Neurological and Oral Complications Following COVID-19 Vaccination

New paper discusses a case report of a 65-year-old woman who experienced neurological complications following the administration of a third dose of the Moderna COVID-19 vaccine. The patient, previously in good health, presented with symptoms that included numbness in the mouth, feet, legs, interscapular space, and hands, along with muscle pain in the lower limbs and interscapular pain.

The clinical evaluation by a neurologist revealed distal and asymmetric sensory axonal polyneuropathy predominantly affecting the right lower limb. Electromyography (EMG) and electroneurography (ENG) tests were conducted to assess the nerve function. The study showed an exclusively sensory polyneuropathy of the axonal type with a distal and asymmetric distribution, predominantly in the right lower limb. There were also findings suggestive of neuropathy due to entrapment of the distal segment of the right median nerve in its course through the wrist. 

The patient's blood work showed elevated transaminases, which could be indicative of myelin damage. Antibody testing for SARS-CoV-2 revealed high levels of specific antibodies, suggesting a robust immune response to the vaccine.

Cervical and dorsal magnetic resonance imaging did not reveal any structural abnormalities in the patient's spinal cord or craniocervical junction that could explain the neurological symptoms.

In terms of the patient's clinical course, the symptoms improved over time, with the paresthesia in the teeth being the first to resolve. Muscular pain and paresthesia in the legs also improved gradually. Importantly, the patient did not require corticosteroid medication, and there was evidence of progressive improvement.

Complications associated with COVID-19 vaccination in the oral region are generally infrequent and predominantly involve mucous membrane issues, such as lip or tongue inflammation, which may be linked to anaphylaxis. Additionally, reports of mucositis leading to moderate pain have been documented. Elderly patients have also exhibited ulcerative mucosal lesions, erythema, fissured tongue,  oral pemphigus (with or without autoimmune complications) and mucosal pain. Cases have been reported of oral lichen planus either emerging after vaccination or worsening pre-existing lichen lesions and various complications within the peripheral nervous system, including conditions like Guillain-Barre Syndrome, subacute axonal sensorimotor polyneuropathy, polyradiculoneuropathy, brachial plexopathy, and chronic inflammatory demyelinating polyneuropathy (CIDP).

This case report highlights the importance of monitoring and studying potential neurological complications following COVID-19 vaccination. 


REFERENCE

López-Carriches, Leco-Berrocal, Bahram-Taheri, Cardona-Moreno, Cortés-Bretón-Brinkmann, Moreno-López (2023) Neurological complications following mRNA COVID-19 vaccination: Oral and lower limb paresthesia. A case discussion and literature review. J Clin Exp Dent (IF: -1) 15(10) e866-e869

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