Cardiac and Neurological Complications Post COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series

"Abstract

... Three electronic databases were searched for case reports and case series with descriptions of cardiac and/or neurological complications in COVID-19 vaccine recipients. A total of 698 vaccinees were included in this review, of which 259 (37.1%) had cardiac and 439 (62.9%) had neurological complications. Inflammatory conditions were the commonest among the cardiac complications; while polyneuropathy, demyelinating diseases and cerebrovascular disorders were the more common neurological complications. The mean age of those with cardiac complications (33.8 years) was much younger than those with neurological complications (49.7 years). There was no notable difference in the gender distribution between these two groups of vaccine recipients. mRNA vaccines (all brands) were associated with almost 90.0% of the cardiac complications, whereas viral vector vaccines were associated with slightly over half (52.6%) of the neurological complications. With regard to the dose, cardiac complications were more common after the second (69.1%), whereas neurological complications were more common after the first dose (63.6%). The majority of the cases had an uncomplicated clinical course. Nevertheless, 5.9% of cases with neurological complications and 2.5% of those with cardiac complications were fatal, underscoring the significance of the consistent surveillance and vigilant monitoring of vaccinated individuals to mitigate these occurrences ... 

Results

3.4 Complications and Outcomes Post COVID-19 Vaccination: Most (86.6%) cases with cardiac complications had an uncomplicated clinical course with a fatality rate of 2.4% (Table 1). The most frequent diagnosis was inflammation of the heart (n = 221, 85.3%). Others were acute myocardial infarction including ST-elevated myocardial infarction (STEMI) and non-STEMI (n = 15, 5.8%), cardiomyopathy (n = 11, 4.2%), myocardial injury, nature not specified (n = 9, 3.5%) and cardiac arrhythmias (n = 3, 1.2%). Among those with inflammation of the heart, most had myocarditis (n = 152), followed by myopericarditis (n = 38), pericarditis (n = 22), the relatively uncommon condition Kounis syndrome (n = 3) and, lastly, non-specific inflammation (n = 6) ... 

The spectrum of neurological complications and their outcomes are listed in Table 3. Most cases (n = 414, 94.3%) were non-fatal and 53.1% (n = 233) involved the central nervous system. The most prevalent complications were polyneuropathy (n = 146, 33.3%), demyelinating disorders (n = 109, 24.8%) and cerebrovascular disorders (n = 65, 14.8%). Less common were cranial nerve palsies (n = 32, 7.3%), plexopathy (n = 23, 5.2%), inflammatory disorders (n = 22, 5.0%) and neuro-immunological disorders (n = 18, 4.1%). Based on specific diagnoses, the most prevalent complication was GBS (n = 139, 31.7%). This was followed by ischemic stroke (n = 58, 13.2%), multiple sclerosis (n = 41 or 9.3%), acute demyelinating encephalomyelitis (ADEM) (n = 26, 5.9%), acute transverse myelitis (n = 21, 4.8%), facial nerve palsy (n = 21, 4.8%) and other relatively uncommon disorders such as plexopathy/brachial neuritis (n = 17, 3.9%) and longitudinal extensive transverse myelitis (LETM) (n = 14, 3.2%) ...

With regard to the COVID-19 vaccine, AstraZeneca was reported as the brand most commonly (46.0%) associated with neurological complications, followed by Pfizer (30.8%) and Moderna (10.3%). Upon closer examination, the Pfizer vaccine was more commonly associated with central nervous system inflammatory disorders (50.0%), followed by AstraZeneca (31.8%) and Moderna (13.6%). Another notable observation regarding the Pfizer vaccine is that it was the primary vaccine associated with cranial nerve disorders (53.1%) and plexopathy (47.8%)."