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Safan AS, Noorain Z, Atta MA, Thekkoth R, Suliman AM, Fadlelmula A, Abdelatey M. CASE REPORT: Fulminant acute hemorrhagic Leukoencephalitis (AHLE): A rare and ruinous outcome with cerebral herniation (COVID-19). eNeurologicalSci 2024; 35:100499. [PMID: 38628435 PMCID: PMC11019095 DOI: 10.1016/j.ensci.2024.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Background Acute hemorrhagic leukoencephalitis (AHLE) is a very rare demyelinating disease with rapid fulminant inflammation of the white matter. Although the exact etiology is unknown, AHLE usually manifests post a viral or bacterial infection and less often seen post vaccination for measles or rabies. AHLE has a very poor prognosis and a high mortality rate. Owing to the rarity of this entity there is not clear consensus on the proper line of management. In this report, we present a case of AHLE as a para-infectious sequel to COVID-19 in a young patient. Clinical presentation We report a 30-year-old turkish patient with an initial presentation of upper respiratory tract infection due to COVID-19. Initially, she was admitted to the hospital with generalized tonic-clonic seizure (GTCS) and deterioration in her level of consciousness lapsing into a coma. An initial CT scan showed diffuse brain edema and an MRI head confirmed the suspicion of Acute hemorrhagic leukoencephalitis (AHLE). Despite prompt and diligent osmotic therapy and pulsed intravenous (IV) methylprednisolone, her condition rapidly depreciated and progressed into cerebral edema with gravid sequela of brainstem herniation. Conclusions AHLE is a very rare entity and perhaps its fulminant debilitating course and high mortality should warrant further studies on disease pathophysiology and its optimal treatment parameters. Life-saving decompressive hemicraniectomy should be considered in the multidisciplinary approach of the management with tailored osmotic and immunotherapy.
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Affiliation(s)
- Abeer Sabry Safan
- Department of Neurology, Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Zeba Noorain
- Department of Neurology, Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A. Atta
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Razna Thekkoth
- Department of Emergency, Hamad Medical Corporation, Doha, Qatar
| | - Aasir M. Suliman
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Abdalrazig Fadlelmula
- Department of Medical intensive Critical care, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Abdelatey
- Department of Medical intensive Critical care, Hamad Medical Corporation, Doha, Qatar
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Lee KW, Yap SF, Amin-Nordin S, Ngeow YF. Cardiac and Neurological Complications Post COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series. Vaccines (Basel) 2024; 12:575. [PMID: 38932303 PMCID: PMC11209191 DOI: 10.3390/vaccines12060575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
Following mass vaccinations for the control of the COVID-19 epidemic, a spectrum of cardiac and neurological disorders was reported among vaccinated individuals. This study examined the range of complications documented and factors related to their occurrence. Three electronic databases were searched for case reports and case series with descriptions of cardiac and/or neurological complications in COVID-19 vaccine recipients. A total of 698 vaccinees were included in this review, of which 259 (37.1%) had cardiac and 439 (62.9%) had neurological complications. Inflammatory conditions were the commonest among the cardiac complications; while polyneuropathy, demyelinating diseases and cerebrovascular disorders were the more common neurological complications. The mean age of those with cardiac complications (33.8 years) was much younger than those with neurological complications (49.7 years). There was no notable difference in the gender distribution between these two groups of vaccine recipients. mRNA vaccines (all brands) were associated with almost 90.0% of the cardiac complications, whereas viral vector vaccines were associated with slightly over half (52.6%) of the neurological complications. With regard to the dose, cardiac complications were more common after the second (69.1%), whereas neurological complications were more common after the first dose (63.6%). The majority of the cases had an uncomplicated clinical course. Nevertheless, 5.9% of cases with neurological complications and 2.5% of those with cardiac complications were fatal, underscoring the significance of the consistent surveillance and vigilant monitoring of vaccinated individuals to mitigate these occurrences.
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Affiliation(s)
- Kai Wei Lee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (K.W.L.); (S.A.-N.)
| | - Sook Fan Yap
- Department of Pre-Clinical Sciences, M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43200, Selangor, Malaysia;
- Dr. Wu Lien-Teh Centre of Research in Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang 43200, Selangor, Malaysia
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (K.W.L.); (S.A.-N.)
| | - Yun Fong Ngeow
- Department of Pre-Clinical Sciences, M. Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang 43200, Selangor, Malaysia;
- Dr. Wu Lien-Teh Centre of Research in Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang 43200, Selangor, Malaysia
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Kalafatakis K, Margoni A, Liakou ME, Stenos C, Toulas P, Korkolopoulou P, Lakiotaki E, Lafazanos SA, Zekiou K, Kardara P, Terentiou A, Nikolaou G, Stouraitis G. Acute hemorrhagic leukoencephalitis following the first dose of BNT162b2 vaccine against SARS-CoV-2: A case report. Heliyon 2024; 10:e25545. [PMID: 38356507 PMCID: PMC10865252 DOI: 10.1016/j.heliyon.2024.e25545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
Acute hemorrhagic leukoencephalitis (AHLE), is a rare inflammatory demyelinating disorder, variant of acute disseminated encephalomyelitis. The diagnosis of AHLE remains challenging due to the rarity of the disease and the lack of a reliable biomarker. We report here a case of a 73-year-old male patient with a progressive, low-grade febrile confusional syndrome 20 days after receiving the first dose of BNT162b2 vaccine against SARS-CoV-2. Evidence indicative of the underlying condition by an extensive panel of imaging (brain magnetic resonance imaging, computed tomography and digital subtraction angiography), laboratory (complete blood count, biochemistry, coagulation, tests for autoimmune or infectious disorders, tumor markers, hormonal levels, cerebrospinal fluid analysis) and electrodiagnostic tests were scarce, and mainly non-specific. Sequential neuroimaging revealed the appearance of extensive T2 lesions (signs of gliosis) along with multiple hemorrhagic lesions at various cortical sites. The patient was treated with corticosteroids, discontinued due to severe adverse effects, and subsequently with sessions of plasmapheresis and monthly intravenous administration of cyclophosphamide. Considering the rapid aggravation of the patient's neurological status, the MRI findings of cortical lesions and the lack of response to any treatment, a biopsy of a frontal lobe lesion was conducted, confirming the presence of confluent, inflammatory-edematous lesions with scattered areas of necrosis and hemorrhage, and ultimately areas of demyelination, thus confirming the diagnosis of AHLE. After more than 5 months of hospitalization the patient was transferred in a primary care facility and remained in a permanent vegetative state until his death, more than 2 years later.
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Affiliation(s)
- Konstantinos Kalafatakis
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
- Faculty of Medicine & Dentistry (Malta Campus), Queen Mary University of London, Victoria, Malta
| | - Anna Margoni
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | | | - Christos Stenos
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Panagiotis Toulas
- Research Unit of Radiology, Second Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Penelope Korkolopoulou
- First Department of Pathology, LAIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftheria Lakiotaki
- First Department of Pathology, LAIKON University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Katerina Zekiou
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Panagiota Kardara
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Aspasia Terentiou
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
| | - Georgios Nikolaou
- Department of Neurology, 417 Army Share Fund Hospital, Athens, Greece
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Stoian A, Bajko Z, Stoian M, Cioflinc RA, Niculescu R, Arbănași EM, Russu E, Botoncea M, Bălașa R. The Occurrence of Acute Disseminated Encephalomyelitis in SARS-CoV-2 Infection/Vaccination: Our Experience and a Systematic Review of the Literature. Vaccines (Basel) 2023; 11:1225. [PMID: 37515041 PMCID: PMC10385010 DOI: 10.3390/vaccines11071225] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The neurological complications of coronavirus disease 2019 (COVID-19) infection and the side effects of vaccination include immune-mediated diseases of the central nervous system (CNS) such as acute disseminated encephalomyelitis (ADEM). It is an acute-onset demyelinating disease that involves a rapid evolution and multifocal neurological deficits that develops following a viral or bacterial infection or, less frequently, following vaccination. Acute hemorrhagic leukoencephalitis (AHLE) is the hemorrhagic variant of ADEM that presents a more severe evolution which can be followed by coma and death. The objectives of this study consist in evaluating the diagnosis, clinical characteristics, imaging and laboratory features, evolution, and treatment of ADEM and AHLE following COVID-19 infection or vaccination. METHODS We performed a systematic review of the medical literature according to PRISMA guidelines that included ADEM cases published between 1 January 2020 and 30 November 2022 following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination and also included our own clinical experience regarding this pathology. RESULTS A total number of 74 patients were diagnosed with ADEM, 45 following COVID-19 infection and 29 after a SARS-CoV-2 vaccine. A total of 13 patients (17.33%) presented AHLE. The moderate form of COVID-19 presented a positive correlation with AHLE (r = 0.691, p < 0.001). The existence of coma and AHLE was correlated with poor outcomes. The following more aggressive immunomodulatory therapies applied in severe cases were correlated with poor outcomes (major sequelae and death): therapeutic plasma exchange (TPE) treatment (r = 382, p = 0.01) and combined therapy with corticosteroids and TPE (r = 0.337, p = 0.03). CONCLUSIONS Vaccinations are essential to reduce the spread of the COVID-19 pandemic, and the monitoring of adverse events is an important part of the strategic fight against SARS-CoV-2. The general benefits and the overall good evolution outweigh the risks, and prompt diagnosis is associated with a better prognosis in these patients.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Mircea Stoian
- Department Anesthesiology and Critical Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Russu
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Marian Botoncea
- Department of General Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Rodica Bălașa
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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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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Nabizadeh F, Noori M, Rahmani S, Hosseini H. Acute disseminated encephalomyelitis (ADEM) following COVID-19 vaccination: A systematic review. J Clin Neurosci 2023; 111:57-70. [PMID: 36963124 PMCID: PMC10030273 DOI: 10.1016/j.jocn.2023.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Although global vaccination against COVID-19 infection has its excellence, potential side effects are yet of concern. Several lines of evidence have proposed ADEM occurrence after SARS-CoV-2 infection. Moreover, a large number of case reports and case series have also suggested the casual association between ADEM and COVID-19 vaccination. To better understand the development of ADEM following COVID-19 vaccination and its potential association, we aimed to systematically review ADEM cases reported after COVID-19 vaccination. METHODS We conducted a comprehensive systematic search using three databases including PubMed, Scopus, and Web of Science. Studies that reported ADEM after COVID-19 vaccination were eligible to include in our study. Observational studies, case reports, and case series which reported cases of ADEM with sufficient detail to confirm clinical diagnosis following COVID-19 vaccination were eligible to enter our study. RESULTS Twenty studies were included in our systematic review after the abstract and full-text screening with a total of 54 cases. Among included patients, 45 (85.1 %) developed ADEM after the first dose of the COVID-19 vaccine, and seven (12.9 %) cases experienced ADEM after the second dose. The median time interval between vaccination and neurological symptoms was 14 days which ranged from 12 h to 63 days. Twelve (22.2 %) patients experienced symptoms of muscle weakness, ten (18.5 %) presented unconsciousness, nine (16.6 %) patients had urinary complaints, nine (16.6 %) had visual impairments, and five (9.2 %) experienced a seizure. After treatments, four (13.8 %) patients died. Forty-six patients had clinical improvement (85.1 %), also improvement in brain MRI was observed among 44 (81.4 %) patients. CONCLUSION In conclusion, it is not clear that ADEM could be a potential complication of COVID-19 vaccination based on the current evidence and further studies are needed. However, this rare condition should not trigger stopping the mass vaccination programs since the only way to eradicate the current pandemic of COVID-19 is to extend the number of immunized people.
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Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Urology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Shayan Rahmani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Helia Hosseini
- Faculty of Medicine, Tehran University of Medical Sciences, Iran
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Rinaldi V, Bellucci G, Buscarinu MC, Reniè R, Marrone A, Nasello M, Zancan V, Nistri R, Palumbo R, Salerno A, Salvetti M, Ristori G. CNS inflammatory demyelinating events after COVID-19 vaccines: A case series and systematic review. Front Neurol 2022; 13:1018785. [PMID: 36530641 PMCID: PMC9752005 DOI: 10.3389/fneur.2022.1018785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/31/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Vaccinations provided the most effective tool to fight the SARS-CoV-2 pandemic. It is now well established that COVID-19 vaccines are safe for the general population; however, some cases of rare adverse events following immunization have been described, including CNS Inflammatory Demyelinating Events (CIDEs). Although observational studies are showing that these events are rare and vaccines' benefits highly outweigh the risks, collecting and characterizing post-COVID-19 vaccine CIDEs might be relevant to single out potential risk factors and suggest possible underlying mechanisms. METHODS Here we describe six CIDEs, including two acute transverse myelitis (ATM), three multiple sclerosis (MS), and one neuromyelitis optica spectrum disorder (NMOSD), occurring between 8 and 35 days from a COVID-19 vaccine. Moreover, we performed a systematic literature search of post-COVID-19 vaccines CIDEs, including ATM, ADEM, MS, and NMOSD/MOGAD, published worldwide between December 2020 and December 2021, during 1 year of the vaccination campaign. Clinical/MRI and CSF/serum characteristics were extracted from reviewed studies and pooled-analyzed. RESULTS Forty-nine studies were included in the systematic review, reporting a total amount of 85 CIDEs. Considering our additional six cases, 91 CIDEs were summarized, including 24 ATM, 11 ADEM, 47 MS, and nine NMOSD/MOGAD. Overall, CIDEs occurred after both mRNA (n = 46), adenoviral-vectored (n = 37), and inactivated vaccines (n = 8). Adenoviral-vectored vaccines accounted for the majority of ADEM (55%) and NMOSD/MOGAD (56%), while mRNA vaccines were more frequent in MS new diagnoses (87%) and relapses (56%). Age was heterogeneous (19-88) and the female sex was prevalent. Time from vaccine to symptoms onset was notably variable: ADEM and NMOSD/MOGAD had a longer median time of onset (12.5 and 10 days) compared to ATM and MS (6 and 7 days) and further timing differences were observed between events following different vaccine types, with ATM and MS after mRNA-vaccines occurring earlier than those following adenoviral-vectored ones. CONCLUSION Both the prevalence of vaccine types for certain CIDEs and the heterogeneity in time of onset suggest that different mechanisms-with distinct dynamic/kinetic-might underly these events. While epidemiological studies have assessed the safety of COVID-19 vaccines, descriptions and pooled analyses of sporadic cases may still be valuable to gain insights into CIDE's pathophysiology.
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Affiliation(s)
- Virginia Rinaldi
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Gianmarco Bellucci
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Buscarinu
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Roberta Reniè
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Antonio Marrone
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Martina Nasello
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Valeria Zancan
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Riccardo Nistri
- Department of Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Palumbo
- Neurology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Antonio Salerno
- Neurology Unit, San Giovanni Addolorata Hospital, Rome, Italy
| | - Marco Salvetti
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - Giovanni Ristori
- Neurology Unit, Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
- Neuroimmunology Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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8
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Kits A, Pantalone MR, Illies C, Antovic A, Landtblom AM, Iacobaeus E. Fatal Acute Hemorrhagic Encephalomyelitis and Antiphospholipid Antibodies following SARS-CoV-2 Vaccination: A Case Report. Vaccines (Basel) 2022; 10:vaccines10122046. [PMID: 36560456 PMCID: PMC9784396 DOI: 10.3390/vaccines10122046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Acute hemorrhagic encephalomyelitis (AHEM) is a rare hyperacute form of acute disseminated encephalomyelitis (ADEM). The disease is characterized by fulminant inflammation and demyelination in the brain and spinal cord and is often preceded by an infection or vaccination. This case report presents a 53-year-old male with rheumatoid arthritis and ongoing treatment with methotrexate and etanercept who developed fatal AHEM following the second dose of the COVID-19 vaccine. The disease course was complicated by multiorgan thromboembolic disease and the presence of high/moderate levels of cardiolipin IgG antibodies and anti-beta-2 glycoprotein 1 IgG antibodies suggesting a possible antiphospholipid syndrome. Treatment with immunosuppressive therapies failed to improve the course. The report comprises comprehensive clinical, neuroimaging, and neuropathological findings. The case highlights diagnostic challenges in a patient with several preceding risk factors, including autoimmune disease, immunotherapy, and vaccination, with possible pathophysiological implications. The temporal association with the COVID-19 vaccination may suggest possible causality although evidence cannot be ascertained. Reporting possible adverse events following COVID-19 vaccination is important to identify at-risk populations and to accomplish control of the current pandemic.
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Affiliation(s)
- Annika Kits
- Department of Neuroradiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Mattia Russel Pantalone
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institute and Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Christopher Illies
- Karolinska University Laboratory, Department of Clinical Pathology and Cancerdiagnostics, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Aleksandra Antovic
- Department of Medicine, Division of Rheumatology, Karolinska Institute and Rheumatology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Division of Neurology, Uppsala University, 751 85 Uppsala, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linkoping, Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Division of Neurology, Karolinska Institute and Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Correspondence:
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Mörz M. A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against COVID-19. Vaccines (Basel) 2022; 10:vaccines10101651. [PMID: 36298516 PMCID: PMC9611676 DOI: 10.3390/vaccines10101651] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
The current report presents the case of a 76-year-old man with Parkinson’s disease (PD) who died three weeks after receiving his third COVID-19 vaccination. The patient was first vaccinated in May 2021 with the ChAdOx1 nCov-19 vector vaccine, followed by two doses of the BNT162b2 mRNA vaccine in July and December 2021. The family of the deceased requested an autopsy due to ambiguous clinical signs before death. PD was confirmed by post-mortem examinations. Furthermore, signs of aspiration pneumonia and systemic arteriosclerosis were evident. However, histopathological analyses of the brain uncovered previously unsuspected findings, including acute vasculitis (predominantly lymphocytic) as well as multifocal necrotizing encephalitis of unknown etiology with pronounced inflammation including glial and lymphocytic reaction. In the heart, signs of chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and vasculitis were present. Although there was no history of COVID-19 for this patient, immunohistochemistry for SARS-CoV-2 antigens (spike and nucleocapsid proteins) was performed. Surprisingly, only spike protein but no nucleocapsid protein could be detected within the foci of inflammation in both the brain and the heart, particularly in the endothelial cells of small blood vessels. Since no nucleocapsid protein could be detected, the presence of spike protein must be ascribed to vaccination rather than to viral infection. The findings corroborate previous reports of encephalitis and myocarditis caused by gene-based COVID-19 vaccines.
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Affiliation(s)
- Michael Mörz
- Institute of Pathology 'Georg Schmorl', The Municipal Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany
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Bastide L, Perrotta G, Lolli V, Mathey C, Vierasu OI, Goldman S, Vandergheynst F. Atypical acute disseminated encephalomyelitis with systemic inflammation after a first dose of AztraZaneca COVID-19 vaccine. A case report. Front Neurol 2022; 13:995875. [PMID: 36105772 PMCID: PMC9465085 DOI: 10.3389/fneur.2022.995875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022] Open
Abstract
Background Only a few cases of acute disseminated encephalomyelitis (ADEM) following coronavirus disease 19 (COVID-19) vaccination have been described since the beginning of the vaccination campaign. Results Here we report the first case of central nervous system (CNS) demyelination with systemic inflammatory findings on whole body 19-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) following the ChAdOx1 nCoV-19 vaccine. Conclusions Clinicians should stay aware of potential new adverse events after immunization.
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Affiliation(s)
- Laure Bastide
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Laure Bastide
| | - Gaetano Perrotta
- Department of Neurology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Valentina Lolli
- Department of Radiology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Céline Mathey
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ortensa-Irina Vierasu
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- Department of Nuclear Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Frédéric Vandergheynst
- Department of Internal Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Safety of COVID-19 Vaccines: Spotlight on Neurological Complications. Life (Basel) 2022; 12:life12091338. [PMID: 36143376 PMCID: PMC9502976 DOI: 10.3390/life12091338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has led to unprecedented demand on the global healthcare system. Remarkably, at the end of 2021, COVID-19 vaccines received approvals for human use in several countries worldwide. Since then, a solid base for response in the fight against the virus has been placed. COVID-19 vaccines have been shown to be safe and effective drugs. Nevertheless, all kinds of vaccines may be associated with the possible appearance of neurological complications, and COVID-19 vaccines are not free from neurological side effects. Neurological complications of COVID-19 vaccination are usually mild, short-duration, and self-limiting. However, severe and unexpected post-vaccination complications are rare but possible events. They include the Guillain-Barré syndrome, facial palsy, other neuropathies, encephalitis, meningitis, myelitis, autoimmune disorders, and cerebrovascular events. The fear of severe or fatal neurological complications fed the “vaccine hesitancy” phenomenon, posing a vital communication challenge between the scientific community and public opinion. This review aims to collect and discuss the frequency, management, and outcome of reported neurological complications of COVID-19 vaccines after eighteen months of the World Health Organization’s approval of COVID-19 vaccination, providing an overview of safety and concerns related to the most potent weapon against the SARS-CoV-2.
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12
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No need for brain biopsy in acute disseminated encephalomyelitis after first Sputnik-V jab. Brain Behav Immun Health 2022; 22:100464. [PMID: 35586360 PMCID: PMC9108446 DOI: 10.1016/j.bbih.2022.100464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022] Open
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Awaya T, Moroi M, Enomoto Y, Kunimasa T, Nakamura M. What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions. Vaccines (Basel) 2022; 10:vaccines10060866. [PMID: 35746474 PMCID: PMC9228524 DOI: 10.3390/vaccines10060866] [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: 05/05/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 01/01/2023] Open
Abstract
COVID-19 vaccines have been used to counteract the global COVID-19 pandemic. While these are effective, adverse reactions have been reported, such as injection-site pain, muscle ache, fever, palpitation, and chest discomfort. The release of inflammatory cytokines, such as interleukin (IL)-6 and IL-1β, is a potential mechanism for post-vaccine side-effects. Chest discomfort after the vaccination, including myocarditis and acute coronary syndrome, is a particularly serious adverse reaction. It is important to be familiar with the differential diagnoses of chest discomfort and organ-specific diseases associated with COVID-19 vaccines as the preparation for booster shots and vaccinations among children aged 5–11 years begins. High-intensity exercise, alcohol, tobacco smoking, and baths promote inflammatory cytokines, such as IL-6, which may exacerbate the adverse reactions after vaccination. Japanese data show that deaths during baths are the most common for several days after mRNA vaccination. Additionally, alcohol and tobacco smoking were identified as predictive factors of lower antibody titers after vaccination. In this review, we aimed to provide a few recommendations to prevent vaccine-associated disease.
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Bensaidane MR, Picher-Martel V, Émond F, De Serres G, Dupré N, Beauchemin P. Case Report: Acute Necrotizing Encephalopathy Following COVID-19 Vaccine. Front Neurol 2022; 13:872734. [PMID: 35572945 PMCID: PMC9099242 DOI: 10.3389/fneur.2022.872734] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Acute necrotizing encephalopathy (ANE) is a rare neurological disorder arising from a para- or post-infectious "cytokine storm. "It has recently been reported in association with coronavirus disease 2019 (COVID-19) infection. Methods A 56-year-old male with a diagnosis of ANE 48 h following the first dose of ChAdOx1 nCoV-19 vaccination was investigated. Cytokine analyses on serum and cerebrospinal fluid (CSF) were performed. The patient was treated with high-dose corticosteroids and followed clinically and radiologically. Results Favorable clinical and radiological outcomes were noted. There was an upregulation in serum levels of CXCL5, CXCL1, Il-8, IL-15, CCL2, TGF-B, and EGF, and up-regulation in CSF levels of CXCL5, IL-2, IL-3, and IL-8. Discussion As COVID-19 infection has been previously reported as a possible rare cause of ANE, we speculate on an aberrant immune response mechanism that was brought about by the vaccine. To increase our understanding of the pathogenesis of ANE in the context of COVID-19 vaccination and to better define its clinical features and outcomes, clinicians and scientists should continue reporting convincing cases of such entities.
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Affiliation(s)
- Mohamed Reda Bensaidane
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
| | - Vincent Picher-Martel
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, CERVO Brain Research Centre, Quebec, QC, Canada
| | - François Émond
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
| | - Gaston De Serres
- Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Nicolas Dupré
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
| | - Philippe Beauchemin
- Department of Medicine, Faculty of Medicine, Centre Hospitalier Universitaire de Québec—Université Laval, Quebec, QC, Canada
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Rizvi I, Garg RK, Gupta P, Malhotra HS, Kumar N, Uniyal R, Pandey S. Acute hemorrhagic leukoencephalitis after administration of the first dose of ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELD™) vaccine. NEUROIMMUNOLOGY REPORTS 2022. [PMCID: PMC8966115 DOI: 10.1016/j.nerep.2022.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Many central and peripheral nervous system complications, following COVID-19 vaccination, have been described. We report an unusual case of central demyelinating disorder, following the administration of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELD™) vaccine. Case-report The 28-year female developed sudden onset headache followed by weakness of the left upper and lower limbs, and gait ataxia. Neurological symptoms developed two weeks after administration of the first dose of the ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELD™) vaccine. Magnetic resonance imaging brain revealed T2/FLAIR hyperintense lesions involving bilateral subcortical white matter, splenium of the corpus callosum, and both cerebellar hemispheres. Few lesions showed blooming on gradient echo sequence suggestive of a hemorrhagic component. Post-contrast T1 images showed mild enhancement of demyelinating lesions. The patient was treated intravenously with methylprednisolone. After 12 weeks of follow-up, there was a substantial improvement in her symptoms. She became independent in all her activities of daily living. Conclusion In conclusion, this is an unusual case of acute hemorrhagic leukoencephalitis following ChAdOx1 nCoV-19 SARS-CoV-2 (COVISHIELD™) vaccination.
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