Multiple cranial nerve palsies following COVID‐19 vaccination—Case report

Abstract

Background The novel COVID‐19 vaccines have side effects that require efficient and close monitoring. Aims of the Study To examine whether the Pfizer‐BioNTech vaccine is associated with multiple cranial neuropathy. Methods We report the case of a 29‐year‐old male patient with no notable history who presented with left oculomotor, abducens, trigeminal and facial palsies 6 days after receiving the first dose of the Pfizer‐BioNTech COVID‐19 vaccine. Results Gadolinium‐enhanced MRI of the brain revealed enhancement in the left facial, trigeminal and oculomotor nerves, which persisted upon repeated examination. The cerebrospinal fluid analysis showed no sign of inflammation, both initially and after 1 month from the start of the patient's symptoms. Other causes were excluded by laboratory tests. The patient received high doses of corticosteroids, with improvement of symptoms. Conclusions In our case, the most probable etiology of the patient's multiple cranial neuropathy is the Pfizer‐BioNTech vaccine, which highlights the need for prolonged surveillance of COVID‐19 vaccine neurological complications.

Ocular Complications Following Vaccination for COVID-19: A One-Year Retrospective

“…Manea et al reported on a 29-year-old man who developed multiple cranial neuropathies six days after receiving his first dose of the BNT162b2 vaccine [123]. In particular, he developed incomplete oculomotor (3rd cranial), abducens (6th cranial), and facial (7th cranial) nerve palsies.…”

Third cranial nerve palsy in an 88-year-old man after SARS-CoV-2 mRNA vaccination: change of injection site and type of vaccine resulted in an uneventful second dose with humoral immune response

“…14 Recently, a report of multiple left-sided cranial neuropathies (an incomplete oculomotor palsy without ptosis, partial abducens palsy, hypoesthesia in middle and lower trigeminal nerve distributions, as well as facial nerve palsy-House-Brackmann grade III) has been described in a patient whose symptoms started 6 days after receiving the first dose of the Pfizer-BioNTech SARS-CoV-2 vaccination. 7 No defined mechanism has been identified for cranial nerve palsies following SARS-CoV-2 mRNA vaccination. Post-vaccine nerve palsy could be interpreted as an autoimmune phenomenon, occurring via either mimicry of host molecules by the vaccinal antigen or activation of quiescent autoreactive T cells.…”

“…Acute peripheral facial nerve paralysis as an AE following immunisation is a rare adverse reaction (1 of 10 000 to 1 of 1000) described in the product information of SARS-CoV-2 mRNA vaccines. However, the incidence of nerve palsy, including facial, is not reported as being higher than other vaccines, such as the Haemophilus influenzae type B vaccine, the pneumococcal 7-valent conjugate, diphtheria, tetanus, whole-cell pertussis vaccine, as well as measles, mumps and rubella vaccine 3 7 8. Moreover, a recent study demonstrated that the level of reporting of facial nerve palsies after SARS-CoV-2 mRNA vaccination was generally equivalent to those following influenza vaccines prior to the COVID-19 pandemic 8…”

“…Aside from the most frequently involved facial nerve, published cases involved abducens nerve palsy 2 days after Pfizer-BioNTech SARS-CoV-2 vaccine13 and other disimmune ocular AEs 14. Recently, a report of multiple left-sided cranial neuropathies (an incomplete oculomotor palsy without ptosis, partial abducens palsy, hypoesthesia in middle and lower trigeminal nerve distributions, as well as facial nerve palsy—House-Brackmann grade III) has been described in a patient whose symptoms started 6 days after receiving the first dose of the Pfizer-BioNTech SARS-CoV-2 vaccination 7…”

Multiple cranial nerve palsies and COVID‐19 vaccination

“…Maneaet al1 concluded that "the most probable etiology of the patient's multiple cranial neuropathy is …..COVID-19 vaccine neurological complications." The neurological adverse effect of COVID-19 vaccination is possible.…”