An 88-year-old woman with acute disseminated encephalomyelitis following messenger ribonucleic acid-based COVID-19 vaccination

Shimizu, Mai; Ogaki, Kotaro; Nakamura, Ryôkô; Kado, Eriko; Nakajima, Sachiko; Kurita, Nobuyuki; Watanabe, Masayuki; Yamashiro, Kazuo; Hattori, Nobutaka; Urabe, Takao

doi:10.1016/j.ensci.2021.100381

Cited by 26 publications

(23 citation statements)

References 6 publications

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“…In a recently reported case based on antemortem medical records and the results of a postmortem investigation, the cause of death was registered as “ADEM in the setting of recent Astra Zeneca COVID-19 vaccination” [ 13 ]. ADEM can present in many ways including focal/multifocal neurological deficits, optic neuritis, seizures, and an altered mental status [ 14 ].…”

Section: Literature Reviewmentioning

confidence: 99%

“…The typical hallmark for ADEM in MRI is asymmetrically bilateral brain lesions in either the supratentorial or infratentorial white matter that present as a hyperintense lesion in T2-weighted and FLAIR sequences [ 10 ]. Ghali et al demonstrated that a biopsy enables a definitive diagnosis of ADEM [ 14 ]. The lesions can be bilateral and asymmetrical, involving the supratentorial cerebral white matter, posterior fossa (brainstem and cerebellum), or spinal cord [ 14 ].…”

Section: Literature Reviewmentioning

confidence: 99%

“…Ghali et al demonstrated that a biopsy enables a definitive diagnosis of ADEM [ 14 ]. The lesions can be bilateral and asymmetrical, involving the supratentorial cerebral white matter, posterior fossa (brainstem and cerebellum), or spinal cord [ 14 ].…”

Section: Literature Reviewmentioning

confidence: 99%

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Acute Demyelinating Encephalomyelitis Post-COVID-19 Vaccination: A Case Report and Literature Review

et al. 2022

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New advancements in the medical community have rapidly occurred with the development of medical information across the globe during the COVID-19 pandemic. Several vaccine manufacturers were able to obtain clearance to administer vaccines in selected age groups and for those at high risk for COVID-19 complications. As vaccines became more readily available, there was a significant effort supported by scientific information to get people vaccinated to boost herd immunity. Acute demyelinating encephalomyelitis (ADEM) is a rare autoimmune disease, causing demyelination in the brain and spinal cord, presenting as monophasic, acute-onset, and rapidly progressive multifocal neurological deficits. A wide variety of precipitating factors can trigger ADEM, and it has long been known to be a rare adverse event following some types of vaccinations including rabies, diphtheria–tetanus–polio, smallpox, measles, mumps, rubella, pertussis, influenza, and hepatitis B vaccines. Recently, ADEM has also been associated with COVID-19 infection and (very rarely) with COVID-19 vaccination. We have a 56-year-old female who was not known to have any medical issues. She voluntarily received her first COVID-19 vaccination (AstraZeneca) ten days after immunization; she developed weakness of the lower limbs and slurred speech. She tested negative for COVID-19, and a brain MRI showed T2-weighted white-matter hyperintense lesions suggesting acute demyelinating encephalomyelitis. She was managed with pulse-dose steroids, which resulted in a marked improvement in her symptoms, and discharged in a stable condition. Physicians should be aware of this neurological disorder and the management options for better patient care and outcomes.

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Acute Demyelinating Encephalomyelitis Post-COVID-19 Vaccination: A Case Report and Literature Review

et al. 2022

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“…Our patient met the diagnostic criteria for ADEM set by the International Pediatric MS Study Group ( 2 ), and alternative diagnoses, such as infectious or another autoimmune encephalitis, were excluded. ADEM, following vaccination, is a well-known entity and has been reported after mRNA SARS-CoV-2 vaccination (Moderna and BioNTech/Pfizer), even among older adults such as our patient ( 5 – 7 ), but also after inactivated vaccine (Sinovac) ( 8 ). Previously reported cases of vaccination-triggered ADEM had an excellent response to systemic corticosteroids and/or intravenous immunoglobulins.…”

Section: Discussionmentioning

confidence: 90%

Multiple Autoimmune Syndromes Including Acute Disseminated Encephalomyelitis, Myasthenia Gravis, and Thyroiditis Following Messenger Ribonucleic Acid-Based COVID-19 Vaccination: A Case Report

Poli

Ziemann

2022

Front. Neurol.

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The global pandemic has resulted from the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing coronavirus disease 2019 (COVID-19). To control the spread of the pandemic, SARS-CoV-2 vaccines have been developed. Messenger ribonucleic acid (mRNA)-based COVID-19 vaccines have been the most widely used. We present the case of a 65-year-old patient, who was diagnosed with acute disseminated encephalomyelitis, ocular myasthenia gravis, and autoimmune thyroiditis, following his third mRNA COVID-19 vaccination. On admission, the patient showed mild left-sided hemiparesis, contralateral dissociated sensory loss, dizziness, and right-sided deafness. Brain MRI revealed multiple acute inflammatory contrast-enhancing periventricular and brainstem lesions with involvement of vestibulo-cerebellar tract and cochlear nuclei. Despite steroid pulse and intravenous immunoglobulin therapy, clinical symptoms and MRI lesions worsened, and additional signs of ocular myasthenia gravis and elevated but asymptomatic thyroid antibodies developed. After repeated plasma exchange, all clinical symptoms resolved. This is, to the best of our knowledge, the first case report of multiple autoimmune syndromes triggered by COVID-19 vaccination. The rare occurrence of such treatable autoimmune complications should not question the importance of vaccination programs during the COVID-19 pandemic.

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“…There have been five published cases of ADEM, 2 or more weeks following COVID-19 vaccination, with favourable response to steroids [ 10 – 14 ]. However, to the best of our knowledge, a presentation with a frontal lobe syndrome has not been described previously.…”

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confidence: 99%

Post ChAdOx1 nCoV-19 vaccination frontal lobe syndrome

et al. 2022

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An 88-year-old woman with acute disseminated encephalomyelitis following messenger ribonucleic acid-based COVID-19 vaccination

Cited by 26 publications

References 6 publications

Acute Demyelinating Encephalomyelitis Post-COVID-19 Vaccination: A Case Report and Literature Review

Acute Demyelinating Encephalomyelitis Post-COVID-19 Vaccination: A Case Report and Literature Review

Multiple Autoimmune Syndromes Including Acute Disseminated Encephalomyelitis, Myasthenia Gravis, and Thyroiditis Following Messenger Ribonucleic Acid-Based COVID-19 Vaccination: A Case Report

Post ChAdOx1 nCoV-19 vaccination frontal lobe syndrome

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