Abstract Details

Title Case Series of New-Onset CNS Immunological Disorders Temporally Associated with mRNA-based COVID-19 Vaccines

Topic Multiple Sclerosis

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 12-006

Background There have been rare reports associating mRNA-based COVID-19 vaccines with central nervous system (CNS) inflammation. We report a case series of five patients with new-onset neurological disorders of immunological origin temporally associated with these vaccines.

Objective To present a single-health system retrospective analysis of post-mRNA-based COVID-19 vaccination CNS autoimmunity conducted in the greater New York City area.

Design/Methods Case-series.

Results Five cases of post-vaccination CNS disorders of immune origin were observed within two weeks of inoculation with either the first or second dose of mRNA-based COVID-19 vaccines (Moderna = 3, Pfizer = 2). This includes: Fatal ADEM (n = 1), new-onset NMO (n = 2), new-onset fulminant MS (n = 1), and meningoencephalitis (n = 1). The age of our patients ranged from 27 to 81, and three were female. None of the patients had pre-existing neurological illnesses and one had a pre-existing autoimmune condition (immune thrombocytopenia purpura). New-onset focal neurological symptoms were present in all five patients, including quadriparesis, numbness, diplopia, and encephalopathy. CSF pleocytosis was present in all patients, and three had elevated protein. All but one patient (meningoencephalitis) had contrast-enhancing lesions involving either the cerebrum or spinal cord. Both NMO patients had longitudinally extensive transverse lesions involving the central thoracic cord. Aquaporin-4 serum antibody was present in one NMO patients and aquaporin-4 CSF antibody present in the other. All but one patient (fatal ADEM) clinically improved with pulse steroids or plasmapheresis.

Conclusions These are among the emerging cases of CNS immunological events temporally associated with mRNA-based COVID-19 vaccines. These findings should be interpreted with great caution as they neither prove a link nor imply a potential long-term increased risk in post-vaccination CNS autoimmunity. Larger prospective studies are needed. The mRNA-based SARS-CoV-2 vaccines should continue to be strongly encouraged given their high efficacy in overcoming this pandemic.

Authors/Disclosures
Ahmad A. Ballout, MD (Hofstra North Shore-LIJ School of Medicine Program) PRESENTER	Dr. Ballout has nothing to disclose.
Anna Babaie, DO	Dr. Babaie has nothing to disclose.
Michael D. Kolesnik, DO (University of Colorado)	Dr. Kolesnik has nothing to disclose.
Natasha Hameed, MD (Northwell Health)	Dr. Hameed has nothing to disclose.
Glenn E. Waldman, MD	No disclosure on file
Frasat Chaudhry, MD (Phelps Hospital)	Dr. Chaudhry has nothing to disclose.
Sami Saba, MD	Dr. Saba has nothing to disclose.
Asaff Harel, MD	Dr. Harel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Harel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Harel has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Expert Institute.
Souhel Najjar, MD (Hofstra University North Shore LIJ School of Medicine Lennox Hill Hospital)	Dr. Najjar has nothing to disclose.