Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination

Abstract

Background Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated inflammatory demyelinating disease of the central nervous system. We report a case of ADEM presenting with bilateral optic neuritis temporally associated with the ChAdOx1 vaccine against SARS-COVID19 virus. Case presentation A 36-year-old female presented with bilateral optic neuritis following her first dose of the ChAdOx1 vaccine. Initial MRI Brain showed evidence of demyelination within the subcortical white matter, with no radiological involvement of the optic nerves. Visual evoked potentials were consistent with bilateral optic neuritis which was confirmed radiologically on follow up MRI. She was treated with intravenous steroids with improvement both in symptoms and radiological appearance. A pseudo-relapse occurred which was treated with a further course of intravenous steroids followed by an oral taper. The clinical, radiological and serological results were most consistent with diagnosis of ADEM. Conclusions ADEM is an exceedingly rare complication of ChAdOx1 vaccine despite millions of doses. While it is imperative clinicians remain aware of neurological complications of vaccines, the importance of vaccination to control a pandemic should not be undermined.

Case report of acute encephalitis following the AstraZeneca COVID‐19 vaccine

“…We also summarize case reports of COVID‐19 vaccine‐related encephalomyelitis in Table 4 . 8 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Similar to our case, the symptoms of encephalitis developed within 30 days after vaccination. After excluding alternative causes, vaccination‐related autoimmune encephalitis was suspected and symptoms rapidly recovered after the initiation of immunosuppressive therapy.…”

“…Zuhorn et al 18 also reported 3 cases of acute encephalitis after AZ vaccine injection. We also summarize case reports of COVID‐19 vaccine‐related encephalomyelitis in Table 4 8,19–26 . Similar to our case, the symptoms of encephalitis developed within 30 days after vaccination.…”

Incidence of Guillain–Barré syndrome following SARS‐CoV‐2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines

“…In the case of mRNA‐vectored vaccines, it is also possible that the lipid nanoparticles required to prevent enzymatic degradation of mRNA particles may be a trigger for GBS in genetically or environmentally susceptible individuals [ 50 , 51 ]. Also, other neuroimmunological syndromes such as fulminant encephalomyelitis (overlapping with GBS), optic neuritis, and acute disseminated encephalomyelitis as AEFIs have been reported among recipients of SARS‐CoV‐2 vaccines [ 52 , 53 , 54 ]. Still, a causal relationship between anti‐SARS‐CoV‐2 vaccines and GBS is unknown.…”

The clinical neurophysiology of COVID-19-direct infection, long-term sequelae and para-immunization responses: A literature review

“…Notably, none of these patients manifested electrophysiological evidence of a peripheral neuropathy. Nagaratnam et al reported a case of bilateral optic neuritis following a ChAdOx1 COVID-19 vaccination ( Nagaratnam et al, 2022 ). Rodrigo-Armenteros et al reported a case of 62-year-old male, with left eye amblyopia since childhood who presented with asymptomatic left optic neuropathy and a prolonged left P100 latency after a COVID-19 infection (Rodrigo-Armenteros et al, 2021).…”