A case of acute demyelinating polyradiculoneuropathy with bilateral facial palsy after ChAdOx1 nCoV-19 vaccine

Nasuelli, Nicola; Marchi, Fabiola De; Cecchin, Michela; Paoli, Irene; Onorato, Susanna; Pettinaroli, Roberto; Savoini, G.; Godi, L.

doi:10.1007/s10072-021-05467-w

Cited by 54 publications

(45 citation statements)

References 9 publications

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“…Nasuelli et al has reported a case of acute demyelinating polyradiculoneuropathy with bilateral facial palsy after AstraZeneca chimpanzee adenovirus vectored vaccine ChAdOx1 nCoV-19 vaccine. 6 The two patients we report here were of similar ages and presented within 1 week of each other, this may be a result of the age-specific vaccination scheme in the UK.…”

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

“…3–5 To date, there have been few case reports of GBS following COVID-19 vaccination reported whereas millions of vaccines have been administered in the UK. 6 7 Therefore, the causal link is not yet provable but given the severity of the cases involved, there is a need for awareness among the clinicians about this possible association. There is also no indication that COVID-19 vaccines should stop being administered and we fully support the current WHO recommendations.…”

Section: Introductionmentioning

confidence: 99%

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Guillain‐Barré syndrome presenting with facial diplegia following COVID‐19 vaccination in two patients

Kanabar

Wilkinson

2021

BMJ Case Rep

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In March 2020, the WHO declared COVID‐19 to be a global pandemic and since December 2020, millions of vaccines have been administered. To date, cases of Guillain‐Barré syndrome (GBS) following a COVID vaccine (Pfizer, Johnson & Johnson, Janssen, AstraZeneca) have been reported. A 61-year-old woman developed bilateral asymmetrical lower motor neuron (LMN) facial weakness followed by limb symptoms, 10 days after receiving the first dose of AstraZeneca COVID vaccine. The second patient was a 56-year-old man who, 9 days after receiving first dose of AstraZeneca COVID vaccine, developed bilateral asymmetrical LMN facial weakness with limb symptoms. Intravenous immunoglobulin was administered with rapid recovery. These cases of GBS following the AstraZeneca COVID vaccine add to cohort of patients reported. We flag up to raise awareness of this condition post‐COVID‐19 vaccine and highlight the prominent bifacial involvement. Early diagnosis and prompt treatment with intravenous immunoglobulin led to rapid recovery.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Guillain‐Barré syndrome presenting with facial diplegia following COVID‐19 vaccination in two patients

Kanabar

Wilkinson

2021

BMJ Case Rep

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“…Cases of GBS have been reported after both ChAdOx1 or BNT162b2. [22–25] In the U.S, 78 cases of GBS have been reported after the use of the adenoviral vector vaccine from Janssen, with a reported frequency of 7.8 cases per million doses,[26] similar to the 6.3 reports per million doses with ChAdOx1, which like the Janssen vaccine is also an adenoviral vector vaccine. Damage to axonal or myelin membranes mediated directly by vaccine virus or vaccine-associated products and cross-reactivity with epitopes on myelin or axonal glycoproteins of peripheral nerves, have been cited as potential mechanisms behind GBS following the administration of vaccines.…”

Section: Discussionmentioning

confidence: 99%

Disproportionality analysis of adverse neurological and psychiatric reactions with the ChAdOx1 (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in the United Kingdom

Pérez-Lloret

Petrovsky

Alami

et al. 2021

Preprint

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Objective: The information on neurologic or psychiatric adverse reactions to the COVID-19 vaccines is limited. Our objective was to examine the odds of neurological and psychiatric adverse reactions to BNT162b2 (Pfizer-BioNTech) and ChAdOx1 (Oxford-AstraZeneca) COVID-19 vaccines. Methods: We analyzed all Adverse Vaccine Reaction reports to the United Kingdom Medicines and Healthcare products Regulatory Agency between December 9, 2020 and June 30, 2021 that mentioned the BNT162b2 or ChAdOx1 vaccines. We compared the rates of adverse neurological and psychiatric reactions with ChAdOx1 to those with BNT162b2. P-values were obtained by a Bonferroni-adjusted Z-test for proportions. Results: As of June 30, 2021, 53.2 M doses of ChAdOx1 and 46.1 M doses of BNT162b2 had been administered. We extracted information from 300,518 distinct reports. The number of individual adverse neurologic or psychiatric reaction reports were less than 200/M doses administered, except headache which was reported in 1,550 and 395 cases/M doses of ChAdOx1 and BNT162b2, respectively. Compared to BNT162b2, cerebral hemorrhagic or thrombotic events, headaches and migraines, Guillain-Barre syndrome and paresthesias, tremor and freezing, delirium, hallucinations, nervousness, poor sleep quality, and postural dizziness were more frequently reported with ChAdOx1. Reactions more frequently reported with BNT162b2 than ChAdOx1 were Bell's palsy, facial paralysis, dysgeusia, anxiety, and presyncope or syncope. Conclusion: Significant differences in the neurologic and psychiatric adverse event profiles of the ChAdOx1 and BNT162b2 vaccines may exist, emphasizing the need for additional research. The beneficial and protective effects of the COVID-19 vaccines far outweigh the low potential risk of neurologic and psychiatric reactions.

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“…[6] Instances of these and other neuro-immune events also have been reported elsewhere. Reports after ChAdOx1 include seven cases of GBS in India, [7] two in the UK, [8,9] one in each of in France, [10] Italy, [11] and Malta, [12] and nine cases of bifacial weakness with paresthesias, a variant of GBS, in the UK, [13,14] and one in Italy, [15] and two cases of sensory GBS in Korea. [16] Three cases of acute transverse myelitis were reported during the clinical trials for ChAdOx1, [17,18] two in case studies, [19,20] and one report of longitudinal extensive transverse myelitis after ChAdOx1 vaccination reported in a case study.…”

Section: Main Text [3177words] Introductionmentioning

confidence: 99%

“Association between COVID-19 vaccination, infection, and risk of Guillain-Barre syndrome, Bell’s palsy, encephalomyelitis and transverse myelitis: a population-based cohort and self-controlled case series analysis”

Martínez‐Hernández

Herranz

et al. 2021

Preprint

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OBJECTIVE We aimed to study the association between COVID-19 vaccines, SARS-CoV-2 infection, and the risk of immune-mediated neurological events. METHODS Design Population-based historical rate comparison study and self-controlled case series (SCCS) analysis. Setting Primary care records from the United Kingdom. Participants Individuals who received the first dose of ChAdOx1 or BNT162b2 between 8 December 2020 and 6 March 2021. A cohort with a first positive RT-PCR test for SARS-CoV-2 between 1 September 2020 and 28 February 2021 was used for comparison. Main outcome measures Outcomes included Guillain-Barre syndrome (GBS), Bell's palsy, encephalomyelitis, and transverse myelitis. Incidence rates were estimated in the 28 days post first-dose vaccine, 90 days post-COVID-19, and between 2017 to 2019 for the general population cohort for background rates. Indirectly standardised incidence ratios (SIRs) were estimated. Adjusted incidence rate ratios (IRR) were estimated from the SCCS when sufficient statistical power was reached. Results We included 1,868,767 ChAdOx1 and 1,661,139 BNT162b2 vaccinees; 299,311 people infected with COVID-19; and 2,290,537 from the general population. SIRs for GBS were 1.91 [95% CI: 0.86 to 4.26] after ChAdOx1, 1.29 [0.49 to 3.45] after BNT162b2, and 5.20 [1.95 to 13.85] after COVID-19. In the same cohorts, SIRs for Bell's palsy were 1.34 [1.05 to 1.72], 1.15 [0.88 to 1.50], and 1.23 [0.80 to 1.89], and for encephalomyelitis 1.62 [0.61 to 4.31], 0.86 [0.22 to 3.46], and 11.05 [5.27 to 23.17], respectively. Transverse myelitis was too rare to analyse (n<5 in all cohorts). SCCS analysis was only conducted for Bell's palsy due to limited statistical power. We found no association between either vaccine and Bell's palsy, with an IRR of 1.10 [0.81 to 1.46] and 1.15 [0.87 to 1.49] for BNT162b2 and ChAdOx1, respectively. Conclusions We found no consistent association between either vaccine and any of the studied neuro-immune adverse events studied. Conversely, we found a 5-fold increase in risk of GBS and an 11-fold of encephalomyelitis following COVID-19.

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A case of acute demyelinating polyradiculoneuropathy with bilateral facial palsy after ChAdOx1 nCoV-19 vaccine

Cited by 54 publications

References 9 publications

Guillain‐Barré syndrome presenting with facial diplegia following COVID‐19 vaccination in two patients

Guillain‐Barré syndrome presenting with facial diplegia following COVID‐19 vaccination in two patients

Disproportionality analysis of adverse neurological and psychiatric reactions with the ChAdOx1 (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in the United Kingdom

“Association between COVID-19 vaccination, infection, and risk of Guillain-Barre syndrome, Bell’s palsy, encephalomyelitis and transverse myelitis: a population-based cohort and self-controlled case series analysis”

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