Acute-onset chronic inflammatory demyelinating polyneuropathy following AstraZeneca COVID-19 vaccine: a case report.

COVID-19 vaccination side effects have been increasingly reported, including new-onset autoimmune diseases such as chronic arthritis, thrombocytopenia, Guillain-Barré syndrome (GBS), and more recently chronic inflammatory demyelinating polyneuropathies (CIDP). Molecular mimicry and vaccine adjuvants appear to be important contributors to immune-mediated neuropathies. However, whether the link between the COVID-19 vaccine and these autoimmune disorders is coincidental or causal remains uncertain. We describe the ever-reported case of acute-onset CIDP following the Oxford/AstraZeneca vaccine in Tunisia. The patient is a 41-year-old man who presented with acute, worsening weakness of the four limbs. The symptoms appeared 15 days after his first dose of the AstraZeneca vaccine. The diagnosis of GBS was initially confirmed according to the clinical features, the albumino-cytological dissociation in the cerebrospinal fluid (CSF), and the electroneuromyography (ENMG) findings. Serum workup for all known infections associated with immune-mediated neuropathy was negative. The patient was treated with plasma exchange without initial improvement followed by aggravation of the symptomatology after an interval of four and a half months. Control ENMG showed signs of CIDP meeting the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) criteria of 2021. The patient was treated with maintenance intravenous immunoglobulin and oral corticosteroids. Neurological examination 3 months after discharge showed partial improvement. Worldwide, cases of demyelinating polyneuropathies post-COVID-19 vaccination are increasingly reported. The acute onset of CIDP might lead to a misdiagnosis of GBS. Awareness of this complication and distinction from GBS enables early relay with maintenance treatment to prevent relapses and severe complications. Post-COVID neuropathies are found to be more frequently linked to the AstraZeneca vaccine, however, temporal association does not confirm causal association.

[Prognostic factors for mortality due to acute arterial stroke in a North African population]. / Facteurs pronostiques de mortalité par accident vasculaire cérébral artériel à la phase aiguë dans une population nord-africaine.

INTRODUCTION: cerebrovascular accident (stroke) constitutes a major public health problem due to the number of people affected and to its medical social and economic consequences. This study aims to identify poor vital prognostic factors for survival in patients with acute arterial stroke. METHODS: we conducted a prospective study of patients with symptoms suggestive of stroke at the two University Hospitals of Sfax, Tunisia over a period of 4 months. Patients were followed-up for a period of 1 month. RESULTS: we collected data from 200 patients. After one month of follow-up, mortality was 19.9%. Poor prognostic factors were: male sex, consumption of tobacco, a history of stroke, low Glasgow score, high NIHSS, headaches, acute symptomatic epileptic seizures, Babinski's sign, mydriasis, aphasia, combined deviation of the head and the eyes, high PAS, PAD and PAM, hyperthermia, hyperglycaemia, leukocytosis, high concentration of CRP, creatinine, urea and troponin T, haemorrhagic stroke, perilesional oedema, a mass effect, commitment, total middle cerebral artery topography of ischemia, early signs of ischemia, meningeal hemorrhage, ventricular flood, hydrocephalus, the recourse to respiratory support, to anti-edematous treatment and to antihypertensive therapy, hemorrhagic transformation, vascular epilepsy, infectious, metabolic complications, complications of bed sores. CONCLUSION: the identification of the predictive factors for survival allows for optimisation of therapeutic procedures and better implementation of patient' management. A comparative study will be considered to measure the impact of the corrective measures.

Facteurs pronostiques de mortalité par accident vasculaire cérébral artériel à la phase aiguë dans une population nord-africaine

Introduction : l'accident vasculaire cérébral (AVC) constitue un problème majeur de santé publique, tant par le nombre de personnes atteintes, que par ses conséquences médicales, sociales et économiques. L'objectif était de dégager les facteurs de mauvais pronostic vital à la phase aiguë de l'AVC artériel. Méthodes: il s'agit d'une étude prospective durant 4 mois portant sur les patients présentant une symptomatologie évocatrice d'AVC aux deux CHU de Sfax, Tunisie. Le suivi a été de 1 mois. Résultats: nous avons colligé 200 patients. Après un mois de suivi, la mortalité était de 19,9%. Les facteurs de mauvais pronostic vital étaient: le sexe masculin, la consommation de tabac, l'antécédent d'AVC, le score de Glasgow bas, le NIHSS élevé, les céphalées, les crises épileptiques symptomatiques aigues, le signe de Babinski, la mydriase, l'aphasie, la déviation conjuguée de la tête et des yeux, les chiffres élevés de pression artérielle systolique (PAS), pression artérielle diastolique (PAD) et pression artérielle pulmonaire (PAP), l'hyperthermie, l'hyperglycémie, l'hyperleucocytose, l'augmentation des CRP, créatinine, urée et la troponine Tc, la nature hémorragique de l'AVC, l'œdème péri lésionnel, l'effet de masse, l'engagement, la topographie sylvienne totale de l'ischémie, la présence de signes précoces d'ischémie, l'hémorragie méningée, l'inondation ventriculaire, l'hydrocéphalie, le recours à une assistance respiratoire, au traitement anti-œdémateux et antihypertenseur, la transformation hémorragique, l'épilepsie vasculaire, les complications infectieuses, métaboliques et de décubitus. Conclusion: l'identification des facteurs prédictifs du devenir vital permet d'optimiser les procédures thérapeutiques et mieux organiser les filières de prise en charge. Une étude comparative sera envisagée afin de mesurer l'impact des mesures correctives