Choi Seo-Young, Choi Jae-Hwan, Oh Eun Hye, Choi Kwang-Dong
Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea.
Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Republic of Korea.
eNeurologicalSci. 2023 Mar;30:100447. doi: 10.1016/j.ensci.2023.100447. Epub 2023 Jan 28.
Many kinds of vaccines have been developed worldwide to bring the coronavirus disease 2019 (COVID-19) to an end. We report a case of recurrent orbital apex syndrome following the first and third doses of SARS-CoV-2 vaccination.
A 71-year-old woman presented with acute painless diplopia and visual disturbance for two days. She had received the first dose of the COVID-19 vaccine two weeks before. She showed decreased visual acuity and ophthalmoplegia in the right eye. An orbital magnetic resonance image (MRI) revealed a hyperintense lesion with enhanced bulging in the right cavernous sinus. Following the steroid pulse therapy, she fully recovered. However, six months after the first attack, painful ophthalmoplegia with decreased visual acuity recurred in her left eye after the booster vaccination for COVID-19. MRI also showed a well-enhanced hyperintense lesion in the left orbital apex. Fortunately, her visual acuity and ocular motility returned to normal after the steroid therapy.
Immunologic reactions from COVID-19 vaccines may cause multiple cranial neuropathies. Diverse individual immunologic states should be considered before any kind of vaccine.
全球已研发出多种疫苗以终结2019冠状病毒病（COVID-19）。我们报告一例在接种严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗第一剂和第三剂后出现复发性眶尖综合征的病例。
一名71岁女性，出现急性无痛性复视和视觉障碍两天。她在两周前接种了第一剂COVID-19疫苗。她右眼视力下降且出现眼肌麻痹。眼眶磁共振成像（MRI）显示右侧海绵窦有一个强化膨出的高信号病变。经类固醇冲击治疗后，她完全康复。然而，首次发作六个月后，在接种COVID-19加强针后，她左眼再次出现疼痛性眼肌麻痹且视力下降。MRI还显示左侧眶尖有一个强化良好的高信号病变。幸运的是，经类固醇治疗后，她的视力和眼球运动恢复正常。
COVID-19疫苗引起的免疫反应可能导致多发性颅神经病变。在接种任何疫苗之前，应考虑个体免疫状态的多样性。
