Table 2.
Demographic and clinical features of MS and NMOSD patients following COVID-19 vaccination.
| Author | Age/gender | Comorbidities | Name of vaccine | Time interval/dose | MS/NMOSD | Vaccine side effects | MS/NMO first signs and symptoms | Laboratory findings | CSF findings | MRI/radiology | Acute treatment | Main treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tagliaferri et al. [37] | 32/F | None | Pfizer-BioNTech (BNT162b2) | 1 week/1st | MS | Left arm Soreness at the site of injection Fevers Chills |
Motor weakness in the right hand Word slurring Gait instability Diffuse right-sided weakness in the upper and lower extremities |
WBC count: 11.3 109/liter ESR: 24 mm/hour CRP: normal Vitamin D: 12.2 nmol/liter |
Myelin basic protein: 13.3 pg/mL OCB: (0–3) |
Brain CT: Normal Brain MRI: Multiple round hyperintensities in the white matter with restricted diffusion in the left pons MRA: Normal MRV: Normal |
IVMP 1g for 3 days Prednisone 60mg for 11 days |
NR | Recovered |
| Fujimori et al. [35] | 40/F | Left peripheral facial nerve palsy | Pfizer-BioNTech (BNT162b2) | 2 weeks/2nd | MS | Fever | Numbness and sensory Disturbance in the right hand and shoulder | AQP4 Ab: negative MOG Ab: negative |
Leukocytes: elevated Protein level: normal Glucose level: normal OCB: positive Myelin basic protein: 146 pg/mL IL-6 level: 2.4 pg/mL |
Brain MRI: Several periventricular or subcortical T2 Hyperintense white matter lesions Spinal MRI: T2 Hyperintense right lesion with Gd enhancement at the level of C5/C6 | IVMP 1g for 3 days | NR | Recovered |
| Badrawi et al. [34] | 34/M | None | Sputnik V (Gam-COVID-Vac) |
3 weeks/2nd | NMOSD | NR | Confusional state Imbalance Headache dizziness |
AQP4 Ab: positive SARS-CoV-2 Abs (IgG): detected |
Normal | Brain MRI: Extensive periventricular and/or peri-ependymal signal changes around the ventricles, along with periaqueductal gray matter, Signal changes in the optic chiasma, thalamus, and corpus callosum Spinal MRI: normal |
PLEX for 5 sessions | NR | Recovered |
| Fujikawa et al. [38] | 46/F | Vitamin B12 deficiency | Moderna (mRNA-1273) | 10 days/1st | NMOSD | NR | Pain in shoulder Bilateral lower-extremity weakness Urinary retention |
AQP4 Ab: Negative | Normal | Brain MRI: normal Cervical spine MRI: Increased, Non-expansile intramedullary signal involving the central gray matter at C6-T2 without enhancement Thoracic spine: normal |
IVMP 1g for 3 days Prednisone |
NR | Recovered |
| Havla et al. [39] | 28/F | NR | Pfizer-BioNTech (BNT162b2) | 6 days/1st | MS | NR | Left abdominal neuropathic pain Sensory impairment Hypoesthesia of right abdominal wall and genital regions Left leg paresis |
SARS-CoV-2 Abs (IgG): Detected | Mild pleocytosis: 7 cells/μL OCB: positive |
Brain MRI: Multiple lesions (>20) Partially confluent lesions with spatial dissemination but without enhancement Spinal MRI: Contrast-enhancing lesion at T6 level T2 hyperintense lesion at level T6 and T7 Contrast enhancement after application of gadolinium is consistent with an active lesion |
IVMP 1g for 5 days, followed by the second cycle of IVMP 2g for 5 days PLEX | NR | Recovered |
| Watad et al. [40] | 45/F | Hypothyroidism | Pfizer-BioNTech (BNT162b2) | 1 week/1st | MS | NR | Left leg weakness Lower limbs distal numbness |
CBC: Normal | OCB: Positive | Brain MRI: Multiple PV white matter changes | IVMP 1g for 5 days Prednisolone 60 mg daily |
NR | Recovered |
| Khayat-Khoei et al. [32] | 26/F | NR | Moderna (mRNA-1273) | 2 weeks/2nd | MS | None | Mild blurring Pain with eye movement OD |
ANA: negative C-ANCA: negative Lyme titer: negative SARS-CoV-2 Abs (IgG): detected |
Cell count: elevated IgG index: elevated OCB: negative |
Brain MRI: Multiple T2 hyperintense periventricular, subcortical, and posterior fossa Spinal MRI: T2 hyperintense focal lesions at C1-2 After gadolinium administration, the spinal cord lesion at C4-5 enhanced |
IVMP 1g for 5 days | NR | Recovered |
| 33/M | None | Pfizer-BioNTech (BNT162b2) | 1 day/2nd | NMO | Arm pain | Unilateral painless blurring of vision | AQP4 Ab: negative | OCB: positive IgG index: Elevated |
Brain MRI: Periventricular and juxtacortical T2 lesions, one of the lesions ring-enhances with GD Multiple T2 hyperintense white matter lesions with a single gadolinium-enhancing lesion consistent with an active demyelinating process Spinal MRI: A T2 hyperintense lesion, no cervical spinal cord enhancing lesions were seen |
IVMP 1g for 3 days Prednisone |
NR | Recovered | |
| 64/M | Sjogren's disease | Pfizer-BioNTech (BNT162b2) | 18 days/1st | NMOSD | None | Pain Paresthesia Numbness Weakness Sphincter dysfunction Balance/gait difficulty |
AQP4 Ab: positive | AQP4 Ab: positive OCB: negative |
Brain MRI: T2 white matter signal abnormalities in the corpus callosum with extension into the left frontal and parietal white matter Multiple T2 white matter signal abnormalities in the corpus callosum with extension into the left frontal and parietal white matter Spinal MRI: Minimally expansile central spinal cord T2 hyperintensity extending from the cervical cord to the conus, with patchy areas of Gd enhancement, consistent with longitudinally extensive transverse myelitis |
IVMP 1g for 3 days PLEX |
Rituximab | Recovered | |
| Chen et al. [41] | NA/F | None | NR | 3 days/1st | NMOSD | Fever Vomiting Diarrhea Cough Dizziness |
Dizziness Unsteady walking Weakened pharyngeal reflex Weakness in limb muscle |
AQP4 Ab: positive ANA: positive SSA: positive SSB: positive, Ro52: positive p-ANCA Abs: positive |
WBC count: 31 per million | Brain MRI: Area postrema and bilateral hypothalamus lesions without Gd enhancement on FLAIR sequence Optic MRI: normal Spinal MRI: normal |
IVMP 500 mg for 5 days | NR | Recovered |
| Mathew et al. [42] | 24/F | History of left facial numbness, left upper limb weakness | AstraZeneca (ChAdOx1 nCoV-19) |
5 days/2nd | MS | NR | Paresthesia in left upper and lower limbs Lhermitte's sign | NR | NR | Brain MRI: Two lesions Spinal MRI: One lesion with enhancement |
IVMP 1g for 5 days | NR | Recovered |
| Toljan et al. [43] | 29/F | Migraine | Pfizer-BioNTech (BNT162b2) | 1 day/1st | MS | NR | Weakness and numbness in left leg Paresthesia in right arm |
NR | IgG index: elevated OCB: unmatched bands Pleocytosis (8 leukocytes/μL) |
Brain MRI: Several periventricular and juxtacortical white matter lesions with one enhancing lesion in the right centrum semiovale Brain: T2-weighted hyperintensities T1-weighted hypointense lesion which showed contrast enhancement |
IVMP 1g for 5 days | Ocrelizumab | Recovered |
| 37/M | None | Pfizer-BioNTech (BNT162b2) | 3 days/1st | MS | NR | Left hand paresthesia | AQP4 Ab: negative, MOG Ab: negative | NR | Brain MRI: Multiple periventricular non-enhancing T2/FLAIR hyperintensities Spinal MRI: A C3-C4 cord T2 and STIR hyperintense lesion T2/FLAIR hyperintensities on axial and sagittal projections, as well as T2- Weighted hyperintense lesions, compatible with multifocal demyelination |
Prednisone 600mg for 3 days | NR | NR | |
| 41/M | None | Moderna (mRNA-1273) | 30 days/2nd | MS | NR | Bilateral foot numbness | AQP4 Ab: negative, MOG Ab: negative | IgG index: elevated OCB: positive Pleocytosis (104 leukocytes/μL) |
Brain MRI: Multiple intracranial periventricular and juxtacortical T2/FLAIR hyperintensities, with most lesions demonstrating contrast enhancement Spinal MRI: Multifocal enhancing and non-enhancing T2 and STIR dorsal cord hyperintensities Prominent T2/FLAIR hyperintensities with contrast enhancement are seen on axial projection, with additional multifocal STIR hyperintensities on sagittal image |
IVMP 1g for 5 days PLEX for 5 sessions Prednisolone |
NR | Recovered | |
| 46/F | History of unilateral optic neuritis | Moderna (mRNA-1273) | NR/1st | MS | NR | Right leg numbness | AQP4 Ab: Negative, MOG Ab: Negative | IgG index: Elevated Pleocytosis (8 leukocytes/μL) | Brain MRI: periventricular and juxtacortical intracranial lesions with enhancement of the periventricular lesion Spinal MRI:Multiple enhancing lesions Sagittal T2/FLAIR sequence projection demonstrates typical MS lesions with associated contrast enhancement and accompanying spinal cord lesions seen on T2-weighted sequence |
IVMP for 5 days | NR | NR | |
| 43/F | NR | Pfizer-BioNTech (BNT162b2) | 35 days/2nd | MS | NR | Weakness in right arm Numbness in right periorbital and palatal |
Cell count: Normal | OCB: Positive | Brain MRI: Enhancing and non-enhancing temporal and callosal periventricular ovoid lesions, and enhancement of the proximal right trigeminal nerve Axial T2/FLAIR sequence demonstrated multiple periventricular and juxtacortical lesion |
IVMP for 3 days | Rituximab | Recovered | |
| Anamnart et al. [44] | 26/F | None | Sinovac (CoronaVac) | 10 days/1st | NMOSD | Watery diarrhea Fatigue |
Weakness in left leg Numbness in left arm and leg |
AQP4 Ab: positive | OCB: negative | Brain MRI: normal Spinal MRI: Focal intramedullary swelling with T2 hyperintense signal and heterogeneous enhancement of left-sided cervical cord at C4-C5 levels |
IVMP PLEX |
Rituximab | Recovered |
| 46/F | None | AstraZeneca (ChAdOx1 nCoV-19) |
10 days/1st | NMOSD | None | Weakness in right leg Hypoesthesia in right side |
AQP4 Ab: Positive | OCB: Negative | Brain MRI: Abnormal T2 hyperintense signals and corresponding T1 hypointense signals with inhomogeneous gadolinium enhancement at the right lateral aspect of the medulla and the subependymal periventricular area along the right lateral ventricle Spinal MRI: Focal intramedullary T2 hyperintense signal with heterogeneous enhancement of right-sided cervical cord at C2-C3 levels |
IVMP for 5 days Prednisolone |
Azathioprine | Recovered | |
| Caliskan et al. [45] | 43/F | None | Pfizer-BioNTech (BNT162b2) | 1 day/2nd | NMOSD | NR | Blurred vision Movement-associated pain in the right eye |
AQP4 Ab: positive MOG Ab: negative |
OCB: positive Mononuclear leukocytes Protein: elevated Glucose: normal Atypical cells: none |
Brain MRI: right optic neuritis Spinal MRI: normal |
IVMP for 10 days | Rituximab | Recovered |
EDSS: expanded disability status scale, CSF: cerebrospinal fluid, MRI: magnetic resonance imaging, F: female, M:male, mRNA: messenger ribonucleic acid, MOG: myelin oligodendrocyte glycoprotein, WBC: white B cell, ESR: erythrocyte sedimentation rate, CRP: c-reactive protein, IVMP: IV methylprednisolone, RAPD: relative afferent pupillary defect, PLEX: Plasmapheresis, ANA: antinuclear antibodies, ANCA: antineutrophil cytoplasmic antibodies, OCB: oligoclonal band, IL: interleukin, OD: oculus dextrus, MRA: Magnetic Resonance, Angiography, MRV: Magnetic Resonance Venography, PV: Partial volume, GAD + Gd: gadolinium, NR: not reported, TPE: therapeutic plasma exchange, STIR: Short-tau inversion recovery. Normal ranges of: WBC: 4.5-11 × 103, ESR: 0-20, Vitamin D: 30–100 ng/mL.