Two Cases of Post-Moderna COVID-19 Vaccine Encephalopathy Associated With Nonconvulsive Status Epilepticus

Liu, Benjamin D.; Ugolini, Corrado; Jha, Pinky

doi:10.7759/cureus.16172

Cited by 36 publications

(50 citation statements)

References 14 publications

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“…Neurological symptoms like pain, headache, dizziness, or muscle spasms are common and self-limited adverse effects after receiving the COVID-19 vaccine. However, major neurological complications, despite the unproven causality, have been reported since the introduction of the COVID-19 vaccine, such as facial palsy, Guillain-Barré syndrome (GBS), seizures, strokes, transverse myelitis, acute disseminated encephalomyelitis (ADEM) and postvaccinal encephalitis ( 13 – 16 ).In addition, an unexplained acute encephalopathy state has also been described after receiving the COVID-19 vaccine ( 13 , 17 , 18 ). The pathophysiology of those complications is still not well understood and only based on hypotheses.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding mRNA vaccines, it has been proposed that spike protein expression by human cells (after translation of the mRNA COVID-19 vaccine by human cells) might trigger an inflammatory reaction, similar to that induced by the virus itself, leading to those neurological complications ( 17 , 21 ). However, other mechanisms might be involved.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Anti-LGI1 Encephalitis Following COVID-19 Vaccination

Zlotnik

Gadoth²,

Abu-Salameh

et al. 2022

Front. Immunol.

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Anti-leucine rich glioma inactivated 1 (LGI1) autoimmune encephalitis (AE) is characterized by cognitive impairment or rapid progressive dementia, psychiatric disorders, faciobrachial dystonic seizures (FBDS) and refractory hyponatremia. Since December 2020, millions of people worldwide have been vaccinated against COVID-19. Several soft neurological symptoms like pain, headache, dizziness, or muscle spasms are common and self-limited adverse effects after receiving the COVID-19 vaccine. However, several major neurological complications, despite the unproven causality, have been reported since the introduction of the COVID-19 vaccine. Herein, we describe a 48 years old man presenting with rapidly progressive cognitive decline and hyponatremia diagnosed with anti LGI1 AE, occurring shortly after the second dose of mRNA COVID -19 vaccine and possibly representing a severe adverse event related to the vaccination. Response to high dose steroid therapy was favorable. As millions of people worldwide are currently receiving COVID-19 vaccinations, this case should serve to increase the awareness for possible rare autoimmune reactions following this novel vaccination in general, and particularly of anti-LGI1 AE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case Report: Anti-LGI1 Encephalitis Following COVID-19 Vaccination

Zlotnik

Gadoth²,

Abu-Salameh

et al. 2022

Front. Immunol.

View full text Add to dashboard Cite

show abstract

“…The severe acute respiratory syndrome coronavirus 2 glycoprotein is included in this antigen. As a result, it can be mentioned that the creation of the spike protein by cells that translate the mRNA initiates the same immune response as a COVID-19 infestation, increased inflammatory signals, culminating in these neurotropic consequences [ 7 ]. Notably, our patient meets this criterion due to high CRP, ESR, and D-dimer levels within days following symptoms began and 2 days from the first immunization.…”

Section: Discussionmentioning

confidence: 99%

“…The most common complications following uptake of the inactivated COVID-19 vaccines are mild pain at the injection site, fatigue, headache, muscle pain, joint pain, chills, and fever [ 6 ]. Along with these, several adverse complications, including shingles, myocardial infarction, and acute encephalopathy, were also observed among people who took the Moderna vaccine [ 7 8 9 ]. While directly jumping to firm conclusions regarding the side effects of COVID-19 vaccines would be severely harmful to the mass vaccination coverage program, it is necessary, as we wait for solid clinical evidence, to carefully observe the immediate onset of severe disorders after vaccination.…”

Section: Introductionmentioning

confidence: 99%

A case of acute encephalopathy and non-ST segment elevation myocardial infarction following mRNA-1273 vaccination: possible adverse effect?

Barsha¹,

Haque

Rashid

et al. 2021

Clin Exp Vaccine Res

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A 77-year-old man with a past medical history of type 2 diabetes mellitus, peripheral neuropathy, and chronic obstructive pulmonary disease was admitted to the intensive care unit of Bangladesh Medical College Hospital with acute encephalopathy and non-ST segment elevation myocardial infarction (NSTEMI). The patient was on antidiabetic medicine along with H 2 blocker and multivitamins for his existing diseases. The patient’s attendant reported that the patient had received his first dose of the Moderna coronavirus disease 2019 (COVID-19) vaccine just 2 days ago. Physical examination revealed that he had a Glasgow Coma Scale of 8/15; a pulse of 106 beats/min; a respiratory rate of 30 breaths/min; oxygen saturation of 80% on room air, which became with 10 L of oxygen and blood pressure of 90/60 mm Hg at the time of admission. During the hospital stay, the patient was treated conservatively with intravenous antibiotics and other necessary medication. Although we have observed the onset of encephalopathy and NSTEMI following COVID vaccination for this patient, we, as healthcare professionals, cannot directly attribute the cause of the complications to the Moderna vaccine without further epidemiological studies with large samples.

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“…40 In another study, an 83-year-old woman and a 76-year-old man with no previous neurological diseases presented with seizures and encephalopathy after receiving Spikevax Moderna COVID-19 vaccination. 41 These COVID-19 vaccine-associated seizures could be attributed to the vaccine-induced cell machinery synthesizing and releasing spike protein, which stimulates an exaggerated inflammatory condition and causes hyperthermia. It is worth mentioning that hyperthermia has been recognized to induce glial cell activation and increase BBB permeability.…”

Section: Seizuresmentioning

confidence: 99%

Post COVID-19 Vaccination-Associated Neurological Complications

Assiri¹,

Althaqafi²,

Alswat³

et al. 2022

NDT

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Neurological sequelae after COVID-19 vaccination are rare. We investigated the possible pathogenesis behind the development of neurological complications within a short period after Saudi residents received a COVID-19 vaccine. Patients and Methods: We evaluated 18 patients who recently received a COVID-19 vaccine (Comirnaty and Vaxzevria vaccines) and presented with neurological complications to the Saudi German Hospitals in Jeddah, Saudi Arabia. Neurologists assessed the patients' clinical presentation, radiological investigations, and laboratory findings. Results: Three patients who received the first dose of the Vaxzevria vaccine experienced severe cerebral venous thrombosis, two of them were complicated by intracranial hemorrhage. Their laboratory investigations showed very high d-dimers and severe thrombocytopenia, which have been linked to higher mortality and poor outcome. Ischemic stroke occurred in eight cases (44.4%) with a predominance in older male patients. Three patients presented with seizures, two had optic neuritis. Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) occurred in two male patients following vaccination with Comirnaty. Conclusion: Neurological complications after COVID-19 vaccinations are very rare, and only a few cases have been reported worldwide. The shared pathophysiological basis between COVID-19 viral infection and COVID-19 vaccines stands behind the very rare neurological complications resulting from the hypercoagulable state triggered by the general inflammatory condition. We suspect some differences in the pathogenesis of ischemic stroke caused by COVID-19 infection and COVID-19 vaccines, which render COVID-19 vaccine-associated ischemic stroke more responsive to treatment. To date, no definitive association between the vaccine and GBS has been proven by any strong evidence, but it has recently been added as a very rare side effect of the Janssen COVID-19 vaccine. No possible links of Miller Fisher syndrome to COVID-19 vaccines have been reported before the one reported in this study.

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Two Cases of Post-Moderna COVID-19 Vaccine Encephalopathy Associated With Nonconvulsive Status Epilepticus

Cited by 36 publications

References 14 publications

Case Report: Anti-LGI1 Encephalitis Following COVID-19 Vaccination

Case Report: Anti-LGI1 Encephalitis Following COVID-19 Vaccination

A case of acute encephalopathy and non-ST segment elevation myocardial infarction following mRNA-1273 vaccination: possible adverse effect?

Post COVID-19 Vaccination-Associated Neurological Complications

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