"Abstract
Acute disseminated encephalomyelitis (ADEM) is a disease of the brain and spinal cord that is an immune-mediated inflammatory and demyelinating disorder, which is commonly preceded by an infection. Some reports have also shown the association of acute demyelination of the central nervous system (CNS) with vaccination. Primarily, the involvement of the white matter of the cerebral hemispheres, brain stem, and spinal cord is observed. Such lesions should be considered as the differentials of ADEM. We would like to report a case of a 77-year-old female who was of post-COVID-19 vaccination status and presented to us with altered sensorium with imaging revealing acute demyelination...
Case Presentation
A 77-year-old female presented to our hospital with complaints of altered sensorium for four hours, aphasia for four hours, and loss of consciousness within one hour. The relatives have mentioned the presence of altered mental status for 15 days for which she was taken to an outside hospital where her routine blood investigations revealed the presence of hyponatremia and she was started on treatment for the same ... The patient had a history of infection with COVID-19 four months back and has also taken her first dose of COVID-19 vaccination 15 days back with AstraZeneca (ChAdOx1 nCov-19) vaccine.
In the emergency department, the Glasgow Coma Scale (GCS) of the patient was 5. In view of low GCS, the patient was intubated and put on a mechanical ventilator ...
The patient was also tested for other causes of encephalitis ... which were ruled out.
Brain MRI of the patient was done, which revealed the presence of multiple white matter hyperintensities in supratentorial brain parenchyma, acute demyelinating disease ...
Despite a prompt diagnosis of acute disseminated encephalomyelitis (ADEM) and early initiation of the treatment, the condition of the patient did not improve. The patient could not be weaned off from the ventilator, and the patient has succumbed to the disease...
Conclusion
Myelitis- and encephalitis-like characteristics after vaccination have been a common entity that has been encountered by clinicians. With the advent of newer vaccines for the SARS-CoV-2 virus and with the lack of long-term studies and the side effects of the vaccination, there have been newer symptoms up-and-coming with each passing day. For a physician encountering patients with sudden neurodeficits, the history of recent vaccinations always plays a key in the diagnosis and the early treatment of the disease. Although ADEM has been seen with good results, there have also been reported mortalities."
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Nimkar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.