Acute disseminated encephalomyelitis following vaccination against SARS-CoV-2: A case report

ABSTRACT

Introduction: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that is usually considered a monophasic disease. Postvaccination ADEM has been associated with several vaccines, however there is scarce information related to SARS-CoV-2 vaccines. We report the case of a 26-year-old female who suffered from ADEM four weeks after Gam-COVID-Vac administration. Method: Case report. Result: A 26-year-old female was admitted after 10 days of temporal spatial disorientation, inappropriate behavior and headache. She reported no upper respiratory infection or diarrhea and she has no significant medical history. Four weeks prior admission she received a first dose of Gam-COVID-Vac vaccine (human adenovirus viral vector). Neurological examination showed failure cognitive function in attention, deferred memory, orientation, visuospatial and language. Montreal Cognitive Assessment (MoCA) 12/30. Also right upper limb weakness and gait ataxia was noted. Her brain magnetic resonance imaging showed widespread abnormal signals on FLAIR images with ring enhancement pattern. Analysis of cerebrospinal fluid was normal and oligoclonal bands were positive. Anti-aquaporin-4 and anti-myelin oligodendrocyte glycoprotein were negative, also infectious diseases were ruled out. ADEM was suspected and she was treated with intravenous Methylprednisolone with partial recovery. MoCA at 30 days was 24/30. A brain biopsy confirmed a perivascular demyelination and reactive astrocytosis. Conclusion: Our patient met the ADEM diagnostic criteria set by the International Pediatric MS Study Group and alternative diagnoses were excluded. Although a plausible relationship was not demonstrated, the possibility of an association with vaccine is suspected.