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

 

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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.

Publication History

Received: 23 November 2022

Accepted: 01 February 2023

Article published online:
17 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag
Rüdigerstraße 14, 70469 Stuttgart, Germany

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