COVID-19 Vaccination and Neurological Manifestations: A Review of Case Reports and Case Series

Abstract

Background: With 10 vaccines approved by the WHO and nearly 48% of people fully vaccinated worldwide, we have observed several individual case studies of neurological manifestations post-COVID-19 vaccination. Through this systematic review, we aim to discern these CNS and PNS manifestations following the COVID-19 vaccine to help produce methods to mitigate them. Methods: We conducted a thorough literature search of Google Scholar and PubMed from 1 December 2020 until 10 October 2021 and included all the case studies of COVID-19 vaccine-associated neurological side effects. The literature search and data analysis were performed by two independent reviewers according to prespecified inclusion and exclusion criteria using PRISMA. Results: The most common CNS manifestation was CVST (14.47%), found in females (64%) younger than 50 years (71%) after the first AstraZeneca dose (93%). Others included CNS demyelinating disorders (TM, ADEM, MS, NMOSD) (9.30%), encephalopathy/encephalitis (3.10%), and others (4.13%). The most common PNS manifestation was GBS (14.67%) found in males (71%) older than 50 years (79%), followed by Bell’s palsy (5.24%) and others (2.10%). Most occurred with the AstraZeneca (28.55%), Pfizer-BioNTech (9.18%), and Moderna (8.16%) vaccines. Nine (64%) out of the 14 patients with CVST died. However, most cases overall (42 out of 51) were non-fatal (82%). Conclusion: Several CNS and PNS adverse events have occurred post-COVID-19 vaccination, including CVST, GBS, and TM. High vigilance with early identification and treatment leads to better outcomes. Further studies with non-vaccinated controls might help in understanding the pathophysiologic mechanisms of these neurological manifestations following COVID-19 vaccination.

A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against Covid-19

“…Moreover, Serious neurological disorders were reported following different mRNA-based vaccination including transverse myelitis, Guillain-Barré syndrome, cranial nerve neuropathies, myelitis, and facial nerve palsy (García-Grimshaw et al, 2021;Lau & Galea, 2022;Malhotra et al, 2021;Michalik et al, 2022;Wan et al, 2022). A study reviewing case reports and case series reported the occurrence of variable central and peripheral nervous system complications in patients receiving gene-based vaccines including transverse myelitis, Guillain-Barré syndrome, and cerebral venous sinus thrombosis (Sriwastava et al, 2022). It was noticed that post-mRNA-based SARS-CoV-2 vaccines, either the first or the second dose, were complicated by new-onset neuroimmunological disorders like acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, and multiple sclerosis (Ballout et al, 2022).…”

Shot in the dark

“…transverse myelitis, acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), and NMOSD. 30 Based on an analysis from the vaccine adverse event reporting system (VAERS), there were only 0.03% of neurological adverse events reported from approximately 306 million doses administered, with most of cases associated with the Janssen COVID-19 vaccine. The analysis also found that the risk of neurological events following SARS-CoV-2 infection was 617 times higher than after COVID-19 vaccination.…”

Chronic Inflammatory Demyelinating Polyneuropathy Incidence in Covid-19 and Covid-19 Vaccines

“…Chen et al described various neurological adverse reactions associated with COVID-19 vaccines [9]. Serious neurological symptoms such as GBS, cranial nerve neuropathies, and transverse myelitis are described in a few case reports [10,11]. Jee-Eun Kim et al reported a thirteen-patient case series that presented with a GBS and variants following COVID-19 vaccination in South Korea [12].…”