Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Department of Infectious Diseases, All India Institute of Medical Sciences, New Delhi, India.
Acta Neurol Belg. 2024 Feb;124(1):193-203. doi: 10.1007/s13760-023-02373-0. Epub 2023 Sep 5.
Although rare, neurological adverse events have been reported post-COVID-19 vaccination. This study reports 16 patients diagnosed with CNS inflammatory demyelinating diseases (CNS-IDD) within 6 weeks of COVID-19 vaccine administration.
A prospective observational study was conducted from June 2021 to May 2022. All patients were diagnosed according to the latest international guidelines with CNS-IDD within 6 weeks of COVID-19 vaccine exposure. Data regarding the demographic profile, clinical features, type of COVID-19 vaccination, radiological findings and occurrence of symptoms were noted and further analysed using descriptive statistics.
We reported 16 cases (median age 40 years) of CNS demyelination: fourteen occurred in temporal association with ChAdOx1-S vaccine and two in association with BBV152 vaccine. Median time duration of presenting symptoms after vaccination was 19 days (3-40 days). The most common presentation was myelitis (7/16 patients), followed by optic neuritis (6/16 patients). Demyelination events were reported after first and second dose in thirteen and five patients respectively, although two patients reported such events after both vaccine dosages. Myelin oligodendrocyte glycoprotein (MOG) IgG antibodies were positive in eight patients. Tumefactive demyelination was seen in four patients. Management included high-dose methylprednisolone, PLEX, IVIG or a combination of those, with a favourable outcome in the majority of cases.
Although a rare event, awareness regarding potential demyelinating episodes post-COVID-19 vaccination can help in early diagnosis. The presence of increased MOG-IgG antibodies with temporal association in post-COVID vaccine patients raises a possibility of an immunogenic phenomenon leading to demyelinating disorders.
尽管罕见，但有报道称 COVID-19 疫苗接种后会出现神经学不良反应。本研究报告了 16 例在 COVID-19 疫苗接种后 6 周内诊断为中枢神经系统（CNS）炎症性脱髓鞘疾病（CNS-IDD）的患者。
本研究为 2021 年 6 月至 2022 年 5 月进行的前瞻性观察性研究。所有患者均根据最新的国际指南，在 COVID-19 疫苗接种后 6 周内被诊断为 CNS-IDD。记录了患者的人口统计学特征、临床特征、COVID-19 疫苗类型、影像学发现和症状出现情况，并使用描述性统计方法进行了进一步分析。
我们报告了 16 例中枢神经系统脱髓鞘病例（中位年龄 40 岁）：14 例与 ChAdOx1-S 疫苗有关，2 例与 BBV152 疫苗有关。接种疫苗后出现症状的中位时间为 19 天（3-40 天）。最常见的表现为脊髓炎（16 例患者中有 7 例），其次是视神经炎（16 例患者中有 6 例）。13 例患者在接种第一剂疫苗后，5 例患者在接种第二剂疫苗后出现脱髓鞘事件，尽管有 2 例患者在接种两剂疫苗后均出现了此类事件。8 例患者的髓鞘少突胶质细胞糖蛋白（MOG）IgG 抗体阳性。4 例患者出现肿块样脱髓鞘。治疗包括大剂量甲基泼尼松龙、血浆置换、静脉注射免疫球蛋白或联合应用，大多数患者预后良好。
尽管罕见，但 COVID-19 疫苗接种后发生潜在脱髓鞘事件的意识可以帮助早期诊断。在 COVID-19 疫苗接种后患者中，MOG-IgG 抗体呈阳性且与时间有关，这提示可能存在一种免疫原性现象，导致脱髓鞘疾病。
