Post COVID-19 vaccination neuromyelitis optica spectrum disorder: Case report & MRI findings

Abstract

There are rising concerns among the medical community and the public regarding the side effects of different vaccines developed throughout the world and their short and long-term effects, particularly COVID19 vaccines. Most notably, post-vaccination demyelinating diseases such as acute disseminated encephalomyelitis, transverse myelitis, and multiple sclerosis relapses have been reported. We present a case of a 32-year-old male who presented with a 2 weeks history of acute confusional state and imbalance 1 week after receiving the second dose of COVID19 vaccination. MRI findings showed typical distribution of neuromyelitis optica spectrum disorder and the patient was positive for AQP4 IgG. The pathogenesis behind developing neuromyelitis optica and vaccines is still unknown. Few case reports have been reported of post-vaccination neuromyelitis optica spectrum disorder but to our knowledge, this would be the first case published of neuromyelitis optica following exposure to COVID19 vaccine.

Neuromyelitis optica complicating COVID vaccinations

“…Despite normal AQP-IgG antibodies NMOSD was diagnosed and steroids restarted resulting in incomplete recovery at the last follow up ( Fujikawa et al, 2021 Sep 14 ). Post-SARS-CoV-2 vaccination NMOSD has been also reported in a 32 years old male who developed balance impairment and a confusional state one week after the second dose of the Sputnik-V vaccine ( Badrawi et al, 2021 Dec ). Cerebral and spinal MRI showed patchy, FLAIR hyperintense lesions along the ependymal surface of the lateral, third, and fourth ventricles, thalamus, corpus callosum, and optic chiasm ( Badrawi et al, 2021 Dec ).…”

“…Post-SARS-CoV-2 vaccination NMOSD has been also reported in a 32 years old male who developed balance impairment and a confusional state one week after the second dose of the Sputnik-V vaccine ( Badrawi et al, 2021 Dec ). Cerebral and spinal MRI showed patchy, FLAIR hyperintense lesions along the ependymal surface of the lateral, third, and fourth ventricles, thalamus, corpus callosum, and optic chiasm ( Badrawi et al, 2021 Dec ). Since AQP-IgG antibodies were positive, NMOSD was diagnosed and upon several plasmaphereses incomplete recovery could be achieved ( Badrawi et al, 2021 Dec ).…”

Real-world data about the side effects of SARS-CoV-2 vaccinations can be obtained only from representative samples undergoing comprehensive investigations

“…Only marginally discussed was the issue that SARS-CoV-2 vaccinations can trigger neuro-immunological disease, such as multiple sclerosis, or can induce flares of known neuro-immunological disorders such as multiple sclerosis or NMO ( Khayat-Khoei et al., 2021 Sep 4 ). An example of such an adverse reaction is the case of a 32 years-old male with an uneventful previous history who presented with a confusional state, dizziness, headache, and imbalance starting one week after the second dose of the Sputnik-V vaccine ( Badrawi et al., 2021 ). Since cerebral MRI showed typical morphology of NMO and aquaporin-4 IgG were positive, the patient was diagnosed with NMO ( Badrawi et al., 2021 ).…”

“…An example of such an adverse reaction is the case of a 32 years-old male with an uneventful previous history who presented with a confusional state, dizziness, headache, and imbalance starting one week after the second dose of the Sputnik-V vaccine ( Badrawi et al., 2021 ). Since cerebral MRI showed typical morphology of NMO and aquaporin-4 IgG were positive, the patient was diagnosed with NMO ( Badrawi et al., 2021 ). Repeated plasmaphereses was beneficial ( Badrawi et al., 2021 ).…”

“…Since cerebral MRI showed typical morphology of NMO and aquaporin-4 IgG were positive, the patient was diagnosed with NMO ( Badrawi et al., 2021 ). Repeated plasmaphereses was beneficial ( Badrawi et al., 2021 ).…”