Miller Fisher Syndrome Following Vaccination against SARS-CoV-2.

After BNT162b2 messenger ribonucleic acid (mRNA) coronavirus disease 2019 (COVID-19) vaccination, a 30-year-old man developed bilateral lateral gaze palsy, diplopia, absent tendon reflexes, and ataxic gait. Serum anti-GQ1b and anti-GT1a immunoglobulin G (IgG) antibodies were strongly positive. Based on those findings, he was diagnosed with Miller Fisher syndrome (MFS). Intravenous immunoglobulin therapy was administered, and his symptoms fully recovered within approximately 3 months. To the best of our knowledge, this is the first report to describe the development of MFS after COVID-19 mRNA vaccination.

[Nephrotic syndrome might be an inhibitor of the endovascular recanalization in a patient with acute ischemic stroke].

A 65-year-old man with left hemiparesis was referred to our hospital by ambulance. Diffusion-weighted magnetic resonance imaging (DWI-MRI) showed a slight hyperintensity area in the right basal ganglion and deep white matter, and brain magnetic resonance angiography (MRA) revealed right middle cerebral artery (MCA) occlusion in the M1 proximal segment. Receiving intravenous rt-PA therapy, the patient showed no neurological improvement. Therefore emergency neuroendovascular revasculization was decided. After the first evacuation of the clot, the occlusion site was partly recanalyzed. However it was re-occluded after a few minutes. Then, mechanical disruption using balloon catheters were added for the occlusion site allowing it to be recanalyzed. After the acute ischemic stroke therapy, the patient was diagnosed as nephrotic syndrome, because his blood chemistry test indicated hypoproteinemia and urine examination showed proteinuria. Renal biopsy confirmed nephrotic syndrome due to AL amyloidosis. Nephrotic syndrome causes hypercoagulability and increases platelet aggregation. Thus we speculated that nephrotic syndrome inhibited the early recanalization in this patient.