underlying mechanisms and risk factors associated with these neurological complications following COVID-19 vaccination.
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Affiliation(s)
- Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrsa Heidari
- Department of Medical Science, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyedeh Shadi Sharif Jalali
- Department of Medical Physics, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Mohammadi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Jin L, Li Z, Zhang X, Li J, Zhu F. CoronaVac: A review of efficacy, safety, and immunogenicity of the inactivated vaccine against SARS-CoV-2. Hum Vaccin Immunother 2022; 18:2096970. [PMID: 35878789 DOI: 10.1080/21645515.2022.2096970] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
CoronaVac, also known as the Sinovac inactivated SARS-CoV-2 vaccine, has been widely implemented in combating the COVID-19 pandemic. We summarized the results of clinical trials and real-world studies of CoronaVac in this review. The overall efficacy for the prevention of symptomatic COVID-19 (before the emergence of variants of concern) using two doses of 3 μg CoronaVac was 67.7% (95% CI, 35.9% to 83.7%). Effectiveness in preventing hospitalizations, ICU admissions, and deaths was more prominent than that in preventing COVID-19. A third dose inherited the effectiveness against non-variants of concern and increased effectiveness against severe COVID-19 outcomes caused by omicron variants compared to two doses. Most adverse reactions were mild. Few vaccine-related serious adverse reactions have been reported. Moreover, three-dose regimen significantly increased the seroconversion levels of neutralizing antibodies against omicron as compared to two-dose regimen. This review of CoronaVac may provide a scientific basis for optimizing global immunization strategies.
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Affiliation(s)
- Lairun Jin
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Zhuopei Li
- School of Public Health, Nanjing Medical University, Nanjing, P.R. China
| | - Xiaoyin Zhang
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Jingxin Li
- National Health Commission (NHC) Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, P.R. China
| | - Fengcai Zhu
- School of Public Health, Southeast University, Nanjing, P.R. China.,National Health Commission (NHC) Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, P.R. China
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5
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Tepmongkol S, Suwanwela NC, Hirankarn N, Tangwongchai S, Vorasayan P, Sukprakun C, Siritaranon N, Kijpaisalratana N, Akarathanawat W, Chutinet A, Tantivatana J. Brain perfusion single photon emission computed tomography abnormality in MRI-negative stroke-like patients post COVID-19 vaccination. Medicine (Baltimore) 2022; 101:e31965. [PMID: 36451484 PMCID: PMC9704968 DOI: 10.1097/md.0000000000031965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Stroke-like symptoms after COVID-19 vaccination was thought to be functional if there was no anatomical image abnormality. We aimed to analyze brain perfusion changes in these patients. A case-control study of brain perfusion single photon emission computed tomography (SPECT) of 12 vaccinated patients with left-sided stroke-like symptoms were compared with 12 age- and gender-matched normal interictal brain SPECTs using voxel-based analysis. Significant hyperperfusion was seen on the right side in postcentral, inferior parietal, mid temporal, parahippocampal, and caudate regions, and on the left side in the thalamus, hippocampus, and mid temporal areas. In addition, there were hypoperfused bilateral superior frontal gyri and right mid/posterior cingulate cortex (Family-wise-error corrected p-values < .05). Both hypoperfusion and hyperperfusion in the brain are demonstrated. We hypothesize that these findings might be the result of the functional neurological disorder. However, based on other previous studies, circulating spike protein in the patients' plasma early after vaccination might also be the cause.
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Affiliation(s)
- Supatporn Tepmongkol
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn University Biomedical Imaging Group (CUBIG), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * Correspondence: Supatporn Tepmongkol, Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Rd., Pathumwan, Bangkok 10330, Thailand (e-mail: )
| | - Nijasri C. Suwanwela
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Comprehensive Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Nattiya Hirankarn
- Center of Excellence in Immunology and Immune-mediated Diseases, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sookjaroen Tangwongchai
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pongpat Vorasayan
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Comprehensive Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chanan Sukprakun
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natakorn Siritaranon
- Division of Nuclear Medicine, Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Naruchorn Kijpaisalratana
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Chulalongkorn Comprehensive Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wasan Akarathanawat
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Comprehensive Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Aurauma Chutinet
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Comprehensive Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jarturon Tantivatana
- Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Good recovery of immunization stress-related responses presenting as a cluster of stroke-like events following CoronaVac and ChAdOx1 vaccinations. PLoS One 2022; 17:e0266118. [PMID: 36006991 PMCID: PMC9409494 DOI: 10.1371/journal.pone.0266118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background Immunization stress-related responses presenting as stroke-like symptoms could develop following COVID-19 vaccination. Therefore, this study aimed to describe the clinical characteristics of immunization stress-related responses causing stroke-like events following COVID-19 vaccination in Thailand. Methods We conducted a retrospective study of the secondary data of reported adverse events after COVID-19 immunization that presented with neurologic manifestations. Between March 1 and July 31, 2021, we collected and analyzed the medical records of 221 patients diagnosed with stroke-like symptoms following immunization. Two majority types of vaccines were used at the beginning of the vaccination campaign, including CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca). Demographic and medical data included sex, age, vaccine type, sequence dose, time to event, laboratory data, and recovery status as defined by the modified Rankin score. The affected side was evaluated for associations with the injection site. Results Overall, 221 patients were diagnosed with immunization stress-related responses (stroke-like symptoms) following CoronaVac (Sinovac) or ChAdOx1 (AstraZeneca) vaccinations. Most patients (83.7%) were women. The median (interquartile range) age of onset was 34 (28–42) years in patients receiving CoronaVac and 46 (33.5–60) years in those receiving ChAdOx1. The median interval between vaccination and symptom onset for each vaccine type was 60 (16–960) min and 30 (8.8–750) min, respectively. Sensory symptoms were the most common symptomology. Most patients (68.9%) developed symptoms on the left side of the body; 99.5% of the patients receiving CoronaVac and 100% of those receiving ChAdOx1 had a good outcome (modified Rankin scores ≤2, indicating slight or no disability). Conclusions Immunization stress-related responses presenting as stroke-like symptoms can develop after COVID-19 vaccination. Symptoms more likely to occur on the injection side are transient (i.e., without permanent pathological deficits). Public education and preparedness are important for administering successful COVID-19 vaccination programs.
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Ozdede A, Guner S, Ozcifci G, Yurttas B, Toker Dincer Z, Atli Z, Uygunoğlu U, Durmaz E, Uçar D, Uğurlu S, Saip S, Tabak F, Hamuryudan V, Seyahi E. Safety of SARS-CoV-2 vaccination in patients with Behcet’s syndrome and familial Mediterranean fever: a cross-sectional comparative study on the effects of M-RNA based and inactivated vaccine. Rheumatol Int 2022; 42:973-987. [PMID: 35376962 PMCID: PMC8977433 DOI: 10.1007/s00296-022-05119-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023]
Abstract
Most of the published data relate to classical forms of rheumatic diseases (RD) and information on rare inflammatory disorders such as Behçet’s syndrome (BS) and familial Mediterranean fever (FMF) is limited. We studied the frequency of side effects and disease flares after COVID-19 vaccination with either Pfizer/BioNTech or Sinovac/CoronaVac in 256 patients with BS, 247 with FMF, and 601 with RD. Telephone interviews were conducted using a questionnaire survey in a cross-sectional design in patients with BS, FMF, and RD followed by a single university hospital. Study participants were vaccinated either with CoronaVac (BS:109, FMF: 90, and RD: 343,) or BioNTech (BS: 147, FMF: 157 and RD: 258). The majority have received double dose (BS: 94.9%, FMF 92.3% and RD: 86.2%). BioNTech ensured a significantly better efficacy than CoronaVac against COVID-19 in all patient groups (BS: 1.4% vs 10.1%; FMF: 3.2% vs 12.2%, RD:2.7% vs 6.4%). Those with at least one adverse event (AE) were significantly more frequent among those vaccinated with BioNTech than those with CoronaVac (BS: 86.4% vs 45%; FMF: 83.4% vs 53.3%; and RD: 83.3% vs 45.5%). The majority of AEs were mild to moderate and transient and this was true for either vaccine. There were also AEs that required medical attention in all study groups following CoronaVac (BS: 5.5%, FMF: 3.3%, and RD:2.9%) or BioNTech (BS: 5.4%, FMF: 1.9%, and RD: 4.7%). The main causes for medical assistance were disease flare and cardiovascular events. Patients with BS (16.0%) and FMF (17.4%) were found to flare significantly more frequently when compared to those with RD (6.0%) (p < 0.001). This was true for either vaccine. BS patients reported mainly skin-mucosa lesions; there were however, 11 (4.3%) who developed major organ attack such as uveitis, thrombosis or stroke. Flare in FMF patients were associated mainly with acute serositis with or without fever. Arthralgia/arthritis or inflammatory back pain were observed mainly in the RD group. Our study demonstrates that BS and FMF patients vaccinated with either CoronaVac or BioNTech demonstrated similar AE profile and frequency compared to RD patients. AEs that required physician consultation or hospitalization occurred in all study groups after either CoronaVac or BioNTech. Increased frequency of flares in BS and FMF compared to that seen in RD might reflect defects in innate immunity and deserves further investigation. Caution should be required when monitoring these patients after vaccination.
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Affiliation(s)
- Ayse Ozdede
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Guner
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Guzin Ozcifci
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, USA
| | - Berna Yurttas
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Toker Dincer
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Atli
- Biostatistics and Informatics, Department of Accounting and Taxation, Sinop University, Sinop, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eser Durmaz
- Department of Cardiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Didar Uçar
- Department of Ophthalmology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Uğurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabahattin Saip
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fehmi Tabak
- Department of Infectious Disease and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Suwanwela NC, Kijpaisalratana N, Tepmongkol S, Rattanawong W, Vorasayan P, Charnnarong C, Tantivattana J, Roongruang S, Ongphichetmetha T, Panjasriprakarn P, Chutinet A, Akarathanawat W, Saver JL. Prolonged migraine aura resembling ischemic stroke following CoronaVac vaccination: an extended case series. J Headache Pain 2022; 23:13. [PMID: 35062869 PMCID: PMC8777408 DOI: 10.1186/s10194-022-01385-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Background After the initiation of the COVID-19 vaccination program in Thailand, thousands of patients have experienced unusual focal neurological symptoms. We report 8 patients with focal neurological symptoms after receiving inactivated virus vaccine, CoronaVac. Case series Patients were aged 24–48 years and 75% were female. Acute onset of focal neurological symptoms occurred within the first 24 h after vaccination in 75% and between 1-7d in 25%. All presented with lateralized sensory deficits, motor deficits, or both, of 2–14 day duration. Migraine headache occurred in half of the patients. Magnetic resonance imaging of the brain during and after the attacks did not demonstrate any abnormalities suggesting ischemic stroke. All patients showed moderately large regions of hypoperfusion and concurrent smaller regions of hyperperfusion on SPECT imaging while symptomatic. None developed permanent deficits or structural brain injury. Discussions Here, we present a case series of transient focal neurological syndrome following Coronavac vaccination. The characteristic sensory symptoms, history of migraine, female predominant, and abnormal functional brain imaging without structural changes suggest migraine aura as pathophysiology. We propose that pain related to vaccine injection, component of vaccine, such as aluminum, or inflammation related to vaccination might trigger migraine aura in susceptible patients. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01385-0.
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Salai G, Bilic E, Primorac D, Lakusic DM, Bilic H, Lazibat I, Grgurevic L. Benign Fasciculation Syndrome and Migraine Aura without Headache: Possible Rare Side Effects of the BNT162b2 mRNA Vaccine? A Case Report and a Potential Hypothesis. Vaccines (Basel) 2022; 10:vaccines10010117. [PMID: 35062778 PMCID: PMC8780563 DOI: 10.3390/vaccines10010117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Grgur Salai
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Teaching Institute of Emergency Medicine of the City of Zagreb, 10000 Zagreb, Croatia
| | - Ervina Bilic
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (E.B.); (D.M.L.); (H.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Dragan Primorac
- St. Catherine Specialty Hospital, 10000 Zagreb, Croatia;
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Eberly College of Science, The Pennsylvania State University, University Park, PA 16802, USA
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT 06516, USA
- Medical School, University of Split, 21000 Split, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Medical School, University of Rijeka, 51000 Rijeka, Croatia
- Medical School REGIOMED, 96450 Coburg, Germany
| | - Darija Mahovic Lakusic
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (E.B.); (D.M.L.); (H.B.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Hrvoje Bilic
- Department of Neurology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia; (E.B.); (D.M.L.); (H.B.)
| | - Ines Lazibat
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
- Department of Neurology, Clinical Hospital Dubrava, 10000 Zagreb, Croatia
| | - Lovorka Grgurevic
- Center for Translational and Clinical Research, Department of Proteomics, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence:
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Garces KN, Cocores AN, Goadsby PJ, Monteith TS. Headache After Vaccination: An Update on Recent Clinical Trials and Real-World Reporting. Curr Pain Headache Rep 2022; 26:895-918. [PMID: 36418848 PMCID: PMC9685066 DOI: 10.1007/s11916-022-01094-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to characterize headache as a vaccine adverse event (VAE) in clinical trials. RECENT FINDINGS Of the recent phase III vaccine RCTs (non-COVID-19), 53 studies reported on headache (13 infectious agents). The median rate (interquartile range) of headache was 15.6% (IQR: 9.6-37.6%). Of these, 24.5% of the RCTs reported headache greater in the vaccine group compared to the placebo/control group. In the herpes zoster vaccination trials, headache was more common in all active groups: median rate 33.9% (IQR: 29.7-40.5%) as compared to placebo: median rate 17.7% (IQR: 15.4-23.8%). Influenza and HPV vaccination trials were the 2nd and 3rd most common to have headache as a VAE. Of the 6 widely distributed COVID-19 vaccinations, median rate of post-vaccination headache was 39% (IQR: 28-50%). Headache is a common VAE in vaccine trials. Standardized grading methods, predictors of persistence, and treatment regimens are warranted.
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Affiliation(s)
- Kimberly N. Garces
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Alexandra N. Cocores
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
| | - Peter J. Goadsby
- NIHR King’s Clinical Research Facility & Headache Group-Wolfson CARD, King’s College London, London, UK ,Department of Neurology, University of California, Los Angeles, Los Angeles, CA USA
| | - Teshamae S. Monteith
- Division of Headache, Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL USA
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Lindner G, Ryser B. The syndrome of inappropriate antidiuresis after vaccination against COVID-19: case report. BMC Infect Dis 2021; 21:1000. [PMID: 34560836 PMCID: PMC8464133 DOI: 10.1186/s12879-021-06690-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise. CASE PRESENTATION A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved. CONCLUSIONS Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.
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Affiliation(s)
- Gregor Lindner
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland
| | - Basil Ryser
- Department of Internal and Emergency Medicine, Buergerspital Solothurn, Schoengruenstrasse 42, 4500, Solothurn, Switzerland.
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SARS-COV-2-vaccine-inactivated-Sinovac-Biotech. REACTIONS WEEKLY 2021. [PMCID: PMC8446179 DOI: 10.1007/s40278-021-02642-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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