Clinical and Radiological Follow-Up of a Pfizer-BioNTech COVID-19 Vaccine-Induced Hemichorea-Hemiballismus

Abstract

Background: Hemichorea-hemiballismus is a rare hyperkinetic movement disorder.Case Report: A 90-year-old male developed left hemichorea-hemiballismus after his second dose of the Pfizer-BioNTech COVID-19 vaccine. A wide range of investigations including magnetic resonance imaging did not reveal an alternative cause. [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) showed increases in right putamen fixation compared to the left side. The patient showed significant improvement after five days of intravenous corticosteroids, with a normal FDG-PET.Discussion: This hemichorea-hemiballismus case shows dynamic restoration of putamen metabolism mirroring clinical evolution after administration of corticosteroids, suggesting an autoimmune COVID-19 vaccine-induced reaction.

Clinical and Radiological Follow-Up of a Pfizer-BioNTech COVID-19 Vaccine-Induced Hemichorea-Hemiballismus; Insights Into Mechanisms of Basal Ganglia Dysfunction

“…Secondary injection 28 days later results in a brisker immune response with an immediate increase in antibodies [8]. This would be consistent with the timing in the current case, with the movement disorder developing at 21 days after the initial injection and hours after the second dose [1]. The other case of hemichorea secondary to Pfizer-BioNTech vaccination occurred at about one day following the second inoculation [6].…”

“…Cerebrospinal fluid (CSF) analysis in the current patient demonstrated elevated oligoclonal bands with an otherwise normal profile [1]. CSF analyses in movement disorders due to COVID-19 infection have largely been normal or nonspecific [4].…”

“…Advanced imaging has been frequently used to help better clarify the underlying changes in non-lesional hemichorea. In this case report, the authors note reversible findings on FDG-PET, with initial decrease in contralateral putamen uptake while the patient was symptomatic that resolved following steroid treatment [1]. PET findings in hemichorea can vary, and the underlying etiology likely determines the direction of the change [11].…”

Hyperkinetic movement disorders following SARS-CoV-2 infection and vaccination — an update

“…showed increased metabolism of the right putamen (compared to the left side). Three weeks later, after steroid treatment, a repeated brain FDG-PET showed resolution of the right putamen and increased metabolism [70]. Among all cases, lumbar puncture was performed in seven patients revealing lymphocytic pleocytosis with elevated protein in one case, isolated lymphocytic pleocytosis in one case, isolated protein elevation in two cases, and normal CSF in three cases.…”

“…A total of eight patients (four women and four men, aged 36-77 years, mean 61) with COVID-19 [60][61][62][63][64][65][66] and an additional seven patients as an adverse event after vaccination against SARS-CoV-2 [67][68][69][70][71] (six men and one woman aged 13-90) have been reported to develop chorea (Tab. 2).…”