Evaluation of neurological events after COVID-19 vaccination

A prospective study found that all patients admitted with new or recurrent neurological events after SARS-CoV-2 vaccination at a New York tertiary hospital had one or more risk factors for neurological conditions. shown.

According to Kiran Thakur, M.D., Columbia University, the most prominent neurological index events in these vaccinated patients were ischemic stroke (37.7%), encephalopathy (32.6%), seizures (15.9%), and intracranial hemorrhage (15.9%). ICH; 9.4%). Irving Medical Center/New York Presbyterian Hospital, New York City, and co-author.

Of the 3,830 individuals screened for COVID-19 vaccination status and neurological status from December 2020 to June 2021, 138 had a differential neurological diagnosis within 6 weeks of admission. received the new coronavirus vaccine. Of these, 126 received the mRNA vaccine. All 138 cases had evidence of at least one risk factor, or known potential cause of neurological events, he reported, Thakur et al. Neurology: clinical practice.

Metabolic disorders were the most common etiologies in vaccinated patients with seizures (53.3%) and encephalopathy (22.7%). Hypertension was the most important risk factor for patients with ischemic stroke (86.5%) and ICH (30.8%).

“At our institution, we were unable to identify a causal relationship between newly diagnosed neurological symptoms and either mRNA or adenovirus COVID-19 vaccination,” the researchers said.

“Our comprehensive clinical review of these cases supports the safety of the mRNA COVID-19 vaccine,” they added.

Researchers and government agencies have warned of rare cases. Cerebral sinus thrombosis (CVST) and Guillain-Barré Syndrome (GBS) Outbreaks among Johnson & Johnson COVID-19 vector vaccine recipients.Otherwise, the US Vaccine Safety Surveillance System has not detected Unforeseen safety concerns Thakur et al. noted clinically severe neurological symptoms following COVID-19 vaccination.

“To date, monitoring of the Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Data Link (VSD) has not identified an increased risk of neurological AEFIs.” [adverse events following immunization] or AESI [adverse events of special interest] After the mRNA COVID-19 vaccine,” they wrote.

As part of its COVID-19 vaccine safety monitoring, the CDC has identified ischemic stroke, encephalopathy, stroke, ICH, encephalitis, multiple sclerosis (MS), Bell’s palsy, myelitis, GBS, chronic inflammatory demyelinating It has prespecified several AESIs, including polyneuropathy (CIDP). , CVST, myasthenia gravis, optic neuritis.

During the first 6 months of the US COVID-19 vaccination program, Thakur et al. The system AESI was screened prospectively.

Investigators identified 172 eligible hospitalized patients with a differential neurological diagnosis who were vaccinated within 6 weeks of admission. Thirty-four were excluded because they had neurological symptoms not on the prespecified AESI list.

The final cohort of 138 included 52 ischemic stroke, 45 encephalopathy, 22 seizures, and 13 ICH. In addition, there were 5 cases of encephalitis, 4 cases of MS (2 new diagnoses, 2 cases of relapse), 3 cases of Bell’s palsy, 2 cases of myelitis, and 1 each of GBS, CIDP and CVST. Nine patients died during acute hospitalization.

Nearly 60% had received the Pfizer BioNtech (BNT162b2; Comirnaty) vaccine and 31% had received the Moderna (mRNA-1273; Spikevax) vaccine. Two-thirds of patients were fully vaccinated before admission.

The median age was 68 years and 51% were female. Overall, 30% were white, 20% were black, and 33% were multiracial or other. About half of the patients with stroke, encephalopathy, or seizures were Hispanic or Latino.

Fifteen patients who had seizures had underlying medical conditions such as ICH, stroke, brain tumor, or encephalitis. Most of the ICH patients had a history of recent anticoagulant medication or hypertension. Over 90% of stroke patients had multiple risk factors, including hypertension, diabetes, and hyperlipidemia. Most of the patients with encephalopathy had multiple comorbid factors, mainly metabolic disorders.

The GBS case had recently been infected with herpes zoster. Cases with CVST had a history of Hashimoto’s thyroiditis, idiopathic intracranial hypertension, and oral contraceptive-induced hypercoagulability. Neither had received the Johnson & Johnson vaccine.

Thakur et al. acknowledged that vaccination cannot be definitively ruled out as a risk factor without a control group. “There may be unknown but attributable SARS-CoV-2 vaccination risks that we have not been able to explain,” they observed.

Sociodemographic risk factors (smoking, age, sex, race) were not included in the assessment. Moreover, a single research center identified a relatively small cohort of patients. “Thus, our study has limited generalizability,” the researchers wrote.