Optic neuromyelitis after vaccination against SARS-CoV-2

Abstract

Neuromyelitis optica is an autoimmune demyelinating astrocytopathy of the central nervous system that primarily affects the optic nerve and spinal cord. It is considered a multifactorial disease associated with antibodies against aquaporin 4, with complement cascade activation and lymphocytic infiltration leading to axonal loss and causing significant morbidity and disability. In addition, cases of inflammatory diseases of the central nervous system have been described after vaccination against SARS-CoV-2, mainly acute disseminated encephalomyelitis. Also, a few cases of neuromyelitis optica spectrum disorder, mostly aquaporin 4+, have been reported. We describe a patient who developed symptoms suggestive of acute disseminated encephalomyelitis the next day after vaccination against SARS-CoV-2. Three months later, a longitudinally extensive transverse myelitis compatible with aquaporin 4+ neuromyelitis optica was successfully treated with an interleukin 6 inhibitor. There is no proven association and research is needed to establish whether optic neuromyelitis is related to vaccination; this is a single case report from which no conclusion can be drawn.

Neurological Adverse Reactions to SARS-CoV-2 Vaccines

“…SC2V-related cerebrovascular diseases include VST, ischemic stroke, ICH, SAB, pituitary apoplexy, RCVS, cerebral vasculitis, and Susac syndrome ( Table 2 ) [ 4 , 6 …”

“…There are a number of reports about vaccinees which reported newly onset or flares (exacerbations) of demyelinating CNS disorders following a SC2V [ 81 ]. Newly onset or exacerbating demyelinating disorders reported after SC2Vs include multiple sclerosis [ 81 , 82 ], cerebral isolated syndrome [ 81 ], optic neuritis [ 83 ], neuromyelitis optica (NMO) spectrum disorders (NMOSD) [ 84 - 86 ], and myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD) [ 62 ]. There is also one report about a 56-year-old female who developed a tumefactive, demyelinating, subcortical lesion 2 days after the first AZV dose [ 87 ].…”