Clinical improvement of a toddler with COVID-19 focal cerebral arteriopathy possibly due to intra-arterial nimodipine

Avital, Dekel; Peretz, Shlomi; Perlow, Eliauh; Konen, Osnat; Inbar, Edna; Bulkowstein, Yarden; Nahum, Elhanan; Aharoni, Sharon; Vig, Lital Cohen; Nevo, Yoram; Uriel, Eitan; Straussberg, Rachel

doi:10.1016/j.ejpn.2022.07.007

Cited by 1 publication

(1 citation statement)

References 25 publications

(26 reference statements)

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“… (years) PCR Antibody 1 1 Female 2 months Irritability, unable to walk, left hemiparesis negative positive (serum) normal n.d. Brain MRI: subacute infarct in the right MCA territory; severe focal stenosis in the M1 segment of the right MCA. None mPSL, Nimodipine, ASA Improved Avital D. 7 2 8 Female 2 weeks Left hemiparesis positive (NP), negative (brain) positive (serum, CSF) CRP 0.8 mg/dL, ESR 11 mm/h Cells 3/µL, protein 21 mg/dL, glucose 72 mg/dL; negative PCR panel including HSV and VZV Brain MRI: a right frontal lobe enhancing lesion with vasogenic edema, histology: vasculitis (infarct-like necrosis with perivascular lymphohistiocytic inflammatory infiltrates) Secondary macrophage activation syndrome mPSL, IVIG, plasmapheresis, CYC, RTX Deceased Poisson KE. 8 3 8 Female 3 weeks Right hemiplegia, language impairment negative positive CRP 2.7 mg/mL, IL-6 3.2 pg/mL n.d. Brain MRI: proximal left M1 occlusion; thick concentric mural enhancement of left ICA Iron deficiency anemia (blood transfusion) mPSL, ASA Walk with support Appavu B.…”

Section: Discussionmentioning

confidence: 98%

Childhood primary angiitis of the central nervous system following COVID-19 vaccination (BNT162b2/Pfizer-BioNtech): A case report

Ariyoshi,

Hoshide,

Motonaga

et al. 2023

Human Vaccines & Immunotherapeutics

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Childhood primary angiitis of the central nervous system (cPACNS) is a vasculitis of unknown etiology that is confined to the central nervous system (CNS) and can lead to repeated cerebral infarctions if left untreated. Several cases of cPACNS after COVID-19 have been reported. Herein, we present a case of post-vaccination cPACNS. A 9-year-old healthy boy presented with persistent headache and fever after receiving the second COVID-19 vaccine (BNT162b2/Pfizer-BioNtech) dose. Brain magnetic resonance angiography (MRA) performed on the sixth day of symptom onset after vaccination revealed stenosis of the left middle cerebral artery; the patient was referred to our department on the 12th day of symptom onset. Blood tests indicated only minimal evidence of inflammation, whereas cerebrospinal fluid examination indicated pleocytosis. Brain magnetic resonance imaging (MRI) revealed vascular wall thickening and contrast enhancement of the artery with worsened stenosis. We diagnosed the patient as having cPACNS and treated him with three courses of methylprednisolone pulse therapy. The headaches and fever disappeared with improvement of vascular stenosis. The patient has been in remission for more than 1 year since cPACNS onset. This is the first report of a case of cPACNS after mRNA vaccination for COVID-19. Most previous cases of COVID-19-associated cPACNS presented with ischemic stroke. However, the present case could be treated for vasculitis prior to stroke and thus had a favorable prognosis. The mRNA vaccine for COVID-19 differs from other existing vaccines, and further accumulation of data of cases is required to determine adverse CNS reactions.

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