Acute Disseminated Encephalomyelitis and Acute Encephalitis Following Vaccination Against SARS-CoV-2: Two Case Reports and Review of Literature

Abstract

The spectrum of severe neurological complications following COVID-19 vaccination includes cerebrovascular events, inflammatory diseases of the CNS, cranial and peripheral nerve involvement and muscle affections. Post-vaccinal acute disseminated encephalomyelitis (ADEM) and acute encephalitis are rare. We report on a patient suffering from acute encephalitis and another with post-vaccinal monophasic ADEM. Beside imaging features typical for acute autoimmune associated inflammation, cranial MRI disclosed also transient haemorrhagic signal alterations in some cerebral lesions. To our best knowledge, this has not been mentioned before in literature. Competing causes were excluded by extensive laboratory investigations including serial CSF analysis. In line with the literature, repeated iv high-dosage corticosteroid therapy resulted in impressive improvement of neurological symptoms in both patients.

Zusammenfassung

Das Spektrum schwerer neurologischer Komplikationen nach COVID-19-Impfung umfasst zerebrovaskuläre Ereignisse, entzündliche Erkrankungen des ZNS, kraniale und periphere Nervenläsionen sowie Muskelaffektionen. Eine postvakzinale akute disseminierte Enzephalomyelitis (ADEM) oder eine akute Enzephalitis sind jedoch selten. Wir berichten über einen weiteren Fall mit einer akuten Enzephalitis und über einen Patienten mit postvakzinaler monophasischer ADEM. Neben den für eine akute autoimmunassoziierte Inflammation typischen bildgebenden Läsionsmustern zeigte die kraniale MRT auch temporäre hämorrhagische Signalalterationen. Dies wurde bislang in der Literatur noch nicht beschrieben. Konkurrierende Ursachen wurden durch umfangreiche Laboruntersuchungen inklusive serieller Liquoranalyse ausgeschlossen.

Key words

acute disseminated encephalomyelitis - encephalitis - vaccination - SARS-CoV-2 - magnetic resonance imaging

Schlüsselwörter

akute disseminierte Enzephalomyelitis - Enzephalitis - Impfung - SARS-CoV-2 - Magnetresonanztomographie

Publication History

Received: 23 November 2022

Accepted: 01 February 2023

Article published online:
17 March 2023

• References

• 1 Malhotra HS, Gupta P, Prabhu V. et al. COVID-19 vaccination-associated myelitis. QJM 2021; 114: 591-593
• 2 Garg RK, Paliwal VK. Spectrum of neurological complications following COVID 19 vaccination. Neurol Sci 2022; 43: 3-40
• 3 Al-Quliti K, Qureshi A, Quadri M. et al. Acute Demyelinating Encephalomyelitis Post-COVID-19 Vaccination: A Case Report and Literature Review. Diseases 2022; 10: 13
• 4 Bhandari B, Rayamajhi G, Lamichhane P. et al. Adverse Events following Immunization with COVID-19 Vaccines: A Narrative Review. BioMed Res International 2022; Article ID 2911333
• 5 Cao L, Ren L. Acute disseminated encephalomyelitis after severe acute respiratory syndrome coronavirus 2 vaccination: a case report. Acta Neurol Belg 2022; 122: 793-795
• 6 Diana K, Sulaiman A. Post COVID-19 Vaccine Encephalitis and Romboencephalitis: Three Cases Report. Open Access. J Neurol Neurosurg 2022; 16: 555949
• 7 Finsterer J, Korn M. Aphasia seven days after second dose of an mRNA-based SARS-CoV-2 vaccine. Brain Hemorrhages 2021; 2: 165-167
• 8 Flannery P, Yang I, Keyvani M. et al. Acute Psychosis Due to Anti-N-Methyl D-Aspartate Receptor Encephalitis Following COVID-19 Vaccination: A Case Report. Front Neurol 2021; 12: 764197
• 9 Garg A, Batra PK, Gupta P. Post COVID-19 Vaccination acute Disseminated Encephalomyelitis: A case report. Curr Med Imaging 2022; online ahead of print
• 10 Gogu AE, Motoc AG, Axelerad AD. et al. Tolosa – Hunt Syndrome and Hemorrhagic Encephalitis Presenting in a Patient after COVID-19 Vaccination Followed by COVID-19 Infection. Brain Sci 2022; 12: 902
• 11 Kaulen LD, Doubrovinskaia S, Mooshage C. et al. Neurological autoimmune diseases following vaccinations against SARS-CoV-2: a case series. Eur J Neurol 2022; 29: 555-563
• 12 Kühne Escolà J, Deuschl C, Junker A. et al. MOG antibody–associated encephalomyelitis mimicking bacterial meningomyelitis following ChAdOx1 nCoV-19 vaccination: a case report. Ther Adv Neurol Disord 2022; 15: 1-6
• 13 Lazaro LG, Perea Cossio JE, Luis MB. et al. Acute disseminated encephalomyelitis following vaccination against SARS-CoV-2: A case report. Brain Behav Immun Health 2022; 20: 100439
• 14 Manzano GS, McEntire CRS, Martinez-Lage M. et al. Acute Disseminated Encephalomyelitis and Acute Hemorrhagic Leukoencephalitis Following COVID-19: Systematic Review and Meta-synthesis. Neurol Neuroimmunol Neuroinflamm 2021; 8: e1080
• 15 Maramattom BV, Lotlikar RS, Sukumaran S. Central nervous system adverse events after ChAdOx1 vaccination. Neurol Sci 2022; 43: 3503-3507
• 16 Matsumoto Y, Ohyama A, Kubota T. et al. MOG Antibody-Associated Disorders Following SARS-CoV-2 Vaccination: A Case Report and Literature Review. Front Neurol 2022; 13: 845755
• 17 Ohara H, Shimizu H, Kasamatsu T. et al. Cytotoxic lesions of the corpus callosum after COVID 19 vaccination. Neuroradiology 2022; 64: 2085-2089
• 18 Permezel F, Borojevic B, Lau S. et al. Acute disseminated encephalomyelitis (ADEM) following recent Oxford/AstraZeneca COVID 19 vaccination. Forensic Sci Med Pathol 2022; 18: 74-79
• 19 Sivji M, Vidya MV, Pratap T. et al. Acute disseminated encephalomyelitis post-SARS-COV-2 vaccination with Chadox1 nCov-19 (AZD1222) – A rare case report. Eastern. J Med Sci 2022; 7: 47-50
• 20 Varadan B, Shankar A, Rajakumar A. et al. Acute hemorrhagic leukoencephalitis in a COVID-19 patient – a case report with literature review. Neuroradiology 2021; 63: 653-661
• 21 Zlotnik Y, Gadoth A, Abu-Salameh I. et al. Case Report: Anti-LGI1 Encephalitis Following COVID-19 Vaccination. Front Immunol 2022; 12: 813487
• 22 Zuhorn F, Graf T, Klingebiel R. et al. Postvaccinal encephalitis after ChAdOx1 nCov-19. Ann Neurol 2021; 90: 506-511
• 23 Khan E, Shrestha AK, Colantonio MA. et al. Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature. J Neurol 2022; 269: 1121-1132
• 24 Pagenkopf C, Südmeyer M. A case of longitudinally extensive transverse myelitis following vaccination against Covid-19. J Neuroimmunol 2021; 358: 577606
• 25 Yu B-Y, Cen L-S, Chen T. et al. Bell’s palsy after inactivated COVID-19 vaccination in a patient with history of recurrent Bell’s palsy: A case report. World J Clin Cases 2021; 9: 8274-8279
• 26 Bennetto L, Scolding N. Inflammatory/post-infectious encephalomyelitis. J Neurol Neurosurg Psychiatry 2004; 75: i22-i28
• 27 Granerod J, Ambrose H, Davies N. et al. Causes of encephalitis and differences in their clinical presentations in England: a multicenter, population-based prospective study. Lancet Infect Dis 2010; 10: 835-844
• 28 Absoud M, Lim MJ, Chong WK. et al. Paediatric acquired demyelinating syndromes: incidence, clinical and magnetic resonance imaging features. Mult Scler 2013; 19: 76-86
• 29 Dale RC, de Sousa C, Chong WK. et al. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain 2000; 123: 2407-2422
• 30 Krupp LB, Tardieu M, Amato MP. et al. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 2013; 19: 1261-1267
• 31 Koelman DLH, Chahin S, Mar SS. et al. Acute disseminated encephalomyelitis in 228 patients: A retrospective, multicenter US study. Neurology 2016; 86: 2085-2093
• 32 Li K, Li M, Wen L. et al. Clinical Presentation and Outcomes of Acute Disseminated Encephalomyelitis in Adults Worldwide: Systematic Review and Meta-Analysis. Front Immunol 2022; 13: 870867
• 33 Pohl D, Alper G, Van Haren K. et al. Acute disseminated encephalomyelitis. Updates on an inflammatory CNS syndrome. Neurology 2016; 87: S38-S45
• 34 European Medicines Agency. Safety of COVID-19 vaccines https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/safety-covid-19-vaccines. Accessed November 20, 2022
• 35 Torisu H, Okada K. Vaccination-associated acute disseminated encephalomyelitis. Vaccine 2019; 37: 1126-1129
• 36 Pohl D, Hennemuth I, von Kries R. et al. Paediatric multiple sclerosis and acute disseminated encephalomyelitis in Germany: results of a nationwide survey. Eur J Pediatr 2007; 166: 405-412
• 37 Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology 2002; 59: 1224-1231
• 38 Verhey LH, Branson MH, Shroff MM. et al. MRI parameters for prediction of multiple sclerosis diagnosis in children with acute CNS demyelination: a prospective national cohort study. Lancet Neurol 2011; 10: 1065-1073
• 39 Yildiz Ö, Pul R, Raab P. et al. Acute hemorrhagic leukoencephalitis (Weston-Hurst syndrome) in a patient with relapse-remitting multiple sclerosis. J Neuroinflammation 2015; 12: 175
• 40 Weidauer S, Wagner M, Nichtweiß M. Magnetic Resonance Imaging and Clinical Features in Acute and Subacute Myelopathies. Clin Neuroradiol 2017; 27: 417-433
• 41 Graus F, Titulaer MJ, Balu R. et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016; 15: 391-404