Reversible neurological and brain MRI changes following COVID-19 vaccination: A case report - 19/04/22

Doi : 10.1016/j.neurad.2022.03.011

Anuj Rastogi ^a,^⁎ , Arina Bingeliene ^a, Antonio P. Strafella ^a,^b,^c, David F. Tang-Wai ^a,^d, Peter E. Wu ^e,^f, Daniel M. Mandell ^g
^a Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
^b Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
^c Morton and Gloria Shulman Movement Disorder Unit and E.J. Safra Parkinson Disease Program, Neurology Division, Department of Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
^d University Health Network Autoimmune Encephalitis Clinic, Krembil Brain Institute, Toronto, Ontario, Canada
^e Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
^f Division of General Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada
^g Division of Neuroradiology, Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada

^⁎Corresponding author at: Toronto Western Hospital, 399 Bathurst Street, Ontario, Canada, M5T 2S8Toronto Western Hospital,399 Bathurst StreetOntarioM5T 2S8Canada

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Abstract

Background

Various neurological sequalae have been described following COVID-19 vaccination. Here we describe the first case of untreated post COVID-19 vaccine encephalitis with spontaneous resolution of contrast enhancing hyperintensities on MRI concomitant with clinical improvement.

Case Presentation

A 59-year-old woman presented with a two-day history of unsteady gait, incoordination, visual symptoms, and lethargy. She had received AZD1222 (AstraZeneca) and mRNA-1273 (Moderna) COVID-19 vaccines at 3 months and 12 days, respectively, before presentation. Brain MRI showed no abnormality on the non-enhanced sequences, but numerous enhancing lesions in the cerebral cortex, deep grey matter, brainstem, and cerebellum. Treatment was expectant, the patient improved clinically over 10 days, and repeat MRI showed near complete resolution of the imaging abnormality.

Conclusions

We describe neurological deterioration 12 days after a second dose of COVID-19 vaccine. There was no evidence of edema or demyelinating lesions in the brain on MRI, but there was extensive contrast-enhancement indicating loss of blood-brain barrier (BBB) integrity. This provides a potential in vivo, clinical-imaging correlate of the post-mortem evidence that SARS-CoV-2 spike protein may induce loss of BBB permeability. While this adds to the list of rare adverse neurological reactions to COVID-19 vaccination, the benefits of receiving the vaccine far outweigh these risks.

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