Assiri Sara A, Althaqafi Raad M M, Alswat Khaled, Alghamdi Ahmed Abdullah, Alomairi Naif E, Nemenqani Dalal M, Ibrahim Zein S, Elkady Ahmed
Otolaryngology-Head and Neck Surgery Department, King Faisal Hospital, Taif, Saudi Arabia.
College of Medicine, Taif University, Taif, Saudi Arabia.
Neuropsychiatr Dis Treat. 2022 Feb 2;18:137-154. doi: 10.2147/NDT.S343438. eCollection 2022.
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.
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.
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.
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.
新冠病毒疫苗接种后的神经后遗症较为罕见。我们调查了沙特居民接种新冠病毒疫苗后短期内出现神经并发症的可能发病机制。
我们评估了18例近期接种新冠病毒疫苗（辉瑞疫苗和阿斯利康疫苗）并在沙特阿拉伯吉达的沙特德国医院出现神经并发症的患者。神经科医生对患者的临床表现、影像学检查和实验室检查结果进行了评估。
3例接种第一剂阿斯利康疫苗的患者发生了严重的脑静脉血栓形成，其中2例并发颅内出血。他们的实验室检查显示D-二聚体水平极高且严重血小板减少，这与较高的死亡率和不良预后相关。8例（44.4%）发生缺血性卒中，以老年男性患者为主。3例患者出现癫痫发作，2例患有视神经炎。2例男性患者在接种辉瑞疫苗后发生格林-巴利综合征（GBS）和米勒-费雪综合征（MFS）。
新冠病毒疫苗接种后的神经并发症非常罕见，全球仅报告了少数病例。新冠病毒感染与新冠病毒疫苗之间共同的病理生理基础是由全身炎症状态引发的高凝状态导致的极其罕见的神经并发症的原因。我们怀疑新冠病毒感染和新冠病毒疫苗所致缺血性卒中的发病机制存在一些差异，这使得新冠病毒疫苗相关缺血性卒中对治疗更敏感。迄今为止，尚无有力证据证明疫苗与GBS之间存在明确关联，但最近它已被列为强生新冠病毒疫苗的一种非常罕见的副作用。在本研究报告之前，尚未有米勒-费雪综合征与新冠病毒疫苗之间可能关联的报道。
