Introduction
Case report
Nerve | Latency (ms) | Amplitude (mV) | MCV(m/s) | SCV (m/s) |
---|---|---|---|---|
Right facial | Patient 1. Unexcitable Patient 2. Unexcitable | Patient 1. Unexcitable Patient 2. Unexcitable | Patient 1. Unexcitable Patient 2. Unexcitable | |
Left facial | Patient 1. Unexcitable Patient 2. Unexcitable | Patient 1. Unexcitable Patient 2. Unexcitable | Patient 1. Unexcitable Patient 2. Unexcitable | Patient 1. Unexcitable Patient 2. Unexcitable |
Right median | Patient 1. 7.2 (F wave: 48.8) Patient 2. Missing data | Patient 1. 8.1 Patient 2. Missing data | Patient 1. 30.1 Patient 2. Missing data | Patient 1. 29.2 Patient 2. Missing data |
Right ulnar | Patient 1. 4.14 (F wave: 46.4) Patient 2. 4.72 (F wave: 44.8) | Patient 1. 6.2 Patient 2. 11.5 | Patient 1. 31 Patient 2. 42.8 | Patient 1. 27.2 Patient 2. 34.5 |
Left median | Patient 1. 6.96 (F wave: 41.8) Patient 2. 7.44 (F wave: 53.9) | Patient 1. 6.6 Patient 2. 10.5 | Patient 1. 29.9 Patient 2. 35.6 | Patient 1. 29.2 Patient 2. 49.3 |
Left ulnar | Patient 1. 4.31 Patient 2. 4.78 | Patient 1. 6.4 Patient 2. 12.1 | Patient 1. 31.3 Patient 2. 37.4 | Patient 1. 31.8 Patient 2. 36.7 |
Right deep peroneal | Patient 1. 8.86 (F wave: absent) Patient 2. 8.80 (F wave: 76.5) | Patient 1. 2.9 Patient 2. 5.5 | Patient 1. 34.4 Patient 2. 39.5 | |
Left deep peroneal | Patient 1. 8.26 Patient 2. 7.58 | Patient 1. 3.6 Patient 2. 6.2 | Patient 1. 25.5 Patient 2. 36.0 | Patient 1. Missing Data Patient 2. 53.0 |
Right tibial | Patient 1. 11 (F wave: 75.5) Patient 2. 7.34 (F wave: 78.5) | Patient 1. 4.9 Patient 2. 8.5 | Patient 1. 31.3 Patient 2. 37.4 | |
Left tibial | Patient 1. 9.79 (F wave: 76.7) Patient 2. 7.35 (F wave: 74.2) | Patient 1. 5.5 Patient 2. 9.1 | Patient 1. 32.2 Patient 2. 40.4 |
Discussion
Demographics | Co-morbidities | Vaccine | Onset of symptoms in relation to vaccination | Clinical presentation | CSF | NCS | Therapy |
---|---|---|---|---|---|---|---|
Age: 65 Sex: Female Ethnicity: Caucasian (Patient 1) | Hypothyroidism due to Hashimoto thyroiditis | AZ | 2 weeks post-1st dose | - Burning pain of lower back—Lower limb paresthesia - Bilateral facial weakness | - Proteins: 259 mg/dl - WBCs: 1/mm^3 | Multifocal demyelinating sensorimotor polyradiculoneuropathy | Intravenous immunoglobulin at 0.4 g/kg per day, for 5 days |
Age: 43 Sex: Male Ethnicity: Caucasian (Patient 2) | None | AZ | 1 week post-1st dose | - Onset of bifacial pain and numbness with weakness of eye closure - Lower limbs and hands paresthesias | - Proteins: 200 mg/dl - WBCs: 6/mm^3 | Multifocal demyelinating sensorimotor Polyradiculoneuropathy with prevalent involvement of lower limbs | Intravenous immunoglobulin at 0.4 g/kg per day for 5 days |
Age: 51 Sex: Male Ethnicity: Caucasian [28] | Non-ST segment elevation myocardial infarction | AZ | 2 weeks post-1st dose | Nadir: at 2 weeks - Lower back pain - Bifacial weakness - Dysphagia - Diplopia - Respiratory failure - Upper limb motor deficit - Progressive ascending lower limb sensorimotor deficit - Areflexia | - Protein: 70 mg/dl - WBCs: 0/mm^3 | Absent ulnar and sural sensory responses with slowed median sensory and motor NCV, prolonged distal motor latencies, absent F waves | Intravenous immunoglobulin |
Age: 65 Sex: Female Ethnicity: Caucasian [28] | None | AZ | Onset: 1 week-post 1st dose | Nadir: at 2 weeks - Lower back pain - Dysphagia - Diplopia - Respiratory failure - Progressive ascending upper limb and lower limb sensorimotor deficit - Areflexia | - Protein: 251 mg/dl - WCC: 5 mm^3 | Absent upper limb sensory responses with sural sparing, prolonged distal latencies, reduced amplitudes with temporal dispersion, slowed motor NCV, absent F waves | Intravenous immunoglobulin |
Age: 66 Sex: Male Ethnicity: Caucasian [28] | Renal cell carcinoma Atrial fibrillation Hypercholesterolemia | AZ | 3 weeks post-1st dose | Nadir at 4 weeks: - Lower back pain - Progressive ascending sensorimotor involvement - Proximal lower limb weakness - Areflexia | - Protein: 150 mg/dl - WCC: 0 | Absent median sensory responses with sural sparing, absent peroneal and tibial motor responses, prolonged median distal motor, and F wave minimum latencies with slowed motor NCV | Intravenous immunoglobulin |
Age: 64 Sex: Female Ethnicity: Caucasian [29] | Hypertension Diabetes mellitus type 2 Hyperlipidemia | Ad26.COV2.S | 2 weeks post-vaccination | - Headache in the frontal and periorbital regions - Ageusia and hyposalivation - Dysarthria, dysphagia, dysphasia - Bilateral facial weakness | - Protein: 302 mg/dl - WCC: 0 | Missing data | IVIG and plasmapheresis |
Age: 38 Sex: Male Ethnicity: Caucasian [30] | Anxiety and depression | Ad26.COV2.S | 2 weeks post-vaccination | - Onset with numbness and tingling in his tongue, lips, and bilateral hands and feet - Facial weakness, slurred speech - Bilateral hand and foot paresthesias - 30 days after vaccination: difficulty moving his mouth and forming words, as well as difficulty drinking from a straw and controlling his lips, cheeks, and tongue while eating | - Protein: 181 mg/dl - WCC: 7 mm^3 | Missing data | Intravenous immunoglobulin (IVIG) over 2 days to a total dose of 2 g/kg |
Age: 37 Sex: Male Ethnicity: Caucasian [31] | None | AZ | 14 days after 1st dose | - Lower back pain - Symmetrical progressive ascending upper limb and lower limb sensorimotor deficit - Areflexia | - CSF protein: 177 mg/dl - WCC: 0 | EMG: patchy attenuation of the upper limb motor responses NCS: demyelinating neuropathy | Intravenous immunoglobulin (IVIg) with a dose of 2 g/kg daily for a total duration of 5 days |
Age: 67 Sex: Male Ethnicity: Caucasian [32] | None | AZ | 15 days after 1st dose | - Bifacial weakness - Progressive bilateral lower limb motor deficit - Areflexia | - Protein: 390 mg/dl - WCC: 0 | Demyelinating neuropathy | Missing data |
Age: 62 Sex: Female Ethnicity: Caucasian [33] | Bronchiectasis, asthma, osteoporosis, and migraine | AZ | 11 days after 1st dose | Ascending bilateral lower limb weakness preceded by paraesthesia and numbness | - Protein: 90 mg/dl - WCC: 1 | EMG: demyelinating, sensorimotor polyneuropathy | Intravenous immunoglobulin at a dose of 2 g/kg body weight divided over 5 consecutive days |
Age: 54 Sex: Male Ethnicity: Caucasian [25] | None | AZ | 16 days post-first dose | - Distal dysesthesia in his feet and hands, which ascended over 2 days, but had begun to recede as facial weakness developed | - Protein: 160 mg/dl - WCC: 17 mm^3 | Demyelinating neuropathy | Oral prednisolone 60 mg for 5 days |
Age: 20 Sex: Male Ethnicity: Iranian [25] | Ulcerative colitis | AZ | 26 days post-first dose | - Occipital headache, dysesthesia in his distal lower limbs and facial diplegia | - Protein: 123 mg/dl - WCC: 14 mm^3 | Demyelinating neuropathy | Oral prednisolone 60 mg for 5 days |
Age: 57 Sex: Male Ethnicity: Caucasian [25] | Asthma and osteoarthritis requiring bilateral knee replacements | AZ | 21 days post-first dose | - Lumbar back pain that radiated into his flanks - After 4 days dysarthria and facial weakness - Distal dysesthesia in his feet and proximal leg weakness that continued to progress until admission | - Protein: 247 mg/dl - WCC: 8 mm^3 | Facial NCS and electromyography were not performed. Sensory and motor NCS were normal in the upper and lower limbs. Minimum F wave latencies were 26 to 33 ms in the median nerves | Missing data |
Age: 43 Sex: Female Ethnicity: Caucasian [26] | AZ | 10 days post-first dose | - Facial diplegia - Motor strength - MRC grade 1/5 in UL and LL - Areflexia - Respiratory failure | - Cells: 2/mm3 (normal < 5 cells/mm3) - Protein: 85 mg/dl (normal 15–45 mg/dl) | NCS: Demyelinating neuropathy (delayed distal motor latencies, slowing of conduction velocity) prolonged F waves, absent sensory nerve action potentials) | IVIg | |
Age: 67 Sex: Female Ethnicity: Caucasian [26] | AZ | 14 days post-first dose | - Right abducens palsy, facial diplegia, and bulbar palsy—Distal sensory impairment in the legs (pinprick) - MRC grade 1/5 power in all limbs - Areflexia - Respiratory failure | - Cells: 3/mm3 - Protein: 345 mg/dl) | NCS: axonal motor — sensory neuropathy (reduced compound motor action potentials, absent F waves, absent sensory nerve action potentials) | IVIg | |
Age: 63 Sex: male Ethnicity: missing data [37] | None | AZ | 9 days following his first dose | - Onset with lower back pain - 5 days later: severe bilateral facial weakness, unsteadiness, lower limb weakness, and paraesthesia over a 48-h period - On his second day of admission, diplopia on lateral gaze bilaterally, consistent with partial cranial nerve III palsies | - Cells: 5/mm3 - Protein: 299 mg/dl | - Long-standing axonal neuropathy with reduced motor and sensory amplitudes - Length-dependent chronic neurogenic changes on EMG, but no acute abnormalities | IVIg |
Age: 61 Sex: Female Ethnicity: missing data [36] | Multiple sclerosis | AZ | 10 days after first dose | - Bifacial, left > right, weakness with prominent lower facial involvement - Asymmetrical, left > right, lower limb weakness (MRC 3/5 proximally and 4/5 distally) - Tingling in her feet and hands | - Cells: acellular - Protein: 164 mg/dl | - Motor NCS fulfilled the criteria for demyelinating polyneuropathy - Sensory NCS were within normal limits - No acute denervation potentials on needle electromyogram (EMG) studies | IVIg |
Age: 56 Sex: male Ethnicity: missing data [36] | None | AZ | A week later first dose | - Sudden‐onset severe back and lower limb radicular pain—Waist down numbness and a sensation of heaviness in his legs - Tingling and numbness in his fingertips—Bilateral lower motor neuron facial weakness - Decreased vibration sensation at the ankles - Areflexia | - Cells: two lymphocytes only - Protein: 160 mg/dl | - Motor NCS fulfilled the criteria for demyelinating polyneuropathy - Sensory NCS were within normal limits - No acute denervation potentials on needle electromyogram (EMG) studies | IVIg |
Age: 41 Sex: male Ethnicity: missing data [34] | Obesity | Ad26.COV2.S | 15 days after vaccination | - Onset with left-sided facial droop - After 7 days: bilateral facial palsy, subjective weakness, and paresthesias in all extremities (motor strength was 4 + /5 (Medical Research Council grade) in all four extremities - Deep tendon reflexes were absent bilaterally at the patella and the Achilles with mute plantar responses | - Cells: 50 mm3 - Protein: 562 mg/dl) | Prolonged distal latency with conduction block and slow conduction velocity in bilateral tibial, peroneal nerve, and absent F waves were supportive for demyelinating GBS | IVIg |
Age: 59 Sex: male Ethnicity: Caucasian [35] | Hypertension and hyperuricemia | AZ | 10 days after vaccination | - Gait ataxia - Global areflexia - Distal paraesthesia both at the lower and upper limbs - Segmental strength was diffusely preserved (MRC: 5/5) - bilateral facial palsy | - Cells: reported as normal - Protein: 140 mg/dl) | Diffuse and evident signs of motor nerve demyelination (upper and lower limbs, and cranial district) | IVIg |
Age: 53 Sex: Female Ethnicity: missing data [38] | No relevant medical history | AZ | 13 days after first dose | Bilateral facial palsy Tetramelic distal paresthesias Progressive minimal limbs weakness | Cells: 4 leukocytes/mm3 Protein: 96 mg/dl | EMG: a microvoltage pattern with reinnervation of orbicularis oris | Five double filtration plasmapheresis session within 10 days |