Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Developing an effective and reliable vaccine was emergently pursued to control the dramatic spread of the global pandemic. The standard stages for vaccine development were unprecedentedly accelerated over a few months. We report a case of new-onset refractory status epilepticus (NORSE) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute the occurrence of NORSE to the vaccine due to the temporal relationship and the lack of risk factors for epilepsy in the patient. This report adds to the literature a possible rare side effect of a COVID-19 vaccine and contributes to the extremely limited literature on potential neurological side effects of viral vector vaccines. Healthcare providers should be aware of the possibility of post-vaccination epilepsy. The patient had recurrent seizures that were refractory to conventional antiepileptic drug therapy with a dramatic response to immunotherapy with pulse steroids and plasmapheresis. This likely reflects an underlying autoimmune mechanism in the genesis of post-vaccination generalized seizures without fever. Further research is needed to probe and study the exact mechanism at a more molecular level.
Coronavirus is a novel human pathogen causing fulminant respiratory syndrome (COVID-19). Although COVID-19 is primarily a disease of the lungs with florid respiratory manifestations, there are increasing reports of cardiovascular, musculoskeletal, gastrointestinal, and thromboembolic complications. Developing an effective and reliable vaccine was emergently pursued to control the catastrophic spread of the global pandemic. We report a fatal case of vaccine-induced immune thrombotic thrombocytopenia (VITT) after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. We attribute this fatal thrombotic condition to the vaccine due to the remarkable temporal relationship. The proposed mechanism of VITT is production of rogue antibodies against platelet factor-4 resulting in massive platelet aggregation. Healthcare providers should be aware of the possibility of such fatal complication, and the vaccine recipients should be warned about the symptoms of VITT.
CASE REPORTA 34-year-old right-handed woman with no history of seizures presented to emergency room after being found lying on the floor confused and incoherent. In the emergency room, she was observed to have fluctuating levels of consciousness characterized by episodic confusion and unresponsiveness lasting up to 30 s with rapid recovery. She subsequently developed recurrent twitching of the legs, especially on the left side, with repetitive posturing of the trunk. The semiology of her seizures evolved into stereotypic eyelid fluttering for a few seconds followed by forced head deviation to the left with occasional versive eye deviation to the right. Generalized tonic-clonic convulsions were not observed.Two weeks prior to presentation, the patient was admitted to psychiatry for a new-onset of delusions and auditory hallucinations. Despite a long-standing history of depression and eating disorder, she had never experienced any psychotic symptom. During this admission, the patient also was found to be pregnant. She was treated with risperdal and trazodone with resolution of the hallucinations and was discharged home. Detailed examination of the patient did
IN is a self-limited condition. Early recognition can lead to institution of appropriate therapy, which includes pain control and withholding insulin. Most cases do not require any work-up and resolve spontaneously.
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