Medical Case Reports

Encephalitis is an inflammatory condition affecting the brain, characterized by the swelling of the brain tissue. This inflammation is often triggered by viral infections, although it can also result from bacterial infections, autoimmune disorders, or vaccination.  Multiple cases have been presented in the literature.  Anti NMDA Autoimmune Encephalitis in a Pediatric Patient: Anti-NMDA receptor encephalitis is a rare autoimmune disorder that affects the central nervous system. In this condition, the body's immune system mistakenly targets and attacks NMDA receptors in the brain. NMDA receptors are essential for normal brain function, and their dysfunction can lead to a range of neurological symptoms. The condition is often associated with the presence of antibodies against the NMDA receptors. The case involves a 13-year-old female who developed anti-NMDA autoimmune encephalitis after receiving the Pfizer–BioNTech COVID-19 vaccine. The patient presented with subacute neurologic...

New case report describes a 56-year-old woman who developed debilitating symptoms, including intense foot pain, discoloration, and swelling, following COVID-19 vaccination with the Pfizer-BioNTech mRNA vaccine. The patient experienced acrocyanosis, constant pain in the soles of her feet, and a throbbing sensation. Symptoms worsened after each COVID-19 vaccine dose, leading to dependency on a wheelchair. Dermatological manifestations included redness, discoloration, and swelling. Initial evaluations suggested erythromelalgia, but subsequent investigations involved multiple medical specialties, including dermatology, vascular surgery, rheumatology, neurology, and orthopedics. Various diagnostic tests, including blood tests, genetic testing, imaging, and biopsies, yielded inconclusive results. Based on the Budapest Criteria for CRPS, the patient fulfilled the criteria, exhibiting allodynia, hyperalgesia, skin color changes, edema, continuing pain, and the absence of a more obvious ex...

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 transamin...

In late July 2021, a 67-year-old woman vaccinated with Sinopharm COVID-19 vaccine (inactivated virus) presented a unique and challenging medical case that underscores potential neurological consequences of both infection and vaccination.  The patient's journey began with the onset of common COVID-19 symptoms: fever, myalgia, mild dyspnea, headache, and a non-productive cough. She had no pre-existing medical conditions. Upon her initial evaluation, her vital signs were within a relatively stable range, with the exception of a slightly decreased oxygen saturation (SpO2) of 91%. Physical examination did not reveal any significant findings. Her positive SARS-CoV-2 polymerase chain reaction test prompted further investigation, given the mild dyspnea and decreased SpO2. A chest computed tomography scan revealed peripheral consolidation and ground glass opacities, typical of COVID-19 pneumonia. Treatment commenced with Dexamethasone and Remdesivir alongside supplemental oxygen. Over the ...

A 55-year-old woman with a long history of chronic migraines saw her symptoms worsen after getting a COVID-19 mRNA vaccine. Normally, her migraines were manageable with topiramate and sertraline. Despite medication adjustments, her pain escalated, scoring a 9 on the Visual Analogue Scale (VAS). The underlying mechanisms of how SARS-CoV-2 impacts the nervous system remain unclear. Research suggests that the virus can invade the nervous system and trigger headaches by causing inflammation and vascular changes. Headache and loss of smell (anosmia) are thought to be linked to this direct neural invasion. Calcitonin gene-related peptide (CGRP) is key in migraine pathophysiology, involved in pain transmission and inflammation. Elevated levels of interleukin (IL)-6 and tumor necrosis factor alpha (TNF-a), common in COVID-19, also increase CGRP, influencing symptoms like cough, fever, and pain. Studies have found structural similarities between CGRP receptors and SARS-CoV-2 spike proteins, sug...

 The lymphatic system in our body acts as a sewage system, filtering out waste and helping fight infections. Axillary lymphadenopathy is a condition where the lymph nodes (small, bean-shaped structures in the lymphatic system) located in the armpit (axilla) area swell up. This usually happens when the body is trying to fight off an infection or in response to certain medications or vaccines. The brachial plexus is a network of nerves that send signals from your spinal cord to your shoulder, arm, and hand. A plexopathy is a disorder that affects this network of nerves, leading to various symptoms including pain, numbness, and muscle weakness in the affected area.  Multiple case reports described lymphadenopathy after COVID-19 vaccination. Previously we talked about vaccine-triggered  Parsonage-Turner syndrome , a rare idiopathic brachial plexopathy in a 50-year old male. 34-year-old healthy male also developed brachial plexus neuropraxia (a mild nerve injury) after ge...

A 50-year-old man visited a primary care clinic with persistent right arm pain and weakness lasting for 9 weeks. These symptoms began 5 days after receiving a mRNA COVID-19 booster vaccination in his right deltoid. The patient experienced a moderate-to-severe ache at the injection site, radiating to his neck. Over time, he developed progressive weakness in his right shoulder and elbow, along with occasional hand paresthesia.  Despite reporting his symptoms to Malaysian equivalent of VAERS database, the patient sought medical attention only after 9 weeks when his symptoms worsened to the point where he needed assistance with daily activities. He had no other symptoms or relevant medical history, except for completing two doses of an inactivated COVID-19 vaccine 7 months prior. Physical examination revealed muscle wasting in the affected areas without skin changes or tenderness. Neurological evaluations, including nerve conduction studies and electromyography, indicated axonal loss r...

The frequency of CNS neuroinflammatory events reported in the literature after both SARS-CoV-2 infection and COVID-19 vaccination is still largely unknown. While these conditions can occur spontaneously, they have also been reported following vaccinations, including those for influenza, hepatitis B, human papillomavirus, and COVID-19. Viruses and their vaccines  may unmask   CNS neuroinflammatory conditions.   A 47-year-old man with a history of psoriasis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection presented with 3 months of subacute lower extremity weakness, erectile dysfunction, and gait instability with falls. His symptoms started 2 weeks after receiving the second of his 2-shot primary mRNA vaccine series for coronavirus disease 2019 (COVID-19) vaccination, which he received 3 months after a mild case of COVID-19. He had no other relevant medical or family history and no recent travel. After evaluation by a urologist, he was prescribed ...

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells responsible for controlling voluntary muscles in the central nervous system, with death usually occurring within two to five years of symptom onset.  In this case study, a previously asymptomatic 47-year-old male presented with left-sided weakness, declining speech, dysphagia, and recurrent falls for nine months, which began one day after receiving the J&J/Janssen viral vector COVID -19 vaccine. His family history of ALS included his grandmother being diagnosed with it.  After getting the vaccine, the patient initially experienced painful inflammation at the injection site. Within a week, he began to feel weakness in his left arm and a weak hand grip. Over the following months, this weakness progressed to his entire left side, and he started to experience declining speech, difficulty swallowing, and falling d...

Multiple sclerosis (MS) is a chronic autoimmune disorder that affects the central nervous system, leading to a wide range of neurological symptoms.  While this disease is most commonly diagnosed in individuals in their 20s and 30s, it is rare for MS to result in sudden death in younger patients.  A 19-year-old male soldier received the second dose of the COVID-19 vaccine (Pfizer-BioNTech). 3 months later, he started experiencing epileptic seizures during sleep and was admitted to an outside hospital. Since the first seizure, he presented with 5 more generalized tonic-clonic seizures within a week. He had no other symptoms or signs of meningeal irritation. Cerebrospinal fluid (CSF) analysis including culture and viral polymerase chain reaction revealed no abnormalities except for mild pleocytosis. Oligoclonal band and aquaporin-4 antibodies were not detected in the CSF and serum. Brain MRI performed 1 day after the seizure revealed T2 hyperintensities in the periventricula...

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune neurological disorder that affects the peripheral nervous system. Unlike Guillain-Barré syndrome (GBS) that develops rapidly and reaches its peak within a few weeks, CIDP is a chronic condition that develops more slowly and can last for months or even years. It is characterized by chronic inflammation and damage to the myelin sheath that covers and protects the nerves, leading to symptoms such as weakness, numbness, and tingling in the arms and legs. CIDP is estimated to affect about 1 to 2 people per 100,000 population per year, and it can occur at any age, although it is more common in middle-aged and older adults. Left untreated, 30% of CIDP patients will progress to wheelchair dependence.  A previously healthy 72-year-old man presented with a progressive tingling sensation and weakness below both knees for two weeks that started two weeks after vaccination with the 3rd dose of mRNA-1273. As the ...

76-year-old man with Parkinson's disease (PD) died three weeks after receiving his third COVID-19 vaccination, 5 months after his second dose (BNT162b2 mRNA vaccine/Comirnaty) and 7 months since his first dose (ChAdOx1 nCov-19 vector vaccine).  On the day of his first vaccination, the individual experienced pronounced cardiovascular side effects, for which he repeatedly had to consult his doctor. After the second vaccination two months later, the family noted obvious behavioral and psychological changes (e.g., he did not want to be touched anymore and experienced increased anxiety, lethargy, and social withdrawal even from close family members). Furthermore, there was a striking worsening of his PD symptoms, which led to severe motor impairment and a recurrent need for wheelchair support. He never fully recovered from these side effects after the first two vaccinations but still got another vaccination in December 2021. Two weeks after the third vaccination, he suddenly collap...

A 17-year-old woman with no specific medical history received the first dose of Pfizer/BioNTech mRNA COVID-19 vaccine on her left upper arm, which caused mild swelling at the site of injection and resolved quickly. Three weeks later, the second dose of the vaccine was administered to her left upper arm, and after a fever which resolved within a few hours, a bruise appeared on the back of her left hand that spread to her entire left hand, became edematous and caused severe pain.  The bruise gradually resolved, but the pain and swelling persisted. Six weeks later, she was diagnosed with Complex Regional Pain Syndrome (CRPS) and received a stellate ganglion block. Two months after second dose of the vaccine, numbness and involuntary flexion of the right hand and fingers began to appear.  Four months later, she developed involuntary movements with pain in her right index finger. She was prescribed medication for the involuntary movements, but it did not improve her symp...

A previously healthy woman in her 60s had mild fever and uneventful course after the 1st dose of  ChAdOx1 nCoV-19 vaccine, but  developed behavioral problems and refusal to take food, one day after receiving the second dose of ChAdOx1 nCoV-19 vaccination (dose interval 84 days). Her condition progressed rapidly with onset of confusion, forgetfulness, and hallucinations within the next 5 days. Over the next two days, the patient developed difficulty in walking and echolalia. She was prescribed amantadine, trihexyphenidyl and clonazepam by a local practitioner but she showed further deterioration in the form of irritability, incoherent speech, aggravated forgetfulness, auditory and visual hallucinations, abnormal movements of limbs, and jaw and neck dystonia. The patient had a serum anti-Spike protein IgG titer of 1891.5 AU/mL (non-reactive<50 AU/mL) at 37 days post-second dose. An initial magnetic resonance imaging (MRI) of the brain had revealed FLAIR hyperintensity in bila...

A previously hypertensive 56-year-old male presented with the subacute onset of severe constipation, urinary retention, erectile dysfunction, sudomotor failure, sicca symptoms, non-reactive pupils and severe orthostatic hypotension shortly after receiving the second dose of the Comirnaty mRNA vaccine against COVID19.  Autonomic testing revealed severe cardiovagal, adrenergic and sudomotor impairment, and tonic 'half-mast' pupils with evidence of sympathetic and parasympathetic denervation (see Figure). T ilt-table testing demonstrated a drop in blood pressure from 140/90 mmHg supine to 54/35 mmHg after two minutes at 60 degrees, with no heart rate response.  There was no heart rate response to Valsalva maneuver  and sympathetic skin responses in the hands and feet were absent. Sweat testing demonstrated complete anhidrosis. Pathological α3-ganglionic ACHR antibodies were positive in serum as detected by a new flow cytometric immunomodulation assay. Malignancy wa...

Healthy 21-year-old male experienced mild pain/tenderness in the arm after receiving the first dose of BNT162b2 vaccine. It resolved in ~3 days. Later he received the second dose of the same vaccine in the deltoid area of his left arm. He gradually noticed a severe burning sensation and weakness in that arm. Half a day later his hand began to hang down at the wrist ("wrist drop").  On neurological examination two days after vaccination, his wrist and finger drop on the left side were near paralysis (MRC grade 1-2 on the scale of 1-5 of muscle power).  In addition, there was weakness in arm extension and flexion (MRC grade 3-4/5). On sensory examination, there was dysesthesia and numbness over the lateral dorsum of the left hand. Reflexes were hypoactive. Left radial neuropathy with demyelination and axonal injury were suspected. Laboratory findings for vasculitis, autoimmune disorders, malignancy and infectious disease were unremarkable . The patient was diagnosed with ipsil...

A 53-year-old healthy man received the first dose of the ChAdOx1 nCoV-19 vaccine (COVISHIELD) into his left deltoid muscle. He experienced pain in the left upper arm, followed by the right upper arm and bilateral calf muscles (left more than right). The pain gradually increased, restricting his daily activities. On the 11th day of vaccination, he had difficulty walking and moving his left arm. He also reported generalized muscle weakness, more pronounced in the proximal upper and lower limbs than the distal ones. His medical history was unremarkable with no evidence of COVID-19 infection in the past. Serologic testing yielded mildly increased serum creatine kinase (187 U/L, reference range 40–171 U/L) and alanine transaminase (50 U/L, reference range 10–40 U/L) concentrations. Serum bilirubin, aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and C-reactive protein levels were normal. Urine analysis excluded myoglobinuria.  On M...

A 45-year-old male was extremely reluctant to be vaccinated but was pressured at his workplace. The patient's unusual behavior began within five days of receiving the one-dose Ad26.COV2.S adenoviral vector vaccine. He became anxious, suspicious, paranoid, disorganized and complained of headaches. No neurological deficits were found upon examination. Two weeks after the COVID-19 vaccination, persecutory delusions and delusions of reference led the patient to suicide attempt by stabbing himself in the abdomen. After abdominal surgery, the patient was admitted to the Clinic of Psychiatry. In addition to paranoid delusions, the psychiatric evaluation revealed intrapsychic tension and low affect modulation. After two weeks of treatment, the patient's condition improved. After 23 days of treatment in the Clinic, he was discharged without psychotic symptoms.    A 41-year-old male patient developed anxiety during the COVID-19 pandemic. Five days after the second dose of ...

Quarantines, masking and physical distancing measures are needed to stop  Covid-19 pandemic  and save lives, but as the crisis drags on, new health challenges arise.    A 57-year-old female working as a kitchen aide had a history of migraine without aura since she was a teenager. Her past medical history included gastroesophageal reflux disease, a pituitary microadenoma and dyslipidemia. Before COVID-19, the characteristics of the pain were bifrontal, pulsatile and of moderate to strong intensity, with nausea, vomiting and photophobia. The frequency was 1 - 2 times per month, with relief provided by common pain medication such as ibuprofen. The pain was triggered by fatigue, cold weather and skin stimulation caused by hair accessories, caps, hats and glasses.  Her allodynia symptom checklist ASC12  was scored as 7 (sensitivity to necklace, glasses, tight clothes, ponytail, hair combing and exposure to cold), before March 2020 , when she began to work ...