Table 2.
Enumerates the clinical details of the cases.
| Demyelination | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Serial No | Age(years) | Gender | Presenting Complaints | Total Duration (days) of Illness | Type of Vaccine/dose | Interval from last vaccination to the onset of first neurological symptoms | Examination finding | Investigations | Diagnosis | Treatment | Prognosis | Causality label$ |
| 1 | 35 | F | Body ache, headache, vomiting followed by altered sensorium and, inability to walk, excessive sleepiness and bladder retention. Known case of well controlled T2DM | 10 | ChAdOx-1/1st dose | 9 days | Hypotonia in both lower limbs and lower limb power 2/5 with biceps, supinator and triceps hyperreflexia and knee and ankle hyporeflexia and left extensor plantar. | CRP, RA factor, ANA profile and ANCA- negative. LP-CSF: Cells- 58/hpf cells (50 L),protein- 47 mg/dl. VEP b/l and BAER, SSEPs – Normal. MRI of Brain and spine T2/FLAIR hyperintensities in mid brain, pons, left MCP, bilateral posterior internalcapsule, thalamus, bilateral centrum semiovale and longitudinally extensive transverse myelitis involving cervical cord and conus. Serum MOG was positive | MOGAD | IV MP (1gm) * 7daysFollowed Mycophenolate mofetil maintenance | Improved (mRS = 2) | Probable |
| 2 | 34 | M | Headache, right eye visual diminution | 14 | ChAdOx-1/1st dose | 1 days | Rt eye- Visual acuity-perceptionof light present, Lteye 6 /18 | CRP, RA factor, ANA profile and ANCA- negative. LP-CSF: Cells- 4/hpf cells (2 L),protein- 26.6 mg/dl. VEP- right eye prolonged P100 and BAER, SSEPs – Normal. MRI of Brain suggestive of right optic neuritis. Serum and CSF aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative Optic neuritis | IV MP (1gm) * 5 days followed by oral prednisolone gradual tapering | Improved (mRS = 0) | Probable |
| 3 | 27 | F | Hiccups and vomiting, tingling numbness in all four limbs and decreased sensation over trunk and lower limbs, weakness in left upper and lower limbs, weakness in right upper limb and lower limb, spasms and pain in right upper limb and lower limb and neck | 80 | BBV152/1st dose | 17 days | Right hemiparesis, Tone:- Tone increased in right upper and lower limbsRight upper and lower limb flexor spam present every 30 min. Right Biceps, triceps,knee,ankle jerks brisk, plantar no response b/l. Sensory- Touch, vibration, JPS impaired b/l Ul and LL. | ESR, and CRP – Elevated. LP-CSF: cells-2(lymphocytes-100 %) protein-23.8 mg/dlSSEP showed absence of wave forms. MRI of Brain and spine – s/o cervical myelitis and medullary involvementSerum aNTI-AQ-4 ANTIBODY – Strongly positive. | NMOSD | LVPP*5 cylcles f/bRituximab | Improved (mRS = 1) | Probable |
| 4 | 38 | M | Urinary incontinence, and weakness in all 4 limbs. Known case of well controlled T2DM | 4 | ChAdOx-1/1st dose | 14 days | Quadriparesis with brisk DTRs andsensory loss over V3 division of trigeminal nerve bilaterally, trunk (till C4 level) and all 4 limbs. | LP-CSF- 370 cells (80 percent neutrophils and 20 percent lymphocytes), protein 174 mg/dl. CSF OCB is positive, serum OCB is negative. ACE, RA factor, ANA profile and ANCA- negative. MRI of Brain and spine – longitudinally extensive transverse myelitis from cervico-medullary junction upto D1 and hyper intensity in left middle cerebellar peduncle and pons. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative CNS demyelination | IV MP (1gm) * 5 days followed by PLEX * 7 cycles followed by Rituximab | Mild Improvement (mRS = 2) | Probable |
| 5 | 54 | M | Tingling paresthesia of right Lower limb and associated with transient tonic posturing of right upper limb lasting for seconds. | 6 | ChAdOx-1/1st dose | 14 days | Tone and power normal, brisk DTRs and flexor plantar response. Sensory examination normal. | MRI of Brain and spine – symmetrical T2/FLAIR hyperintensities in b/l corticospinal tract and, cerebral peduncles and middle cerebellar peduncle. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative CNS demyelination | Symptomatic management of paresthesia and antiepileptic | Improved (mRS = 0) | Probable |
| 6 | 36 | F | Tingling parasthesia in both lower limbs,weakness of both lower limb and urinary symptoms | 20 | ChAdOx-1/2nd dose | 32 days | Hypotonia with sluggish DTRs in lower limb and lower limb power 0–1/5, sensory loss till D4. | CRP, RF, ANA, ANCA and Paraneoplastic profile -negative. LP-CSF: 720 cells (lymphocytes-580, polymorphs-20, degenerated cells-120), elevated protein (144 mg/dl), elevated lactate (32 mg/dl) and normal glucose. VEPwas absent in right eye and prolonged in left eye. SSEP- absent wave forms LL and prolonged in UL. MRI of Brain and spine – longitudinally extensive transverse myelitis predominantly involving central and posterior cord sparing anterior part extending from obex till conus with cord swelling with left optic neuritis. Serum MOG – Positive | MOGAD | IV MP (1gm) * 5 days followed by PLEX * 7 cycles | Improved (mRS = 1) | Probable |
| 7 | 30 | M | Pain in the right eye and diminution of vision,and pain in left eye and diminution of vision. | 13 | ChAdOx-1/1st dose | 14 days | Right RAPD was present. Right eye perception on light was absent. Left eye 6/60.Fundus showed bilateral papilledema grade 3 (right more than left) | ANA profile and ANCA were negative. Serum NMO MOG panel was negative. Viral markers were negative. CSF analysis showed 1 cell with normal protein. Evoked potentials showed bilateral absence of P100 and BAER and SSEP were normal. MRI brain showed optic nerves hyperintensities bilaterally with volume loss more on left side. MRI spine screening was normal. | Bilateral Optic neuritis | LVPP*5 cylcles f/b1gm IVMP*2 days f/b oral steroid and Rituximab | No improvement (mRS = 5) | Probable |
| 8 | 50 | F | Tingling paresthesia and both upper and right lower limbs weakness. Known case of hypothyroidism on treatment. | 10 | ChAdOx-1/1st dose | 28 days | Right lower limb power 3–4/5, spastic and DTRs in right side, Knee and ankle jerks are brisk with right extensor plantar | ANA profile – PCNA 1 +.LP-CSF: Cells- 2/hpf cells (2 L),protein- 28.3 mg/dl. MRI of spine C7 level short segment T2/FLAIR hyperintensities. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Short segment transverse myelitis | Oral prednisolone and mycophenolate mofetil | Improved (mRS = 1) | Probable |
| 9 | 44 | M | Imbalance while walking and vomiting, acute urinary retention, band like sensation and double vision | 12 | ChAdOx-1/1st dose | 13 days | Quadriparesis with brisk DTRs andsensory loss over V3 division of trigeminal nerve bilaterally, trunk (till C4 level) and all 4 limbs. | LP-CSF: Lymphocytic pleocytosis with elevated proteinMRI of Brain and spine – T2/FLAIR long segment non expansile hyperintensities in the cervical and dorsal cord and conus medullaris with involvement of 2/3rd cross sectional area of cord. Serum SARS-CoV2 S1,S2 (IgG&IgM)- PositiveSerum MOG – Positive | MOGAD | IV MP (1gm) * 5 days followed by Mycophenolate mofetil | Improved (mRS = 0) | Probable |
| 10 | 38 | M | Vertigo, double vision on looking left, Imbalance while walking and blurring of vision in Right eye with Headache | 26 | ChAdOx-1/1st dose | 6 days | Pupils:3 mm equal and reactiveV/A- 6/9 in RE, 6/6 in LEFundus – NormalEOM: fullGaze evoked horizontal and torsional nystagmus. | CRP,RF, ANA profile and ANCA- Negative. LP-CSF- Traumatic tap. MRI of Brain and spine – patchy areas of demyelination in left MCP, right corona radiata with T2/FLAIR hyperintensity in right vestibular apparatus. VEP- Prolonged P100 latency and low amplitude BAER waveforms. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | CNS demyelination with Vestibulopathy | IVMP 1gm *5 days f/b oral steroid | Mild Improvement(mRS = 2) | Probable |
| 11 | 53 | F | Paresthesia of both lower limb, urinary hesitancy, paresthesia and tightness of both upper limbs over trunk,and band like sensation over chest. Known case of medically controlled hypertension since 1 year. | 12 | ChAdOx-1/2nd dose | 1 day | Fine touch reduced bilaterally from toes to epigastrium and in bilateral medial part of forearm and middle and little fingersPain: decreased bilaterally from toes to epigastriumVibration: Absent on both sides till knee. Joint position sense: Absent in great toes, thumbs on both sides. Plantar: Bilateral extensor. Rhomberg s: Positive | ACE levels, ANA Profile, ANCA, CRP, RA Factor- Negative. LP-CSF showed 6 cells, 57 mg/dl protein. Serum anti-recoverin- Positive. MRI of Brain and spine – T2/FLAIR hyper-intensities in the bilateral periventricular white matter, bilateral insula and bilateral cerebellar hemispheres. Few short segment expansive T2 hyperintensities are noted in the cervical cordat C5,6,7 levels and dorsal cord at D6-7 level with involvement of central cord. SARS-CoV2 S1,S2 (IgG&IgM)- PositiveSerum and CSF aNTI-AQ-4 ANTIBODY and MOG – Negative | CNS demyelination | IVMP 1gm *5 days f/b oral steroid | Mild Improvement (mRS = 1) | Probable |
| 12 | 35 | F | Blurring of vision of both eyes, walking difficulty, mild pain thorax and breathing problem in supine position. | 20 | ChAdOx-1/2nd dose | 14 days | Visual acuity-bilateral 6/9. E.O.M.-full. Pupils-bilateral 3 mm,pupils equally reactive to light. Lower limb power 3–4/5, Sensory-90 percent loss of pain,touch,temperature in bilateral lower limbs,bilateral upper limbs. 100 percent pain,touch,temperature sensation present in right side of face. Joint,position sensation, and vibration impaired in bilateral lower limbs. | ESR-raised, CRP,ANA-Negative. LP-CSF: cells-17(all lymphocytes), protein-64 mg/dlV.E.P.-left(P100-115.8), right(P100-125.7),prolonged S.S.E.P inlower limb(P37-43),normal S.S.E.P. in upper limb(N20-19.3)and normal value of ABR. MRI of Brain and spine – few short segment T2 hyperintensities in thecervical (C2-3 level) and dorsal cord (D1 to D3) with patchy heterogeneous enhancement. Posterior intra-orbital segment of bilateral optic nerves, optic chiasm and the bilateral proximal optic tracts also showed T2/ FLAIR hyperintensity with patchy contrast enhancement along with signal change in the hypothalamus, left trigeminal nerve (root entry zone and cisternal segment), right lateral medulla extending to the cervicomedullary junction. Serum aNTI-AQ-4 ANTIBODY and MOG – NegativeCSF OCB- Pattern 4. | Bilateral Optic Neuritis and Brainstem demyelination | LVPP*5 cylcles f/b1gm IVMP*5 days f/b oral steroid and Rituximab | Improved (mRS = 0) | Probable |
| 13 | 30 | F | Shock like sensation on flexing the neck and tingling paraesthesia of B/l hand | 3 months | ChAdOx-1/2nd dose | 15 days | Tone- Normal. Power-normal in U/L and L/L including intrinsic muscles of handReflexes −2Plantar bilateral- flexorSensory system −40 percent reduction in sensation to touch over both palms. | ESR-68 mm, ACE,RA, ANA profile-negativeMRI of Brain and spine – T2 hyperintensities short segment at C3 level. Evoked potentials are normal. Serum SARS-CoV2 S1,S2 (IgG&IgM)- Positive. CSF OCB- Positive. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative CNS demyelination | LVPP*5 cylcles f/b1gm IVMP*5 days f/b oral steroid | Improved (mRS = 0) | Probable |
| 14 | 26 | F | Weakness of bilateral lower limbs,sensory loss below the chest, urinary retention, weakness and paresthesias of both upper limbs | 4 | BBV152/1st dose | 5 days | Quadriparesis Sensory examination – absent sensation to touch and pin prick below T4 Level. JPS and vibrationimpaired in lower limbs. DTRs – upper limb 2, lower limbs absent | ANCA, RA factor, and CRP – negative. ANA profile – anti PCNA strongly positive. LP-CSF: cells-207(lymphocytes-40 %, PMN-60 %), protein-95.8 mg/dlSSEP showed absence of wave forms. MRI of Brain and spine – long egment transverse myelitis from cervical region to lower lumbar region. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative CNS demyelination | LVPP*5 cylcles f/b1gm IVMP*5 days f/b oral steroid | Improved (mRS = 2) | Probable |
| 15 | 27 | F | Pain in left upper and lower limb and right lower limb, headache, weakness of left upper and lower limb and right lower limb | 30 | ChAdOx-1/ 1st dose | 5 days | MotorGrade 1 spasticity in left upper limbPower- 5/5Tendon reflexes- 3Plantars- Bilaterally flexorSensory- Touch, pain, joint position sense- Normal | ANA profile, ANCA, ACE – negative. LP-CSF: cells-0, protein-27.7 mg/dlMRI Brain – multifocal mildly expansile discrete T2 heterogeneously hyperintense lesions without FLAIR suppression in periventricular white matter along lateral ventricles, subcortical -deep white matter of bilateral frontal -parietal – temporal lobes, right caudate nucleus body, right PLIC -adjacent thalamus. Larger lesion in bilateral corona radiata show peripheral diffusion restriction and peripheral thin rim of blooming on SWI. Post contrast enhancementin few lesions in bilateral periventricular -deep white matter. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Acute disseminated encephalomyelitis(ADEM) | IVMP 1gm*5 days f/b oral steroid | Improved (mRS = 2) | Probable |
| 16 | 45 | F | Bilateral visual loss | 4 | ChAdOx-1/ 1st dose | 5 days | VA- Bilateral lowMotor, sensory, cerebellar- normal | RA factor, and ANA profile – negativeLP-CSF: cells-2(lymphocytes-100 %), protein-52.3 mg/dlVEP- b/l prolonged P100. CSF OCB- Negative. MRI of Brain and spine – No significant signal changes. Serum MOG – Positive | MOGAD | LVPP*5 cylcles f/b1gm IVMP*5 days f/b mycophenolate mofetil | Improved (mRS = 1) | Probable |
| 17 | 20 | F | Double vision | 5 | ChAdOx-1/1st dose | 3 days | Brisk DTRs and mild spatic lower limbs. | CRP, RA factor, ANA profile and ANCA- negative. MRI of Brain multple discrete T2/FLAIR hyperintensities in pericallosal, callosal and frontal regions. Serum aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative CNS demyelination | IV MP (1gm) * 5 days followed by oral prednisolone gradual tapering | Improved (mRS = 0) | Probable |
| 18 | 55 | F | Right lower limb pain and weakness and then after 2 month paresthesia left lower limbKnown case of medically controlled T2DM | 60 | ChAdOx-1/ 1st dose | 2 days | Pupil, EOM- fullRight hemiparesisRight UL and LL DTRs brisk | ESR (57 mm) and CRP(11 mg/L) – elevated. ANA profile – NegativeParaneoplastic profile: anti-Tr and anti-GAD65, LP-CSF: cells-2(lymphocytes-100 %), protein-28.3 mg/dlSSEP showed absence of wave forms. MRI of Brain and spine – multiple T2 hyper intensities in the cervico-dorsal spine. CT abdomen, pelvis, thorax- negative for malignancy. Serum and CSF aNTI-AQ-4 ANTIBODY and MOG – Negative | Seronegative CNS demyelination | 1gm IVMP*5 days f/b oral steroid | Improved (mRS = 1) | Probable |
| 19 | 16 | F | Recurrent vomiting, burning sensation of both upper limbs, tremuloousness of b/l upper limbs, imbalance while walking, double vision and swallowing difficulty | 90 | BBV152/2nd dose | 14 | EOM: Bilaterally abduction, Upbeat nystagmus in all directions ofgaze. Bilateral LMN facial palsy. Trismus, jaw opening restricted. Power 4/5Cerebellar signs present b/l, DTRs brisk, plantar b/l extensorSevere gait ataxia | Serum ANA, ANCA negative. MRI brain-T2/Flair diffuse white matter hyper-intensities involving lower mid brain to C4 level of spinal cord. LP-CSF: nil cells-2, protein-28.0 mg/dl. Serum and CSF NMO was strongly positive. | NMOSD | LVPP*5 cylcles f/b1gm IVMP*5 days f/b oral steroid and Rituximab | Mild Improved (mRS = 3) | Probable |
| 20 | 54 | M | Imbalance, Dysarthria, weakness of both lower limbs, dysphagia | 10 | ChAdOx-/2nd dose | 14 | Dysarthria-scanningVA-Right eye-6/36,Left eye-6/36Tone- Hypotonia b/l LLPower- LL 4/5DTRs- BriskPlantar- Extensor b/lJPS- impairedCerebellar signs- present | ANA profile: AntiRNP,Anti JO 2 + ANCA,Serum.NMOMOG:negative. ESR was 90 mm/hr. MRI Brain:T2 /FLAIR patchy hyper intense lesion in pontine region | Seronegative CNS demyelination | 1gm IVMP*5 days f/b oral steroid and Rituximab | Improved (mRS = 1) | Probable |
| 21 | 29 | F | Headache, Rt eyeblurring of vision | 15 | ChAdOx1nCoV- 19 /1st dose | 11 | Rt: eye RAPD, VA –Rt: hand movementclose to face; Lt − 6/6 | CSF: 0 cells, P:18 mg/dl, G: 61 mg/dl Serumand CSF OCB absentANA, ANCA, RAfactor, CRP -negativeSerum MOG- positiveVEP: Rt – absentwaveform, Lt – normalMRI brain: T2 /FLAIRhyperintensity of longintraorbital segment ofRt optic nerve withcontrast enhancement | MOGAD | Inj. MP 1 gm × 5 days 1 cycle ofLVPP T. Prednisolone 40 mg OD followedby taperingdoses | Improved (mRS = 1) | Probable |
| 22 | 54 | F | Progressivequadriparesisfollowed byaltered sensorium | 42 | ChAdOx1nCoV- 19 /1st dose | 14 | Drowsy, not openingeyes, bl UL flexionposturing, quadriparesis with2/5 power in UL and0/5 power in LL. | CSF: 8 cellslymphocyticpredominant, P:77 mg/dl, G:98 mg/dlANA, ANCA, CRP-negative Serum NMOMOG-negative MRIbrain: T2/FLAIRhyperintensities in thecorpus callosum, blperiventricular andsubcortical whitematter, infratentorialregion with patchycontrast enhancement | ADEM | Inj. MP 1 gm × 5 days 5 cycles ofLVPP Inj. Iv Ig100 g T. Prednisolone 40 mg OD followedby taperingdoses | Mild Improved (mRS = 2) | Probable |
| 23 | 44 | M | Hiccups, vomiting, urinaryretention, doublevision, Imbalance onwalking | 12 | ChAdOx1nCoV- 19 /1st dose | 7 | Lt VA: 6/9, Rt – 6/6. spasticquadriparesis, bilateral cerebellarsigns in UL | CSF: Lymphocytic pleocytosis with elevated protein. ANA, ANCA -negativeSerum and CSF MOGStronglypositive, MRI: T2 hyperintensities inthe cervico-dorsalcord and conus | MOGAD | Inj. MP 1 gm × 5 days 5 cycles ofLVPP T. Prednisolone 40 mg OD | Mild Improved (mRS = 2) | Probable |
| 24 | 39 | M | Rt eye painfollowed byblurring of vision | 20 | ChAdOx1nCoV- 19 /1st dose | 14 | RT eye-RAPD, Rt VA: Finger counting at 2 m Visual field- rightinferonasal quadrantinvolvement | ANA, ANCA, APLA-negative, Serum MOG- positive, VEP- bl prolonged (Right-132 ms, left-115 ms) MRI: T2 /FLAIRhyperintensity of longintraorbital segment ofRt optic nerve withcontrast enhancement | MOGAD | Inj. MP 1 gm × 5daysT. Prednisolone 40 mg OD | Improved (mRS = 0) | Probable |
| 25 | 54 | M | Left eye blurringof vision | 21 | ChAdOx1nCoV- 19 /1st dose | 14 | VA: Bl 6/12, Lt eyeRAPD present, Rteye-normal pupillaryreaction. | ANA profile anti Jo1 1 + positive, ANCA, VDRL-negative, VEP: Rt- 127 ms, Lt-absentwaveform Serum MOG–Strongly positive MRIbrain and spine: T2/FLAIR hyperintensityin Rt pons | MOGAD | Inj. MP 1 gm × 5 days T. Prednisolone 40 mg OD | Mild Improved (mRS = 1) | Probable |
| 26 | 31 | M | Bladderdisturbancesfollowed byprogressivenumbness ofwhole body andLL weakness | 5 | ChAdOx1nCoV- 19 /1st dose | 14 | Lower limbspasticity, paraparesis withpower 1/5, decreased sensationsby 70 % below L1, plantars extensor, ULDTRs-3 + and LL 2+ | CSF: 370 cells -polymorphicpredominant, P: 174 mg/dl, G: 168 mg/dlANA profile, ANCA, VDRL, RA factor, CRPnegativeSerum andCSF NMO-MOG –negative VEP andBERA- normal, SSEP ofLt. LL prolonged (55.9 ms) MRI: long segmentcervico-dorsal T2/ FLAIR hyperintensitywith subtleenhancement | Seronegative CNS demyelination | Inj. MP 1 gm × 5 days T. Prednisolone 40 mg OD 7 cyclesof LVPP Inj. Rituximab 1 gm | Mild Improved (mRS = 2) | Probable |
| 27 | 20 | F | Rt ULparaesthesiasfollowed byparaparesis &altered sensorium | 2 | BBV152 /1st dose | 1 | VA: Bl 6/6. LLproximal weakness (3/5), distal 4/5, DTRs- 3+, Rt LL50% decreasedsensation, PlantarsEquivocal | CSF: 8 cells -lymphocyticpredominant,P:24.9 mg/dl, G:61 mg/dlANA profile, ANCA, VDRL, RA factor, CRP-negative Serum andCSF NMO-MOGnegative, CSF OCB –Positive VEP, BERA, SSEP- normal MRI: few juxtacortical andshort segment cervicalT2/FLAIRhyperintensity at C5level with subtleenhancement | Seronegative CNS demyelination | Inj. MP 1 gm × 5 days T. Prednisolone 40 mg OD 5 cyclesof LVPP | Mild Improved (mRS = 2) | Probable |
| 28 | 33 | F | Fever, vomitingfollowed byaltered sensoriumand persistentparaesthesiasbelow midthoracic level | 28 | ChAdOx1nCoV- 19 /1st dose | 14 | VA: Rt 6/12, Lt 6/9, Bl normal pupillaryreaction, no otherfocal deficits | CSF: 105 cells -lymphocyticpredominant, P: 28.12 mg/dl, G: 70.4 mg/dlSerum MOG –Stronglypositive MRI brain: T2/FLAIRhyperintensity in Blfronto parietal region, no enhancement | MOGAD | Inj. MP 1 gm × 5 days T. Prednisolone 40 mg OD | Minimal improvement (mRS = 3) | Probable |
| 29 | 60 | M | Acute onsettinglingparaesthesias andmotor weaknessin left upper andlower limb, followed bybehavioural andmemorydisturbances | 34 | ChAdOx1nCoV- 19 /2nd dose | 14 | MMSE-27/30 Cranialnerves-VA:R-6/6, L-6/9, nystagmuspresent Motorsystem-Power: normal,DTRs-brisk | CSF: 9 cells – 90 %lymphocytes, P:68.3 mg/dl, G:132 mg/dl, OCBs-negative ANA, ANCA,B12, Homocysteine,VDRLnegative, ACE-normalSerum NMO and MOG-negative, VEP-normalMRI brain: multiplefocal lesions in rightpons, midbrain, medial temporal lobes, splenium of corpuscallosum, high parietallobe with tumefactionand peripheralenhancement | ADEM | Inj MP 1 gm × 5 days T. Prednisolone 40 mg OD T. MMF (1gm) | Mild Improved (mRS = 2) | Probable |
| 30 | 23 | F | Burningparaesthesias inright palmassociated withnumbness andmotor weaknessfollowed byburning sensationin right foot overnext 7 days | 41 | ChAdOx1nCoV- 19 /2nd dose | 7 | VA-6/6 Bl Cranialnerves-normal Motorsystem-normalSensory systemdecreasedvibrationalong distal rightupper and lower limbjoints | CRP- 23 mg/dl ANAnegativeSerum NMOand MOG-negativeCSF-OCB negative MRIbrain-T2/flairhyperintensitiesadjacent to rightfrontal horn, ependymal margins ofbilateral lateralventricles MRI spineshortsegmenthyperintensities at C2-C3,C5,D4 | SeronegativeCNS demyelination | Inj MP 1 gm × 5 days T. Prednisolone 40 mg OD | Minimal Improved (mRS = 3) | Probable |
| 31 | 40 | M | Blurring of visionfrom left eyefollowed by acuteurinary retentionnd right eyevision loss | 77 | ChAdOx1nCoV- 19 /1st dose | 10 | VA- 6/18 Bl Cranial, motor and sensoryexamination-normal | CSF: 8 cells – 100 %lymphocytes, P:32 mg/dl, G:68 mg/dl, OCB-positive ANA, ANCA,VDRL-negative, Serum MOG-positive MRI brain: T2 Hyperintensities inpons, bilateralthalami, right frontalcortex MRI spinelongitudinallyextensive myelitisfrom C4-D3 | MOGAD | Inj MP 1 gm × 5 days T. Prednisolone 60 mg OD T. MMF (2gm) | Mild Improved (mRS = 2) | Probable |
| 32 | 45 | M | H/o feveraccompanied byurinary retentionand difficulty inwalkingprogressing toaltered sensorium | 5 | ChAdOx1nCoV- 19 /1st dose | 10 | VA-6/6 BL Cranialnerves-normal Motorsystem-Tone andpower normal inupper limbs LLhypotonia, grade-0 power withhyporeflexia, plantars mute | CSF: 44 cells – 44 %lymphocytes, P:90.9 mg/dl, G:68 mg/dl, rabies CSF PCRNegativeVEP-L-141,R-129,BERA-normal, N20-normal, P37–40 (mildly prolonged), ANA-U1RNP-1+,CANCA-,Serum MOG –strongly positive S. NMO–Negative MRI of brain and spinehyperintensitiesinbrainstem, cervicodorsal cord andsupratentorial regionswith central cordswelling | MOGAD | INJ MP-5 days, LVPP 3 CYCLESTABWYSOLONE 40MG TAB MMF1.5 GM | Mild Improved (mRS = 1) | Probable |
| 33 | 34 | F | H/o recurrentvomiting andhiccupsprogressing toimbalance whilewalking | 60 | ChAdOx1nCoV- 19 /2nd dose | 36 | Cranial nerves: Rightgaze evokednystagmus, restnormal Motorexamination::Toneand power normal, DTRs brisk BLSensoryexamination: pseudoathetosisLeft > Right,, Romberg’s positive, Tandem gaitimpaired | CSF-1 cell,P-15,3 mg/dl, 63 mg/dl,OCBNegative ESR-46 mm/hr Serum NMO-weaklypositive Serum MOGnegativeANA:Ro-521+,ANCA-negativeMRI brain:T2hyperintensity indorsal aspect ofmedulla | NMOSD | I/V MP-5 daysLVPP-3 cyclesTab Wysolone40 mg InjRituximab | Mild Improved (mRS = 2) | Probable |
| 34 | 31 | M | H/o progressiveupper and lowerlimb tingling f/bdifficulty inwalking, urinaryurgency, andconstipation | 17 | ChAdOx1nCoV- 19 /1st dose | 42 | Cranial nervesnormalUL motorexamination-normal, LL power-4/5,briskDTRs, extensorplantars Sensorylevel at T4 | CSF: 32 cells – 100 %lymphocytes, P:49.2 mg/dl, G:74 mg/dlANA,ANCA,VDRL-negative, Serum NMOand MOG -negativeMRI brain: T2Hyperintensities incervicomedullaryjunction, right frontalsubcortical region MRIspine-cervical cord HIC2-C5,also in dorsalcord | SeronegativeCNS demyelination | I/V MP-5 daysLVPP-4 cyclesTab Wysolone40 mg Tab MMF1.5 gm | Mild Improved (mRS = 1) | Probable |
| 35 | 52 | F | H/o progressiveslurring of speechwith right upperlimb and lowerlimb weakness, followed byappearance ofswallowingdifficulty | 51 | ChAdOx1nCoV- 19 /1st dose | 35 | Spastic anarthria + Gaze restrictedleft > right Rightfacial weaknessMotor examinationhypotonicrightupper and lower limbwith 0/5 power, leftsided power-5/5,BLDTRs brisk andplantars extensor | CSF-2 CELLS,P-40.5 mg/dl,G-56 mg/dlESR-18,CRP-POSITIVEANA,ANCA-Negative, VDRL-Negative S. NMO and MOGNegativeMRI brain: tumefactivedemyelination in leftfrontal hemispherewith insularinvolvement alongwith left more thanright midbraininvolvement | ADEM | I/V MP-5 daysLVPP-4 cyclesTab Wysolone40 mg InjRituximab | Minimal Improved (mRS = 3) | Probable |
| 36 | 65 | F | H/o urinaryretentionfollowed bynumbness andweakness of bothhands andblurring of visionof right eye | 30 | ChAdOx1nCoV- 19 /1st dose | 42 | V/A-R- handmovements close toface,L-6/18 UL: motor examinationnormal LL: Power-0/5 DTRs absent in LLSensory level:T6 | CSF-17 CELLS,P-49 mg/dl,G-59 mg/dlESR-97 ANA,ANCANegative, VDRLNegativeS.NMOStronglypositive S. MOG-Negative VEP-RNotrecordable, LNormalSSEP-LLabsent MRI brain: fewhyperintensities infrontal subcorticalwhite matter MRISpine: D2-D11hyperintensity withpatchy contrastenhancement andbright spotty areas | NMOSD | LVPP – 3 cyclesI/V MP-5 daysTab Wysolone40 mg Tab MMF1.5 gm | Mild Improved (mRS = 2) | Probable |
| 37 | 20 | F | H/o tingling intips of right handfollowed byprogressive imbalance whilewalking | 24 | ChAdOx1nCoV- 19 /2nd dose | 39 | V/A-6/6 BL Motorexamination: Toneincreased in rightupper limb and lower limb Power − 5/5 inall 4 limbs DTRs: normal Plantar rightextensor and leftflexor Sensorysystem- Pain andtouch decreased by10 percent in rightupper and lower limbJPS normal Vibrationnormal Rombergpositive Gait ataxic | CSF- 4 CELLS,P-23 mg/dl,G-111 mg/dl, CSF- OCB + ANA-,ANCA-,CRP-13 mg/dl,,EBV-IGG + S.NMO and MOG-NegativeMRI brain: hyperintensities in BLjuxtacortical, subcortical, periventricular whitematter, anteriortemporal lobes as wellas infratentorialregions includingpons, MCP andmedulla MRI Spine: short segment lesionsin cervical and dorsalspine | CNS Demyelination- MS | I/V MP-5 daysTab Wysolone40 mg InjRituximab | Mild Improved (mRS = 1) | Probable |
| 38 | 23 | F | Heaviness in the legs followed by weakness of both legs over 7 days | 13 | ChAdOx1nCoV- 19 /2nd dose | 1 | VA-Right- 6/24, Left- 6/9Power- UL 5/5, LL-0–1/5, DTRs- BriskPlantars- B/l extensorPain touch decreased below T4, JPS- impaired in LL | ANA screening positive (1:80 titres), and anti sm-RNP 2 positive. CSF −9 cells (all lymphocytes) with normal protein and glucose. Serum and CSF NMO- MOG strongly positive for NMO. MRI spine – long segment transverse myelitis in thoracic spinal cord. | NMOSD | LVPP*5 cylcles f/b1gm IVMP*2 days f/b oral steroid and Rituximab | Mild Improved (mRS = 1) | Probable |
| 39 | 28 | M | Right eye visual loss | 12 | ChAdOx1nCoV- 19 /1st dose | 11 | RAPD right eyeVA- right 6/36, left-6/6 | LP-CSF- Normal cell and proteinMRI Brain-Intraneural T2WI-FLAIR hyperintensity noted involving right optic nerve intraconal & intracanalicular segments. | SeronegativeCNS demyelination | IVMP*5 days f/b oral steroid | Mild Improved (mRS = 1) | Probable |
| Guillain Barre Syndrome | ||||||||||||
| 40 | 34 | F | Numbness in both upper and lower limbs, weakness in all limbs, speech disturbances and swallowing difficulty. Is a known patient of Rheumatoid arthritis since 2014. Currently asymptomatic since 2 years, not on any medication. | 10 | ChAdOx-1/ 2nd dose | 14 days | Bifacial weakness present. tongue movements reduced. Tone: hypotonia in all 4 limbs. Quadriparesis, global areflexia | NCS- Motor axonopathyLP-CSF: Albuminocytological dissociation (cells-Nil, protein-147.0 mg/dl) LFT, RFT, Serum electrolytes, CBC, homocysteine,folate, Vit B12, thyroid function test were within normal limits. Antiganglioside antibody IgM,IgG negative. Serum Rheumatoid factor elevated (33 Iu/ml) | Guillain Barre Syndrome | LVPP * 7 cycles | Improved (mRS = 2) | Probable |
| 41 | 34 | F | Weakness of both lower limbs, weakness of both upper limbs and paresthesias of all 4 limbs | 20 | ChAdOx-1/ 2nd dose | 3 days | Tone: hypotonia in all 4 limbs. Quadriparesis, global areflexia | NCS- Axonal and demyelinating neuropathyLP-CSF: Albuminocytological dissociation (cells-Nil, protein-123.6 mg/dl) ANA profile, ANCA, ACE levels and anti-ganglioside antibodies werenegative. Urine for Bence jones proteins was negative. Serum Rheumatoid factor elevated (33 Iu/ml) | Guillain Barre Syndrome | LVPP * 7 cycles f/b IVMP 1gm * 5 days | Improved (mRS = 2) | Probable |
| 42 | 44 | M | eakness of both upper and lower limbs, and paresthesias of all 4 limbs | 10 | ChAdOx-1/ 1st dose | 16 days | Tone: hypotonia in all 4 limbs. Quadriparesis, global areflexia | NCS- Axonal and demyelinating neuropathyLP-CSF: Albuminocytological dissociation (cells-Nil, protein-75.7 mg/dl) ANA profile, ANCA, ACE levels and anti-ganglioside antibodies werenegative. Urine for Bence jones proteins was negative. Serum Rheumatoid factor elevated (33 Iu/ml) | Guillain Barre Syndrome | IvIg 0.4 g/kg/day * 5 days | Improved (mRS = 1) | Probable |
| Stroe | ||||||||||||
| 43 | 16 | F | Headache followed by right upper and lower limb weakness with slurred speech | 3 | BBV152/1st dose | 5 days | right upper and lower limbs spastic hemiparesis | MRI- acute infarcts in left MCA territory with left M1 MCA occlusionESR-51mmPlatelet-57Lakh/cmmPT,INR,aPTT-NormalANA Profile, ANCA- NegativeFasting lipid profile-Normal panelHbA1C,FBS,PPBS-NormalSickling test- NegativeCardiac evaluation-Normal | Acute ischemic stroke | Statin, antiplatelet and antioedema measures | Status quo (mRS = 3) | Probable |
| 44 | 35 | Headache and left upper limb and face paresthesia and weaknsess | 2 | ChAdOx-1/ 2nd dose | 10 days | left upper and lower limbs spastic hemiparesis | MRI- venous sinus filling defect involving the anterior 2/3rd of the superior sagittal sinus and bilateral frontal and parietal infarctESR-12 mm, CRP- NegativePlatelet-376Lakh/cmmPT,INR,aPTT-NormalPCV-NormalHomocysteine, Vitamin B12-Folate- Normal. Fasting lipid profile-Normal panelHbA1C,FBS,PPBS-NormalCardiac evaluation-Normal | Cerebral Sinus Venous Thrombosis | Anticoagulation | Status quo (mRS = 3) | Probable | |
| 45 | 80 | M | Sudden onset right upper and lower limbs weakness. | 1 | ChAdOx-1/ 1st dose | 15 days | Right hemiparesis | MRI-left basal ganglia infarctPlatelet-96Lakh/cmmaPTT-79secCRP-Negative) d-dimer-1381 ng/mlFibronogen- 443 mg/dlFasting lipid profile-Normal panelHbA1C,FBS,PPBS-NormalCardiac evaluation-Normal | Acute ischemic stroke with coagulopathy | Statin, antiplatelet | Status quo (mRS = 4) | Probable |
| 46 | 56 | M | Sudden onset left upper and lower limbs weakness | 2 | BBV152/1st dose | 14 days | left upper and lower limbs spastic hemiparesis | MRI- right MCA-PCA territory watershed infarctPlatelet-254Lakh/cmmPT,INR,aPTT-NormalFasting lipid profile-Normal panelHbA1C,FBS,PPBS-NormalCardiac evaluation-Normal | Acute ischemic stroke | Statin, antiplatelet | Status quo(mRS = 3) | Probable |
| 47 | 65 | M | Tingling paresthesia of left half of the body. Known case of medically well controlled dyslipidemia and T2DM | 4 | BBV152/1st dose | 3 days | Tone, power-normal | MRI- right thalamic infarctPlatelet-293Lakh/cmmPT,INR,aPTT-NormalFasting lipid profile-Normal panelHbA1C,FBS,PPBS-NormalCardiac evaluation-Normal | Acute ischemic stroke | Statin, antiplatelet | Status quo (mRS = 1) (mRS = 1 | Possible |
| 48 | 55 | M | Headache, and right upper and lower limbs weakness. Known case of medically controlled hypertension | 1 | ChAdOx-1/ 2nd dose | 2 days | Right spastic hemiparesis | MRI-Acute infarct noted involving left corona radiata, posterior putamen and posterior limb of internal capsule. And Eccentric vessel wall enhancement noted involving left MCA distal M1 and M2 segment (inferior division). Platelet-275Lakh/cmmPT,INR,aPTT-NormalCRP-6 mg/dl(Positive) Fasting lipid profile-Normal panelHbA1C,FBS,PPBS-NormalCardiac evaluation-Normal | Acute ischemic stroke | Statin, antiplatelet | Status quo (mRS = 4) | Possible |
| Encephalitis | ||||||||||||
| 49 | 23 | F | Irrelevant talkConfusion and disorientation | 2 | ChAdOx-1/ 1st dose | 2 days | Alopecia, knuckle hyperpigmentationMMSE:9/30Speech- suggestive of transcortical sensory aphasiaNo meningeal signsEOM- fullPupils- Equal, reactive to lightOther cranial nerves- normalSensory, motor, cerebellar signs- negativeGait- normalPlantars- flexors | CRP-24 mg/L. Serum homocysteine- 132 umol/LVitamin B12- 50 pg/ml (low) LP-CSF: cells-14(PMN-10), protein-27.5 mg/dl. Normal sugar. HSV and other viral agents including chikunguniya, AFB staining, culture sensitivity. ANA profile, ANCA, serum and CSF autoimmune encephalitis panel, RF, creatine kinase, TFT, lipid profile, viral markers including HIV, HbSAg, HCV, VDRL were all normal or negative. Serum dengue and chikunguniya was negative. EEG showed bilateral intermittent slowing (Left more than right). MRI of Brain and spine – left temporal lobe FLAIR hyperintensity suggestive of cerebritis. Serum lactate was persistently elevated (70 mg/dl). | Possible Postvaccinal encephalitis with pre-existing possible mitochondrial cytopathy with primary hyper homocysteinemia | Acyclovir 500 mg iv TID × 7 daysCeftriaxone 1gm iv BD × 7 daysAnd Inj Methyl prednisolone 1gm iv OD × 5 daysFollowed by mitochondrial supplements and oral steroid. | Improved (mRS = 1) | Possible |
| 50 | 52 | F | Pain in the both lower limbs and Stiffness of both lower limbs | 360 | ChAdOx-1/ 22nd dose | 7 | Severe spasticity (grade 4) in both lower limbs(left > right) Plantar- b/l extensor | LP-CSF: nil cell, protein-26.7 mg/dl. ANA profile- anti- SS-A and AntiRo-52 positive. Serum and CSF NMO-MOG were negative. Paraneoplastic antibody- Anti GAD65 ab strongly positive. MRI Brain and Spine: Unremarkable. Whole bodyPET MRI: Normal tracer uptake | Stiff Person Syndrome | Oral steroidDiazepamBaclofen | Mild Improved (mRS = 2) | Probable |
| Myositis | ||||||||||||
| 51 | 58 | M | Pains of both lower limbs, weakness of both lower limbs, weakness of both upper limbs. | 60 | BBV152/1st dose | 15 days | Wasting of bilateral supraspinatus, ifraspinatus, deltoid, biceps, and triceps was noted. Tone- Hypotonia in all 4 limbs. Quadriparesis, proximal and flexor group predominant weakness in UL and LL. DTRs- Hyporeflexic | ESR was 22 mm/hr and CRP was positiveSerum Creatine kinase (CPK) was elevated (13,786 U/L at presentation). Urine routine showed 2 plus blood and myoglobin was positive. ANA profile showed anti-RO52 1plus positive. Myositis profile showed anti-SRP 3 plus positive. Muscle biopsy: polygonal to rounded, myofibers with moderate variation in fiber size and prominent features of active myopathy in the form of myonecrosis. ACR/EULAR2017: Definite myositis | Inflammatory Myositis | IVMP 1gm *5days f/b Rituximab | Improved (mRS = 1) | Probable |