Childhood primary angiitis of the central nervous system following COVID-19 vaccination (BNT162b2/Pfizer-BioNtech): A case report

Abstract

Childhood primary angiitis of the central nervous system (cPACNS) is a vasculitis of unknown etiology that is confined to the central nervous system (CNS) and can lead to repeated cerebral infarctions if left untreated. Several cases of cPACNS after COVID-19 have been reported. Herein, we present a case of post-vaccination cPACNS. A 9-year-old healthy boy presented with persistent headache and fever after receiving the second COVID-19 vaccine (BNT162b2/Pfizer-BioNtech) dose. Brain magnetic resonance angiography (MRA) performed on the sixth day of symptom onset after vaccination revealed stenosis of the left middle cerebral artery; the patient was referred to our department on the 12th day of symptom onset. Blood tests indicated only minimal evidence of inflammation, whereas cerebrospinal fluid examination indicated pleocytosis. Brain magnetic resonance imaging (MRI) revealed vascular wall thickening and contrast enhancement of the artery with worsened stenosis. We diagnosed the patient as having cPACNS and treated him with three courses of methylprednisolone pulse therapy. The headaches and fever disappeared with improvement of vascular stenosis. The patient has been in remission for more than 1 year since cPACNS onset. This is the first report of a case of cPACNS after mRNA vaccination for COVID-19. Most previous cases of COVID-19-associated cPACNS presented with ischemic stroke. However, the present case could be treated for vasculitis prior to stroke and thus had a favorable prognosis. The mRNA vaccine for COVID-19 differs from other existing vaccines, and further accumulation of data of cases is required to determine adverse CNS reactions.

COVID-19 vaccination-related tinnitus is associated with pre-vaccination metabolic disorders

“…In addition to direct interaction with the brain cells, COVID-19 vaccines can cause rapid systemic inflammatory responses secondary to reactogenicity of the vaccines ( Heo et al, 2022 ). COVID-19 vaccines have also been associated with endothelial dysfunction and vascular inflammation ( Terentes-Printzios et al, 2022 ; Yoshimoto et al, 2023 ; Cernera et al, 2024 ), including brain blood vessels ( Ariyoshi et al, 2023 ). These systemic and vascular inflammation could disrupt blood-brain barrier and other brain function, and potentially lead to tinnitus and other mental health issues (G. Yang, Parkhurst, Hayes and Gan, 2013 ).…”

Neurovascular Adverse Effects of Sars-Cov-2 Vaccination

“…Whereas several cases of PACNS after COVID-19 have been reported, 77 , 78 we found only a case of primary angiitis of the central nervous system in a 9-year-old boy following his second dose of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2). 79 Symptoms began one day post-vaccination, including persistent headache and fever. Diagnostic MRI on the sixth day revealed stenosis of the left middle cerebral artery.…”