Central Nervous System Demyelination Following COVID-19 mRNA-Based Vaccination: Two Case Reports and Literature Review

Shirley Lee; Jyh Yung Hor; Kee Leong Koh; Yuen Kang Chia

doi:10.1177/11795735221102747

Central Nervous System Demyelination Following COVID-19 mRNA-Based Vaccination: Two Case Reports and Literature Review

J Cent Nerv Syst Dis. 2022 May 24:14:11795735221102747. doi: 10.1177/11795735221102747. eCollection 2022.

Authors

Shirley Lee¹, Jyh Yung Hor², Kee Leong Koh¹, Yuen Kang Chia¹

Affiliations

¹ Department of Neurology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia.
² Department of Neurology, Penang General Hospital, Penang, Malaysia.

Abstract

As the world embarks on mass vaccination against SARS-CoV2 to alleviate the spread of this highly contagious novel coronavirus, there are growing anecdotal reports on immune-related neurological complications following immunisation. Similarly, we encountered 2 cases of central nervous system demyelination at our centre with Comirnaty (BNT162b2), a mRNA-based COVID-19 vaccine. Our first patient had typical clinical-radiological manifestations of acute disseminated encephalomyelitis (ADEM) after his COVID-19 vaccination. This was the sixth reported case to date. Our second patient presented with an unusual complaint of trigeminal neuralgia, with an identifiable demyelinating lesion observed in the pons on neuroimaging. Both cases responded well to immunotherapy. However, larger prospective controlled studies and formal registries are much needed to ascertain a possible relationship between COVID-19 vaccines and acute central nervous system demyelination.

Keywords: COVID-19 vaccines; Central nervous system demyelinating diseases; SARS-CoV2; acute disseminated encephalomyelitis; mRNA-based; trigeminal neuralgia.

Publication types

Case Reports