Cytotoxic Lesion of the Corpus Callosum (CLOCCs) after SARS-CoV-2 mRNA Vaccination

Youn, Taeho; Yang, Hee Won

doi:10.3346/jkms.2021.36.e228

Cited by 15 publications

(12 citation statements)

References 5 publications

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“…Although he had recent clinical Lyme disease, we do not believe it explains his MIS-C-like syndrome. Our patient's clinical presentation has similarities with previous reports of CLOCCs in children in the setting of COVID-19 or MIS-C [1], probable myocarditis after COVID-19 vaccination in children [14][15][16], and CLOCC in a previously healthy young male after initial COVID-19 mRNA vaccination [17].…”

Section: Discussionsupporting

confidence: 82%

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

et al. 2021

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A 12-year-old male was presented to the hospital with acute encephalopathy, headache, vomiting, diarrhea, and elevated troponin after recent COVID-19 vaccination. Two days prior to admission and before symptom onset, he received the second dose of the Pfizer-BioNTech COVID-19 vaccine. Symptoms developed within 24 h with worsening neurologic symptoms, necessitating admission to the pediatric intensive care unit. Brain magnetic resonance imaging within 16 h of admission revealed a cytotoxic splenial lesion of the corpus callosum (CLOCC). Nineteen days prior to admission, he developed erythema migrans, and completed an amoxicillin treatment course for clinical Lyme disease. However, Lyme antibody titers were negative on admission and nine days later, making active Lyme disease an unlikely explanation for his presentation to hospital. An extensive workup for other etiologies on cerebrospinal fluid and blood samples was negative, including infectious and autoimmune causes and known immune deficiencies. Three weeks after hospital discharge, all of his symptoms had dissipated, and he had a normal neurologic exam. Our report highlights a potential role of mRNA vaccine-induced immunity leading to MIS-C-like symptoms with cardiac involvement and a CLOCC in a recently vaccinated child and the complexity of establishing a causal association with vaccination. The child recovered without receipt of immune modulatory treatment.

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Section: Discussionsupporting

confidence: 82%

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

et al. 2021

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“…To the best of our knowledge, this is the first report of neurological manifestations with CLOCCs that occurred approximately 1 week after COVID-19 vaccination. Thus far, 2 case reports showed that CLOCCs emerged 2 or 3 days after COVID-19 vaccination [11,12]. On the other hand, Patient 1 in our study demonstrated that MRI on Day 9 was negative for the splenial lesion and CLOCCs was noticed on Day 18, and IL-6 elevation in the CSF.…”

Section: Discussionmentioning

confidence: 43%

Cytotoxic lesions of the corpus callosum after COVID-19 vaccination

Ohara

Shimizu

Kasamatsu³

et al. 2022

Neuroradiology

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A 23-year-old previously healthy man (Patient 1) and a 33-year-old woman with a past history of depression (Patient 2) developed neurological symptoms approximately 1 week after receipt of the first COVID-19 mRNA vaccination and deteriorated over the next week. Patient 1 reported nausea, headache, a high fever, and retrograde amnesia. Patient 2 reported visual disturbance, headache, dysarthria, a left forearm tremor, dysesthesia of the mouth and distal limbs, and visual agnosia. PCR test results for SARS-CoV-2 were negative. Complete blood cell count, biochemistry, and antibody test and cerebrospinal fluid test findings were unremarkable. Diffusion-weighted and fluid-attenuated inversion recovery MRI of the brain showed a high signal intensity lesion at the midline of the splenium of the corpus callosum compatible with cytotoxic lesions of the corpus callosum (CLOCCs). High-dose intravenous methylprednisolone improved their symptoms and imaging findings. CLOCCs should be considered in patients with neurological manifestation after COVID-19 vaccination.

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“…[1][2]7 It is important to notice that CLOCCs have been recently associated with COVID-19 and SARS-CoV-2 mRNA vaccine (BNT162b). [3][4] To our knowledge, this is the second case of CLOCCs after SARS-CoV-2 vaccination described in the literature. Fever is usually a prodromic manifestation and is accompanied by headache.…”

Section: Discussionmentioning

confidence: 76%

“…In this case, initial symptoms have started 2 days after SARS-CoV-2 mRNA vaccine, a finding consistent with the data reported by Youn et al, who reported a case of cytotoxic lesions of the corpus callosum 3 days after BNT162b vaccine. 3 As regards CLOCCs correlated to other vaccinations, only mumps vaccination has been previously associated with CLOCCs and some authors have reported that the onset of symptoms ranged from 13 to 21 days after mumps vaccination, likely to the incubation period of mumps infection. 8 - 9 Typical MRI characteristics demonstrate a transient and reversible hyperintense lesion on long TR sequences in the corpus callosum, associated with restricted diffusion on diffusion-weighted images (DWIs).…”

Section: Discussionmentioning

confidence: 99%

“…Restricted diffusion and no contrast enhancement are typically associated with the finding. Cytotoxic lesions of the corpus callosum have been recently associated with coronavirus disease 2019 (COVID-19) and SARS-CoV-2 mRNA vaccine (BNT162b) 3 - 4 and may share clinical and radiological features with acute disseminated encephalomyelitis (ADEM). 5 …”

Section: Introductionmentioning

confidence: 99%

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“Reversible cytotoxic lesion of the corpus callosum following SARS-CoV-2 mRNA vaccine administration: a finding to be aware of”

et al. 2022

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Cytotoxic lesions of the corpus callosum (CLOCCs) are a clinical-radiological spectrum of disorders secondary to several etiopathogeneses. Cytotoxic lesions of the corpus callosum are typically associated with mild clinical symptoms including fever, headache, confusion, and altered mental status. We present a case of a 51-year-old Caucasian woman who developed a reversible lesion of the splenium of the corpus callosum associated with small round-shaped white matter hyperintensities after the first dose of SARS-CoV-2 mRNA vaccine. Magnetic resonance imaging is fundamental for diagnosis and no treatment is generally required.

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Cytotoxic Lesion of the Corpus Callosum (CLOCCs) after SARS-CoV-2 mRNA Vaccination

Abstract: Graphical Abstract

Cited by 15 publications

References 5 publications

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

Multisystem Inflammatory-like Syndrome in a Child Following COVID-19 mRNA Vaccination

Cytotoxic lesions of the corpus callosum after COVID-19 vaccination

“Reversible cytotoxic lesion of the corpus callosum following SARS-CoV-2 mRNA vaccine administration: a finding to be aware of”

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