Neurological Manifestations Post-COVID-19 Vaccination: A Review of Case Studies (P12-3.010)

Abstract

<h3>Objective:</h3> To discern the central (CNS) and peripheral nervous system (PNS) manifestations associated with COVID-19 vaccines from individual case studies and describe their clinical and imaging findings, management, and outcomes. <h3>Background:</h3> With ten vaccines approved by the World Health Organization (WHO) and nearly 64% of people fully vaccinated worldwide, we have observed several neurological presentations post-COVID-19-vaccination, such as acute disseminated encephalomyelitis (ADEM), which have been reported in the Vaccine Adverse Event Reporting System (VAERS) and the Medicines and Healthcare products Regulatory Agency (MHRA). <h3>Design/Methods:</h3> A thorough literature search of Google Scholar and PubMed was conducted from December 2020 to October 2021, which included case reports of neurological complications with the following COVID-19 vaccines: Pfizer-BioNTech, Moderna, J&amp;J/Janssen, AstraZeneca, Sinovac-CoronaVac, Sputnik V, and COVAXIN. <h3>Results:</h3> Among the 51 cases, AstraZeneca was the most frequently administered vaccine (28, 55%), followed by Pfizer-BioNTech (8, 16%), Moderna (2,4%), Janssen (2,4%), Sputnik (1, 2%), and COVAXIN (1, 2%). The most common CNS manifestation was cerebral venous sinus thrombosis (CVST) (n=14) in females (64%) younger than 50 years (71%) after the first AstraZeneca dose (93%). Others included CNS demyelinating disorders [transverse myelitis, ADEM, multiple sclerosis, and neuromyelitis optica] (n=9), encephalopathy/encephalitis (n=3), seizures (n=3), and aseptic meningoencephalitis (n=1). The most common PNS manifestation was Guillain–Barré syndrome (GBS) (n=14) in males (71%) older than 50 years (79%), followed by Bell’s palsy (n=5), small fiber neuropathy (n=1), and phantosmia (n=1); most of these occurred with AstraZeneca (28.55%) and Pfizer-BioNTech (9.18%). IVIG and steroids were the treatment of choice. Nine out of the 14 patients with CVST (64%) died. However, most cases overall (42 out of 51) were non-fatal (82%). <h3>Conclusions:</h3> Several post-marketing CNS and PNS adverse events have occurred following the COVID-19 vaccination, including CVST, GBS, and TM. Further studies with non-vaccinated controls might help understand the pathophysiologic mechanisms of these neurological manifestations. <b>Disclosure:</b> Miss Beard has nothing to disclose. Kanika Sharma has nothing to disclose. Dr. Sharma has nothing to disclose. Dr. Basha has nothing to disclose. Mr. JHA has nothing to disclose. Dr. Sriwastava has nothing to disclose.