Neurological problems of SARS-CoV-2 vaccines

 In a study published in the latest issue of the Journal of Neurological Sciences, a team of researchers describes a three-patient case series presented with neurological manifestations following the coronavirus disease 2019 (COVID-19) vaccine, followed by a literature review of the hypothesis. How to develop neurological symptoms after vaccination to propose.

Vaccination with COVID-19 is important to reduce the spread of this deadly infectious disease and to control the mortality rate. Assessing the risks of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 vaccine is equally important.

Several studies have reported neurological symptoms in patients with SARS-CoV-2-infection, although little is known about the neurological problems that follow the SARS-CoV-2 vaccine.

 

 Furthermore, studies have not provided sufficient evidence that episodes of Slow breathing and focal neurological symptoms observed in some patients are directly related to vaccination after COVID-19 vaccination.

 Clinical representation of cases A, B, and C

 Three cases namely Case A, Case B, and Case C are described in the present case study.

Case A patient, an 87-year-old man with hypertension, was diagnosed with COVID-19 in November 2020. Thirteen days after the onset of the initial, mild flu-like symptoms, he developed bilateral deformity, progressive myoclonus with mild dysarthria. No laboratory tests showed the cause of the metabolism. His brain showed magnetic resonance imaging (MRI) NP structural lesions and cerebrospinal fluid (CSF) analysis showed no abnormalities, but anti-neuronal antibodies in the serum were negative.

They also tested a reverse transcriptase-polymerase chain reaction (RT-PCR) - negative. Doctors treated him with clonazepam, and pulse therapy of methyl prednisolone. Three months after primary SARS-CoV-2 infection, action-induced myoclonus became mild, although symptoms persisted.

 

 Two months after the initial SARS-CoV-2 infection, this patient received the Pfizer / Biotech vaccine. After the first dose of the vaccine, initially, myoclonus symptoms increase for a day, but over the next few days, they subside. Their symptoms did not worsen after their second dose, 30 days after their first vaccination.

 

Case B patient is a 62-year-old woman with a medical history of ocular melanoma. He complained of a sudden severe headache after the SARS-CoV-2 vaccine (Pfizer / BioNTech). A day later, the headache subsided on its own. She lost consciousness shortly after the head injury, and 10 days after her COVID-19 vaccination came the second episode of a direct thunderstorm headache.

Neurological examination revealed slow breathing with motor dysphagia and mild symmetric in all extremities. Her lab test results were general, including brain computed tomography (CT) and MRI, electroencephalography (EEG), and CSF analysis. Furthermore, she has no abnormalities in blood pigmentation, cytology analysis, and cardio-logical workup. Physicians were unable to determine the cause of the headache, including any of the symptoms of cerebral reversible vasoconstriction syndrome, and within a few days, the symptoms disappeared on their own. After receiving the second dose of the vaccine, the patient experienced another episode of Thunderclap headache, but no neurological deficit.

 The Case C patient was a 21-year-old woman who developed a general illness with a sub febrile fever within two hours of receiving her first Kovid-19 vaccine (Oxford / AstraZeneca). Within six hours she had a thunderstorm, headache, nausea, and vomiting. Although her neurological tests, including CT-angiography and venography, blood tests, and brain CT were normal, she was unstable and suffered from tachycardia and hypertension. Doctors prescribe non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, intravenous morphine, and oxygen therapy. Although the headache subsided within 24 hours, it took a few days to recover.

 Test result

 SARS-CoV-2 Omicron variant exhibits increased resilience to antiviral type I interferon response

Immunity to BNT162b2 booster in adults who have previously been inactivated COVID-19 vaccine

 Using lateral flow testing to define COVID-19 self-isolation duration

Following the SARS-CoV-2 vaccine, as seen in the case of para-infectious myoclonus A, the researchers hypothesized that they were autoimmune-mediated. Presumably, the antibodies produced by the activated immune system binding to the SARS-CoV-2 spike protein also cross-react with components of the nervous system, manifesting as neurological symptoms.

 

 Because there is a relatively short time between the first and second vaccinations, the Case A patient still has an active immune system, which explains why his symptoms did not worsen after the second vaccination. Overall, the pathophysiological mechanism of the patient's neurological symptoms has not been fully elucidated.

 

 Patients in cases B and C were never infected with SARS-CoV-2, and the authors believe that the cause of their headache after vaccination may be different. Furthermore, disease symptoms in these patients appeared immediately after vaccination, indicating a direct association with the COVID-19 vaccine.

Subsequently, the authors proposed three different hypotheses on how neurological symptoms may develop after vaccination. According to their first hypothesis, headache is more common in patients with a respiratory virus infection or patients receiving vaccines, including SARS-CoV-2-vaccination, because the underlying pathophysiological mechanisms behind the two are the same. Although not fully understood, it may be due to fever, activation of immune inflammatory mediators, or direct exposure to specific microorganisms. This hypothesis also describes the symptoms of post-vaccination headache and illness, and sub febrile fever.