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.
Introduction
Phosphorylated tau (p‐tau)181 has become a promising blood‐based Alzheimer's disease (AD) biomarker. We studied the agreement of plasma p‐tau181 and cerebrospinal fluid (CSF) markers in patients with alteration of consciousness (AOC).
Methods
Plasma and CSF were simultaneously collected in participants presenting with AOC. Plasma p‐tau181 was measured using the single‐molecule array. CSF biomarkers were classified according to the amyloid/tau/neurodegeneration (AT[N]) framework.
Results
Among participants enrolled, the median (interquartile range) age was 57 (28.5–75) years and 5.8% had AD. Plasma p‐tau181 yielded area under the curve of 0.85 and showed moderate correlation with CSF p‐tau181 (Rho = 0.42,
P
< .001). Using the historical cut‐point, many non‐AD participants had elevated plasma p‐tau181 resulting in a specificity of 0.57. Plasma p‐tau181 correlated with the glomerular filtration rate (Rho = –0.52,
P
< .001). Among A− participants with elevated plasma p‐tau181, 42% had kidney dysfunction.
Discussion
Plasma p‐tau181 showed inadequate specificity in patients with AOC partially attributable to concomitant kidney dysfunction.
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