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. 2023 Mar 22;111:57–70. doi: 10.1016/j.jocn.2023.03.008

Table 1.

Characteristics and clinical findings of inlcuded studies.

First author Country Age Sex Neurological symptoms Type of COVID-19 vaccine Dosage of COVID-19 vaccine Time interval between vaccination and neurological symptoms MRI results CSF findings Auto-antibodies SARS-CoV-2 PCR Treatment Outcome
Al-Quliti et al. 2022 Saudi Arabia 56 Female Gradual discomfort + generalized weakness + myalgias + difficultly in the articulation of speech + needed assistance to ambulate + anorexia + dysmetria AstraZeneca (ChAdOx1) 1st 10d MRI: the T2 and FLAIR sequences demonstrated large multifocal, bilateral, asymmetric, multiple hyperintensities in the subcortical and deep white matter involving the basal ganglia with no contrast enhancement CSF: protein = 1.76, CSF glucose = 4.62; CSF WBC count = 1, RBC count = 7; (CSF differential cells) CSF segs = 20 %, CSF mono = 64 %, lymphocytes = 16 % NR Negative Omeprazole + acetaminophen + hypertonic saline at 2 % + sodium correction over the next 24 h + MPS + physical and occupational therapy Complete resolution of her symptoms, continued to improve and was able to mobilize freely without assistance, discharged from hospital
Ancau et al. 2021 Germany 61 Male Fever + headache + apathy + unconscious + foaming around the mouth + generalized seizure + comatose AstraZeneca (ChAdOx1) 1st 2d MRI: bilateral confluent cortical and subcortical FLAIR hyperintense lesions with hemorrhagic involvement of the basal ganglia CSF: normal cell counts (1 leukocyte per μl) and moderate disturbance of the blood–brain-barrier + No CSF-specific oligoclonal bands or intrathecal IgG/-A/-M−synthesis were detected against aquaporin-4 (AQP4) or myelin oligodendroyte glycoprotein (MOG) in cell-based assays (CBA) = negative + Screening for antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA), antiphospholipid antibodies, neuronal and paraneoplastic antibodies = all negative. Negative Endotracheal intubation + MPS + PE Slight improvement, reduction in size of the brain lesions, on clinical follow-up after 14 weeks of rehabilitation, the patient presented with a vegetative state
25 Female Severe cephalgia + thoracic back pain + mild weakness + ascending numbness + complete paraplegic syndrome AstraZeneca (ChAdOx1) 1st 9d Spinal MRI: a longitudinal edema throughout the thoracic spinal cord exhibiting mild contrast enhancement as well as focal central hemorrhages + Cranial MRI: bi-hemispheric white matter lesions with focal contrast enhancement CSF: erythrocytes 5,284 cells/μl, leukocytes241 cells/μl + highly elevated CSF/serum quotient for albumin of 164.7 × 10–3 + No CSF-specific oligoclonal bands were detected Intrathecal IgM synthesis = positive, but IgG or IgA synthesis = negative / glial-, neuronal-targeting, and paraneoplastic autoantibodies (CBA for AQP4- and MOG-, immunofluorescence assays in the serum for ANA, ANCA, anti-double stranded DNA antibodies) = negative Negative MPS + PE Cephalgia improved drastically and the sensory components slightly, clinical improvement of only sensory symptoms
55 Female Progressive nausea + dizziness + meningism + severe spastic tetraparesis + increased intracerebral pressures + comatose + anisocoria AstraZeneca (ChAdOx1) 1st 9d Brain MRI: multiple FLAIR-hyperintense and hemorrhagic lesions in the right parietal and temporal lobes, bilaterally in fronto-temporal distribution as well as in the right occipital lobe and left fronto-basal region CSF: mixed granulocytic and lymphocytic pleocytosis (10/μl) and a normal CSF/serum quotient for albumin of 7.4 × 10–3 + No CSF-specific oligoclonal bands were detected Intrathecal IgM, IgA and IgG synthesis = positive / Both autoimmune (AQP4-, MOG-autoantibodies as measured by CBA), and paraneoplastic antibodies (immunofluorescence assays in the serum) = negative Negative emergency right-sided decompressive hemicraniectomy + MPS Significant improvement of vigilance and motor function, died (due to progressive intracerebral hemorrhage of the brain stem)
Ballout et al. 2022 USA 81 Male Change in mental status + severe encephalopathy + viral-like illness + fever + fatigue + myalgia + acute inflammatory demyelinating process Moderna 1st 13d Brain MRI with gadolinium: on hospital Day 5 a diffusion restricting lesion involving the right dorsal medulla with corresponding T2 FlAIR hyperintensity, very faint left pontine, midbrain, and thalamic T2 FlAIR hyperintensity, and minimal T2 sulcal hyperintensity without apparent enhancement suggestive of a possible inflammatory or infectious process / Repeated Brain MRI with gadolinium: on hospital day 17 demonstrated multiple, non-enhancing, T2 hyperintense lesions involving bilateral frontoparietal lobes, lentiform nuclei, thalami, cerebral peduncles, pons, and right posterior medulla 1st CSF: opening pressure = 26 cmH2O, glucose = 69 mg/dL (reference range 40–70 mg/dL), protein = 45 mg/dL (reference range 15–45 mg/dL), and WBC count = 3 cells/μL (reference range 0–5 cells/μL). / 2nd CSF: a mild lymphocytic pleocytosis with a WBC count of 11 cells/μL and protein of 52 mg/dL / A CSF autoimmune encephalitis panel + negative / 3rd CSF: pleocytosis of 69 cells/μL with 83 % lymphocytic predominance, protein of 45 mg/dL, and significantly elevated myelin basic protein (MBP) > 167.0 ng/mL (reference range 0–6.0 ng/mL). anti-MOG antibody = negative Negative Vancomycin + IVIG + MPS + PE Died (due to hemorrhagic shock of probable gastrointestinal origin)
Francis et al. 2022 UK 36 median 14 Female Transeverse myelitis + optic neuritis + Fever + Headache + dysesthesia + Posterma + Facial nerve palsy + paraplegia 18 AstraZeneca (ChAdOx1) and 7 Pfizer (BioNTech) 23 at 1st and two at 2nd 20d Brain MRI: Involving cerebrall peduncles, internal capsule, splenium, and spinal cord. Longitudinally extensive transverse myletis and periependymal FLAIR hyperintensities. CSF: Protein (0.63 g/L, range 0.33–2.25), lymphocyte count was 36 × 106/L, and negative oligoclonal bands (OCBs) in MOGIgG + Patients. Twelve patients were MOGIgG + and two patients were AQP4IgG+ NR IVMP + PE + IVIG Only two patients had poor recovery
Ahmad et al. 2022 USA 61 Female General weakness and difficulty in communications Pfizer (BioNTech) 1st 63d Brain MRI: Signficant diffuse and symmetric acute leukoencephalopathy process involving the deep white matter extending downward through the brainstem into the cerebellar white matter tracts White blood cell count of 10.1 K/uL and hemoglobin of 12.6 g/dL. Her comprehensive metabolic panel was significant for potassium of 3.2 mmol/L, bicarbonate of 11 mmol/L, chloride of 120 mmol/L. Additional tests, including procalcitonin, cortisol, glucose level, thyroid function tests, antinuclear antibody screen, and COVID RNA nasopharyngeal swab, were within normal limits. Her urinalysis was unremarkable, but her urine toxicology was positive for tetrahydrocannabinol. Negative myelin oligodendrocyte glycoprotein (MOG) Negative MPS + IVIG Significant improvement in the patient’s mentation. There was no further disease progression in brain MRI
Cao et al. 2021 China 24 Female Somnolence + memory decline + headache + low-grade fever + muscle stiffness + extremity weakness + reduced appetite + generalized tonic–clonic seizure Vero Cells 1st 2w (14d) Brain MRI: abnormal signals in the bilateral temporal cortex / Repeat brain MRI: an increased number of lesions, which were more striking in appearance on day 10; the lesions were improved by day 15 1st CSF: WBC count = 51 × 106/L / 2nd CSF: WBC count = 25 × 106/L anti-aquaporin-4, anti-myelin basic protein, anti-MOG, anti-glial fibrillary acidic protein, autoimmune encephalitis, and paraneoplastic syndrome = all negative Negative Ceftriaxone + acyclovir + diazepam + levetiracetam + IVIG MMSE scores improved, discharged, on a visit 1 month after discharge, felt no discomfort, and a repeat MRI showed complete resolution of brain lesions
Kania et al. 2021 Poland 19 Female Severe headache + fever + back and neck pain + nausea + vomiting + urinary retention + atopic dermatitis + depression + nuchal rigidity + bilateral Babinski signs Moderna 1st 2w (14d) Brain MRI: multiple, poorly demarcated, hyperintense lesions in T2‐weighted and fluid‐attenuated inversion recovery (FLAIR) images located in both brain hemispheres, pons, the medulla oblongata, and cerebellum. Few of them were contrast‐enhanced lesions. Cervical and thoracic MRI revealed a widespread hyperintense area in T2‐weighted and FLAIR images extended from medulla oblongata to Th11 segment with overlapping few contrast‐enhancing lesions CSF: WBC count = 294 × 106/L, lymphocytes = 91 %, monocytes = 8 %, neutrophils 1 %, protein levels = 648 mg/L, RBC count = 77/µL / Control lumbar puncture was done 12 days after the first one; CSF WBC count = 61 × 106/L and protein levels = 338 mg/L. anti‐aquaporin‐4 and anti‐myelin oligodendrocyte glycoprotein = negative NR Ceftriaxone + acyclovir + MPS + PE The clinical status improved after MPS, discharged from the hospital without any symptoms except a mild headache
Kenangil et al. 2021 Turkey 46 Female Tonic–clonic seizure Sinovac 2nd 1 month (30d) Cranial MRI: There were scattered hyperintense lesions in the left thalamus, bilateral corona radiata, left diencephalon, and right parietal cortex on T2 and FLAIR sequences on MRI. Some of these lesions showed mild restricted diffusion on DWI CSF: acellular with normal protein content (45 mm/dL), an IgG index of 0.64 + no oligoclonal bands ANA (1/100) + anti-SOX1 antibody = positive / anti-double-stranded DNA and extractable nuclear antigen (ENA) panel, anti-aquaporin-4 and anti-myelin oligodendrocyte (MOG) antibodies = negative Negative Steroids Controlled MRI, without any new signs, symptoms, or seizures.
Lazaro et al. 2022 Argentina 26 Female Disorientation + inappropriate behavior + headache + gait imbalance + deferred memory + hypoprosexia + anosognosia + incoherent speech + visuospatial failures + Right upper limb weakness + gait ataxia Sputnik 1st 4w (28d) Brain MRI: nodular hyperintense lesions on T2-weighted image and fluid attenuated inversion recovery without restricted diffusion on diffusion. Marked vasogenic edema and T1-weighted image post contrast incomplete annular enhancement was observed CSF: 3 cells, 50 g proteins/L, normal glucose + Oligoclonal bands (OCB) = positive / White blood cell count = 3–66 % mononuclear, Proteins = 50.6, Glucose = 78.3, Lactic acid = 1.74, Culture (bacterial, fungal and KOCH) = Negative, VDRL = Negative, Viral PCR (Herpes simplex I/I, Varicella Zoster, Cytomegalovirus, Epstein Barr, Enterovirus, Chagas, John Cunningham) = Negative, Mycobacterium Tuberculosis PCR = Negative, Oligoclonal Bands = Type 2 Anti-myelin oligodendrocyte glycoprotein antibody (anti-MOG) IGG = negative NR MPS The clinical course was favourable, neurological examination was normal, the MRI was repeated after three months, showing clear imaging improvement of all the lesions
Maramattom et al. 2022 India 64 Male Ascending paresthesias in the legs + epigastric band-like sensation + leg stiffness + hand paresthesias AstraZeneca (ChAdOx1) 2nd 20d Brain and spine MRI: bilateral corticospinal tract hyperintensities, Dorsal cord hyperintensity at D8–9, Whole-body PET/CT normal (multifocal cord hyperintensities and bilateral hemispheric corticospinal tract hyperintensities) CSF: normal NMDA/VKGC/NMO, MOG/paraneoplastic panel = negative NR IVIG + IVMP + rituximab A repeat MRI at 1 month showed stabilization of the lesions and no new contrast enhancement (mRS 1 Level 2)
46 Male Urinary complaints + progressive lower limb weakness + numbness + fever AstraZeneca (ChAdOx1) 1st 4d Brain and spine MRI: extensive supratentorial + infratentorial + long segment spinal cord hyperintensities + longitudinally extensive transverse myelitis (MRI brain: T2, FLAIR hyperintensities in bilateral middle cerebellar peduncle (left > right), pontine tegmentum, right paramedian medulla, and left thalamocapsular region) CSF: 63 cells/mm3, Protein (52 mg/dl), sugar (93 mg/dl), CSF encephalitis panel: negative Serum NMO, MOG, ANCA = negative Negative MPS + IVMP + PE Improved significantly and was able to ambulate independently (Recovered, mRS 1 Level 2)
42 Female Severe daily headache + photophobia + papilledema AstraZeneca (ChAdOx1) 1st 5d MRI: initial MRI: leptomeningeal and sulcal enhancement / 25 days later: large right temporal irregular enhancing lesion with significant perilesional edema CSF: opening pressure 32 cm H2O, CSF parameters normal Serum & CSF autoimmune encephalitis/NMO, MOG/viral encephalitis panel = all negative NR Decompression of lesion + Excisional biopsy + Oral prednisolone Headache remitted spontaneously after the excision biopsy (mRS 1)
Miyamoto et al. 2022 Japan 54 Female Fever + headache + somnolence + urinary retention + decreased level of consciousness Pfizer (BioNTech) 2nd 12d Brain MRI: lesions in the bilateral basal ganglia, midbrain, and cerebral white matter CSF: elevated protein levels (31.2 mg/mL) + increased cell count (23/µL, 91 % mononuclear cells) + elevated myelin basic protein (809.8 pg/mL) anti-aquaporine-4 antibody + other encephalitis-related auto-antibodies (glutamate receptors, leucine-rich glioma-inactivated protein 1, contactin-associated protein 2, and glial fibrillary acidic protein) = all negative NR MPS + PE + IVIG Discharged and recovered, able to perform activities of daily living independently.
Mumoli et al. 2021 Italy 45 Male Objective vertigo + fever + diffuse myalgia + feeling of burning on the back + backpain + (knees, thighs and perineum) numbness and hypoesthesia + urinary retention + loss of feet’s vibration sensation + gait difficulties and febrile status AstraZeneca (ChAdOx1) 1st 12 h (0.5d) Spinal cord MRI: a central non expansive short tau iversion recovery (STIR) signal lesions extended to spinal cord from D10 until conus without enhancement after administration of gadolinium CSF: 43 cells (cut off < 25) associated with mild hyperproteinorachia (406 mg/l; cut off 305) + normal glycorrhachia and oligoclonal bands IgG = positive / Autoimmune screening = normal / Acquaporin-4 antibodies = negative / anti-MOG = positive with a titer 1:2560 (positive ≥ 1:160) Negative Ceftriaxone + piperacillin/tazobactam + MPS Brain and Spinal cord status was improved, the hyperintense streak in STIR has almost completely disappeared, and Anti MOG titer was stable.
Nagaratnam et al. 2022 Australia 36 Female Headache + photophobia + blurred vision + bilateral visual impairment + subjective colour desaturation + painful eye movements + fatigue + painful eye movements AstraZeneca (ChAdOx1) 1st 14d Brain MRI: multiple T2/ FLAIR hyperintense lesions involving the subcortical white matter, posterior limb of bilateral internal capsules, pons and left middle cerebellar peduncle. The largest lesion was in the right frontal centrum semiovale measuring 17 × 17 mm with multiple internal punctate foci of gadolinium contrast enhancement + There was no callosal involvement. Notably, there was no definite abnormal signal or enhancement of optic nerves / Spine MRI: evidence of demyelinating disease CSF: a normal protein of 0.4 g/L (0.19 – 0.56 g/L), glucose of 4.8 mmol/L (2.8 – 4.5 mmol/L) with pleocytosis (white cell count 59 × 106/L) (<5 × 106/L) + CSF IgG was 0.06 g/L (<0.03 g/L) with serum IgG of 12.4 g/L (7.0 – 16 g/L) + oligoclonal IgG bands were present / Serum and CSF aquaporin 4 antibodies = negative Serum myelin oligodendrocyte glycoprotein antibody (MOG) = negative NR MPS Improvement in vision and discharged, repeat MRI Brain showed further improvement, visual evoked potentials showed improvement, no new symptoms to suggest a clinical relapse, consistent with a monophasic illness.
Netravathi et al. 2022 India 54 Female Progressive quadriparesis + altered sensorium + drowsiness AstraZeneca (ChAdOx1) 1st 14d Brain MRI: T2/FLAIR hyperintensities in the corpus callosum, bl periventricular and subcortical white matter, infratentorial region with patchy contrast enhancement CSF: 8 cells- lymphocytic predominant, Protein:77 mg/dl, Glucos:98 mg/dl ANA, ANCA, CRP -negative Serum NMO-MOG = negative NR MPS + PE + Prednisolone Significant improvement
35 Female Progressive paraparesis + altered sensorium + conscious + confused + paraparesis AstraZeneca (ChAdOx1) 1st 9d MRI: T2/FLAIR hyperintensities in mid brain, pons, left MCP, bl posterior internal capsule, thalamus, bl centrum semiovale and LETM from cervical cord to conus CSF: 58 cells -lymphocytes P: 47.4 mg/dl, G: 106 mg/dl ANA profile, ANCA, VDRL, RA factor = negative / serum MOG = positive / VEP, BERA, SSEP = normal NR MPS + Prednisolone Significant improvement
20 Female Paraesthesias + paraparesis + altered sensorium Covaxin (BBV152) 1st 1d MRI: few juxtacortical and short segment cervical T2/FLAIR hyperintensity at C5 level with subtle enhancement CSF: 8 cells + lymphocytic predominant, P:24.9 mg/dl, G:61 mg/dl ANA profile, ANCA,VDRL, RA factor, CRP = negative / Serum and CSF NMO-MOG = negative / CSF OCB = Positive / VEP, BERA, SSEP = normal NR MPS + PE + Prednisolone Significant improvement
33 Female Fever + vomiting + altered sensorium + persistent paraesthesias AstraZeneca (ChAdOx1) 1st 14d Brian MRI: T2/FLAIR hyperintensity in Bl fronto parietal region, no enhancement CSF: 105 cells + lymphocytic predominant, P: 28.12 mg/dl, G: 70.4 mg/dl Serum MOG = Strongly positive NR Acyclovir + MPS + Prednisolone Significant improvement
60 Male Tingling paraesthesias + motor weakness + behavioural and memory disturbances AstraZeneca (ChAdOx1) 2nd 14d Brain MRI: multiple focal lesions in right pons, midbrain, medial temporal lobes, splenium of corpus callosum, high parietal lobe with tumefaction and peripheral enhancement CSF: 9 cells – 90 % lymphocytes, P:68.3 mg/dl, G:132 mg/dl, OCBs-negative ANA,ANCA,B12,Homocysteine,VDRL = negative / ACE = normal / Serum NMO and MOG = negative / VEP = normal NR MPS + Prednisolone Significant improvement
45 Male Fever + urinary retention + difficulty in walking AstraZeneca (ChAdOx1) 1st 10d Brain and spine MRI: hyperintensities in brainstem, cervicodorsal cord and supratentorial regions with central cord swelling CSF: 44 cells – 44 % lymphocytes, P:90.9 mg/dl, G:68 mg/dl + rabies CSF PCR = Negative VEP-l-141,R-129,BERA = normal / N20 = normal / P37–40(mildly prolonged), ANA-U1RNP-1+,C-ANCA-, Serum MOG = strongly positive / S.NMO = Negative NR MPS + PE + cycles tab WYSOLONE + MG tab Significant improvement
52 Female Progressive slurring of speech + muscle weakness + swallowing difficulty AstraZeneca (ChAdOx1) 1st 35d Brain MRI: tumefactive demyelination in left frontal hemisphere with insular involvement along with left more than right midbrain involvement CSF: 2 CELLS,P-40.5 mg/dl,G-56 mg/dl ESR-18 ANA, ANCA = Negative / VDRL = Negative / S.NMO and MOG = Negative NR Rituximab + cycles Tab Wysolone + PE Remained critically ill, requiring invasive ventilation, and died (after a prolonged intensive care unit stay and superimposed infection)
Permezel et al. 2021 Australia 63 Male Vertigo + abdominal pain + fatigue + ketoacidosis + silent myocardial infarction + declining cognition + emerging disorientation + impaired attention AstraZeneca (ChAdOx1) 1st 12d Brain and cervical spine MRI: numerous bilateral foci (>20) of high T2 and FLAIR signal in the cerebral white matter, with both periventricular and juxtacortical involvement NR NR NR Empiric antibiotics + antivirals + corticosteroids + PE MRI brain was repeated on day 19 and demonstrated no changes, and died on day 20 of admission.
Rinaldi et al. 2021 Italy 45 Male Numbness + reduced visual acuity + dysarthria + dysphagia + clumsy right hand movements + urge incontinence AstraZeneca (ChAdOx1) 1st 12d Brian MRI: large, poorly marginated T2-weighted hyperintensities in the pons (which appeared swollen), right cerebellar peduncle, right thalamus, and multiple spinal cord segments (at the cervical, dorsal, and conus medullaris level). All lesions, except the thalamic one and a single dorsal spinal area, showed blurred gadolinium enhancement on T1-weighted images CSF: mild lymphocytosis (44 leucocytes, 98 % mononuclear cells), normal proteins, no evidence of tumor cells on CSF cytology / CSF immunoelectrophoresis: the presence of three oligoclonal bands, with normal Link’s Index / Extensive panel for onco-neural antibodies on serum and CSF = negative Anti-aquaporin-4 (AQP4), anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, anti-nuclear, anti-extractable nuclear antigens, anti-neutrophil cytoplasmic, and anti-cardiolipin antibodies = all Negative NR MPS + prednisone Clinically improved in a few days, and MRI significantly improved
Shimizu et al. 2021 Japan 88 Female Impaired consciousness + gaze-evoked nystagmus Pfizer (BioNTech) 2nd 29d Brian MRI: signal abnormalities in the bilateral middle cerebellar peduncles CSF: bacterial and fungal cultures, a CSF oligoclonal band screen, and a test for autoantibodies against myelin basic protein = all negative antinuclear-, autoimmune vasculitis-, onconeural-, and anti-ganglioside antibodies = all negative NR MPS Impaired consciousness and gaze-evoked nystagmus were found to improve, further MRI brain scans revealed the signal abnormalities had decreased (Complete clinical recovery)
Simone et al. 2021 Italy 51 Female Acute urinary retention + bilateral hypoesthesia NR NR 2w (14d) MRI: enhancing T2 hyperintense lesions in the spinal cord with longitudinal extension, in the midbrain and in the optic nerves bilaterally CSF: lymphocyte pleocytosis (50 cells/μL), negative oligoclonal bands anti-MOG-IgG antibody = positive Negative MPS Clinical improvement
Vogrig et al. 2021 Italy 56 Female Unsteadiness of gait + clumsiness of left arm + malaise + chills + diplopia + mild ataxia + left-ward deviation of gait + urinary retention Pfizer (BioNTech) 1st 2w (14d) Brain MRI: an area of hyperintensity on fluid attenuated inversion recovery (FLAIR) sequences involving the left cerebellar peduncle, with modest mass effect on the fourth ventricle, which was not present on the previous MRI examination. No contrast enhancement was observed and the lesion did not exhibit diffusion restriction. In addition, new supratentorial areas of hyperintensity on FLAIR sequences were observed, the largest in the left centrum semiovale (unremarkable) CSF: pleocytosis (80 cells/mm3), protein and glucose levels = normal MOG, AQP4, GM1, GM2, GM3, GM4, GD1a, GD1b, GD2, GD3, GT1a, GT1b, GQ1b = all negative Negative Prednisone Spontaneously recovered and underwent regular follow-up
Yazdanpanah et al. 2022 Iran 37 Male Muscle weakness + dysphagia + drooling + nausea + vomiting + bilateral facial nerve paralysis Sinopharm 1st 1 month (30d) Brain MRI: typical imaging findings which presented as multifocal T2-FLAIR signal changes in the corticospinal tract, pons, and temporal lobe with diffusion restriction. CSF: 2 WBCs, 32 RBCs, 56 mg/dL protein, and glucose of 97 mg/dL + IgG oligoclonal bands = negative NR Negative PE + IVIG + antibiotic therapy + Heparin + Pantoprazole + Clindamycin + Paracetamol + MPS Showed progressive recovery of motor function, and discharged (with an excellent general condition)

PE: Plasma exchane, MPS: Methylprednisolone, IVIG: Intravenous immuneglobulin, IVMP: IV methylprednisolone, NR: Not reported.