Painless idiopathic neuralgic amyotrophy after COVID‐19 vaccination: A case report

Abstract

Painless idiopathic neuralgic amyotrophy after COVID-19 vaccination: A case reportOn December 11, 2020, the Food and Drug Administration issued an emergency use authorization of the Pfizer-BioNtech COVID-19 vaccine for coronavirus disease 2019 (COVID-19) infection prevention, consisting of two intramuscularly administered doses 21 days apart. 1 Large-scale placebo-controlled studies showed a 95% efficacy for COVID-19 infection prevention, with injection-site pain, fatigue, and headaches being commonly reported adverse events. 2 Although idiopathic neuralgic amyotrophy (INA) has been reported after COVID-19 infection, there are currently no published cases of INA occurring after COVID-19 vaccination. 3 A 35-year-old left-hand dominant woman presented with new-onset painless left-arm weakness, numbness, and paresthesias 9 days after receiving the Pfizer-BioNtech COVID-19 vaccine in the right deltoid. She had no history of neurologic diseases or allergies and denied recent trauma or infection. A detailed physical examination showed left upper extremity decreased antigravity strength in the deltoid, supraspinatus, biceps brachii, triceps brachii, extensor carpi radialis, extensor digitorum communis, extensor indicis proprius, flexor digitorum superficialis, and flexor digitorum profundus. Left-arm light touch sensation was decreased in the lateral antebrachial cutaneous (LAC), radial, and median nerve distributions. Hyporeflexia of the left biceps, brachioradialis, and triceps deep-tendon reflexes was present. Normal strength, sensation, and reflexes were present in the right upper extremity, without increased tone, fasciculations, or atrophy. She exhibited left medial scapular winging, with negative provocative tests for radiculopathy, musculoskeletal shoulder pathology, and peripheral nerve entrapment.Cervical spine computed tomography showed mild degenerative changes without foraminal narrowing. She was started on high-dose prednisone after neurology and physiatry evaluations, with paresthesia improvement and weakness stabilization within 1 week of medication initiation. Serologic evaluation including C-reactive protein, erythrocyte sedimentation rate, antinuclear antibody, rheumatoid factor, Lyme antibodies, and angiotensin-converting enzyme was negative. COVID-19 IgG and IgM antibodies were detected.The patient was reevaluated 6 weeks after symptom onset with significant strength improvement and resolved numbness and paresthesias. She underwent

Parsonage–Turner syndrome following coronavirus disease 2019 immunization with ChAdOx1-S vaccine: a case report and review of the literature

“…Parsonage-Turner syndrome has already been reported in three other patients who were vaccinated against COVID-19 (Table 1) [6][7][8]. Patients aged between 35 and 51 years, and the time to onset of first symptoms ranged from 5 to 9 days after the first dose.…”

Leg paralysis after AstraZeneca COVID-19 vaccination diagnosed as neuralgic amyotrophy of the lumbosacral plexus: a case report

“…5,6 Most patients with NA typically present with paralysis preceded by pain; however, atypical cases may suffer painless attacks. 6,7 Most cases of NA involve the brachial plexus and, less frequently, the lumbosacral plexus, peripheral nerves, and nerve roots. 7,8 The present patient presented with NA in her left leg.…”

“…NA is characterized by the sudden onset of pain, followed by patchy flaccid paralysis, muscle atrophy, and sensory deficits. 5,6 Most patients with NA typically present with paralysis preceded by pain; however, atypical cases may suffer painless attacks. 6,7 Most cases of NA involve the brachial plexus and, less frequently, the lumbosacral plexus, peripheral nerves, and nerve roots.…”

COVID-19 Vaccines and Anesthesia

“…Bunların dışında 2 olguda transvers miyelit, 4 olguda fasiyal paralizi, 1 olguda miyokard enfarktüsü bildirilmiş, ancak aşı ile direkt ilişkisi saptanamamıştır (9) . COVID-19 infeksiyonu sonrası gelişebilen idiopatik nörojenik amyotrofinin Pfizer-BioNTech aşı sonrası bir olguda görüldüğü bildirilmiştir (10) . Johnson & Johnson's Janssen aşı sonrası 6 olguda trombositopeni ve serebral venöz sinüs trombozu rapor edilmiştir (9) .…”