Post COVID-19 Vaccination-Associated Neurological Complications

Sara A Assiri; Raad M M Althaqafi; Khaled Alswat; Ahmed Abdullah Alghamdi; Naif E Alomairi; Dalal M Nemenqani; Zein S Ibrahim; Ahmed Elkady

doi:10.2147/NDT.S343438

Post COVID-19 Vaccination-Associated Neurological Complications

Neuropsychiatr Dis Treat. 2022 Feb 2:18:137-154. doi: 10.2147/NDT.S343438. eCollection 2022.

Authors

Sara A Assiri¹, Raad M M Althaqafi², Khaled Alswat², Ahmed Abdullah Alghamdi³, Naif E Alomairi^{2

4}, Dalal M Nemenqani², Zein S Ibrahim⁵, Ahmed Elkady⁴

Affiliations

¹ Otolaryngology-Head and Neck Surgery Department, King Faisal Hospital, Taif, Saudi Arabia.
² College of Medicine, Taif University, Taif, Saudi Arabia.
³ College of Medicine, Al-Baha University, Al Baha, Saudi Arabia.
⁴ Neurology Department, Saudi German Hospital, Jeddah, Saudi Arabia.
⁵ Department of Physiology, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.

Abstract

Purpose: Neurological sequelae after COVID-19 vaccination are rare. We investigated the possible pathogenesis behind the development of neurological complications within a short period after Saudi residents received a COVID-19 vaccine.

Patients and methods: We evaluated 18 patients who recently received a COVID-19 vaccine (Comirnaty and Vaxzevria vaccines) and presented with neurological complications to the Saudi German Hospitals in Jeddah, Saudi Arabia. Neurologists assessed the patients' clinical presentation, radiological investigations, and laboratory findings.

Results: Three patients who received the first dose of the Vaxzevria vaccine experienced severe cerebral venous thrombosis, two of them were complicated by intracranial hemorrhage. Their laboratory investigations showed very high d-dimers and severe thrombocytopenia, which have been linked to higher mortality and poor outcome. Ischemic stroke occurred in eight cases (44.4%) with a predominance in older male patients. Three patients presented with seizures, two had optic neuritis. Guillain-Barré syndrome (GBS) and Miller Fisher syndrome (MFS) occurred in two male patients following vaccination with Comirnaty.

Conclusion: Neurological complications after COVID-19 vaccinations are very rare, and only a few cases have been reported worldwide. The shared pathophysiological basis between COVID-19 viral infection and COVID-19 vaccines stands behind the very rare neurological complications resulting from the hypercoagulable state triggered by the general inflammatory condition. We suspect some differences in the pathogenesis of ischemic stroke caused by COVID-19 infection and COVID-19 vaccines, which render COVID-19 vaccine-associated ischemic stroke more responsive to treatment. To date, no definitive association between the vaccine and GBS has been proven by any strong evidence, but it has recently been added as a very rare side effect of the Janssen COVID-19 vaccine. No possible links of Miller Fisher syndrome to COVID-19 vaccines have been reported before the one reported in this study.

Keywords: cerebral venous thrombosis; ischemic stroke; optic neuritis; seizures; vaccine.