Background Guillain–Barré syndrome (GBS) is an acute monophasic immune‐mediated polyradiculoneuropathy, preceded by gastrointestinal or respiratory infections in up to two‐thirds of patients. On rare occasions, people develop GBS after vaccination, but no causal association has been proven. In the current coronavirus disease 2019 (COVID‐19) pandemic, some cases have been reported associating COVID‐19 vaccine with GBS. Case presentation We report a case of a 62‐year‐old woman with GBS after the first dose of the Oxford/AstraZeneca vaccine against SARS‐CoV‐2. The symptoms started 3 weeks after the vaccine, and were characterized by ascending and progressive paresthesia in the upper and lower limbs, followed by loss of strength of the upper limbs and dysphagia for solids. The hypothesis of GBS was confirmed by clinical presentation compatible with albuminocytologic dissociation in cerebrospinal fluid and based on the Brighton criteria level 2. The treatment was a 5‐day course of intravenous immunoglobulin with an improvement of symptoms. Conclusions In the absence of other causes, the diagnosis of GBS was made, with evidence of a clear temporal association with COVID‐19 vaccine. However, a cautious position is important when assigning a particular side‐effect directly to a vaccine. It is important to emphasize that it is a temporal association only and the benefits of COVID‐19 vaccination continue to outweigh the possible consequences.

Background: Transverse myelitis (TM) is most often triggered by an autoimmune reaction due to infections and perhaps vaccines. During the current coronavirus disease 2019 (COVID-19) pandemic, some case reports have shown a temporal association between TM and COVID-19 vaccine. We aimed to report a case of TM with a temporal association with ChAdOx1 nCoV-19 (AZD1222, Oxford/AstraZeneca) vaccine in a Brazilian public hospital. Case Presentation: A 27-year-old woman experienced fever, low back pain and urinary retention 3 weeks after the first dose of the ChAdOx1 nCoV-19 vaccine. Two days later, she experienced decreased strength of the lower limbs associated with paresthesia of the distal extremities. At the hospital, there was progression of weakness associated with anesthesia in T4-L1. Magnetic resonance imaging findings were suggestive of demyelination and acute inflammation. Cerebrospinal fluid analysis showed monomorphonuclear pleocytosis, increased protein and decreased glucose.Gram stain, oligoclonal bands, anti-aquaporin-4 antibody, and screening for infectious agents and connective tissue disease were all negative. During treatment, the patient received 5-day pulse therapy with methylprednisolone, acyclovir and 7-day plasmapheresis. Despite all treatments, she persisted with lower limb plegia, areflexia and anesthesia at the level of T4. She was discharged with a monthly cyclophosphamide plan and outpatient follow up. Conclusions:In the absence of other causes, the diagnosis of TM was made with evidence of a possible temporal association with ChAdOx1 nCoV-19 vaccine. It is important to emphasize that it is a temporal association only and the benefits of vaccination continue to outweigh the risk of TM.

Introdução A mielite transversa (MT) geralmente é desencadeada por uma reação autoimune, devido a infecções e, possivelmente, vacinas. Na pandemia atual, há alguns relatos de casos que demonstram uma associação temporal entre a MT e a vacina COVID-19. Em seguida, pretendemos relatar um caso de MT com associação temporal com a vacina ChAdOx1 nCoV-19 (AZD1222, Oxford / AstraZeneca) em um hospital público brasileiro. Descrição do caso Uma mulher de 27 anos começou com febre, dor lombar e retenção urinária três semanas após a primeira dose da vacina ChAdOx1 nCoV-19. Dois dias depois, teve diminuição da força de membros inferiores associada a parestesias de extremidades distais. No hospital, houve progressão da fraqueza associada à anestesia em T4-L1. Na ressonância magnética, houve achados sugestivos de desmielinização e inflamação aguda. A análise do LCR mostrou pleocitose monomorfonuclear, aumento da proteína e diminuição da glicose. A coloração de Gram, a pesquisa de bandas oligoclonais, aquaporina-4 e triagem para agentes infecciosos e doença do tecido conjuntivo foram todas negativas. Durante o tratamento, ela recebeu 5 dias de pulsoterapia com metilprednisolona, aciclovir e sete sessões de plasmaférese. Apesar de todos os tratamentos, ela persistiu com plegia de membros inferiores, arreflexia e anestesia ao nível de T4. Recebeu alta com plano mensal de ciclofosfamida e acompanhamento ambulatorial. Comentários Na ausência de outras causas, o diagnóstico de MT foi feito com evidências de uma possível associação temporal com a vacina ChAdOx1 nCoV-19. É importante enfatizar que é apenas uma associação temporal e os benefícios da vacinação continuam a superar o risco da MT.

Introduction: Cat scratch disease is an infection caused by Bartonella henselae, usually transmitted to humans through cat scratch or bite. The most common clinical manifestation is lymphadenitis, but 5 to 10% of patients with cat scratch disease may have ocular involvement. Objectives and methodology: This work aims to report a case of Neuroretinitis optica by Bartonella Henselae. Data were collected through analysis of medical records with the patient’s consent. Results / Case report: Female, 22 years old, born in Joinville, presented, acutely, decreased visual acuity in RE, without pain on eye movement. She reported flu with fever in the previous month and denied recent vaccination. Visual acuity was 20/40 in RE and the fundus revealed papilla edema, hemorrhage and uveitis (+ / 4 +). In laboratory tests there were no changes. Serology for toxoplasmosis revealed a slight increase in IgM and the other serologies were negative. Sulfamethoxazole 800 mg / trimethoprim 160 mg started 12/12 hs and prednisone 80 mg / day, without improvement. Evolved with worsening and visual acuity (20/100) in OD. Retinography showed vascular narrowing, papillary blurring, decreased foveal brightness and macular edema, configuring optic neuritis D, with no changes in the LE. The neurological evaluation did not find any findings other than visual changes. The CSF study, cranial and orbit MRs were normal. At that time, the patient reported having had contact with a dead kitten. Serology was positive for Bartonella (IgM 1/100). Doxycycline 100mg started at 12 / 12h. After 15 days, a stellate macula and a slight improvement in papilla edema were observed. The patient evolved with full recovery. Conclusion: B.henselae is the main etiological agent of DAG. Kittens are the main reservoirs of B.henselae. Contact with mucous membranes or conjunctivae may be involved. Cat scratch disease (GAD) has two clinical presentations. Typical GAD is characterized by subacute regional lymphadenopathy; atypical GAD is the designation for numerous manifestations involving several organs, and occurs in 10- 15% of cases, being responsible for Parinaud’s oculoglandular syndrome.

Background Atrial fibrillation (AF) is an important cause of cardioembolic stroke, and population aging has increased its prevalence. Objective To evaluate the incidence of cardioembolic stroke caused by AF in the city of Joinville, Brazil, as well as previous diagnoses and use of medication. Methods Between 2017 and 2020 we extracted data from the population-based Joinville Stroke Registry. Demographic characteristics, diagnosis of AF, and patterns of medication use were collected, and the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) system was used to classify the etiology. Results There were 3,303 cases of ischemic stroke, 593 of which were cardioembolic, and 360 had AF. Of the patients with AF, 258 (71.6%) had a previous diagnosis of the disease, and 102 (28.3%) were newly diagnosed after the stroke. Among patients with a previously-diagnosed AF, 170 (47.2%) were using anticoagulants, and 88 (24.4%) were using other medications. Conclusion During the analyzed period, ischemic stroke caused by AF was a significant burden on the population of Joinville, and a considerable number of patients had undiagnosed or untreated AF.