Cytotoxic lesions of the corpus callosum after COVID-19 vaccination

Abstract

A 23-year-old previously healthy man (Patient 1) and a 33-year-old woman with a past history of depression (Patient 2) developed neurological symptoms approximately 1 week after receipt of the first COVID-19 mRNA vaccination and deteriorated over the next week. Patient 1 reported nausea, headache, a high fever, and retrograde amnesia. Patient 2 reported visual disturbance, headache, dysarthria, a left forearm tremor, dysesthesia of the mouth and distal limbs, and visual agnosia. PCR test results for SARS-CoV-2 were negative. Complete blood cell count, biochemistry, and antibody test and cerebrospinal fluid test findings were unremarkable. Diffusion-weighted and fluid-attenuated inversion recovery MRI of the brain showed a high signal intensity lesion at the midline of the splenium of the corpus callosum compatible with cytotoxic lesions of the corpus callosum (CLOCCs). High-dose intravenous methylprednisolone improved their symptoms and imaging findings. CLOCCs should be considered in patients with neurological manifestation after COVID-19 vaccination.

Before blaming a COVID vaccine for cytotoxic lesions of the corpus callosum all other differentials must be ruled out

“…We disagree with the notion that side effects of SARS-CoV-2 vaccinations are not life-threatening, as stated in the introduction [ 1 ]. Several fatal adverse reactions to SARS-CoV-2 vaccinations have been reported.…”

“…We read with interest the article by Ohara et al about two patients developing a cytotoxic lesion of the corpus callosum (CLOCC) about 1 week following the first dose of the Biontech Pfizer vaccine (BPV) [ 1 ]. Both patients were treated with methyl-prednisolone and partially recovered at the last reported follow-up [ 1 ]. The study is promising but raises concerns that should be discussed.…”

“…A shortcoming of the study is that the cause of CLOCC in patient 2 was not clarified. The patient did not undergo cerebrospinal fluid (CSF) investigations, had no ophthalmologic investigations, and no blood coagulation tests had been carried out [ 1 ]. Serum levels of B-vitamins, including B1 and B12, should have been carried out.…”

Mild Encephalopathy With Partial Reversible Splenium Lesion Associated With SARS-CoV-2 Infection

“…Risk factors for encephalopathy include older age, vision impairment, history of Parkinson's disease or stroke, and prior psychoactive medication use [9]. Several cases of patients in pediatric and adult populations with acute SARS-CoV-2 infection presenting with MERS or CLOCCs have been reported [3][4][5][8][9][10][11]. Three cases of MERS following SARS-CoV-2 vaccination have also been reported [10][11].…”

“…Several cases of patients in pediatric and adult populations with acute SARS-CoV-2 infection presenting with MERS or CLOCCs have been reported [3][4][5][8][9][10][11]. Three cases of MERS following SARS-CoV-2 vaccination have also been reported [10][11].…”