Abstract

Background: Since introducing the SARS-CoV-2 vaccination, different adverse effects and complications have been linked to the vaccine. Variable neurological complications have been reported after receiving the COVID-19 vaccine, such as acute encephalopathy.

Case presentation: In this report, we describe three cases previously healthy men who developed acute cerebellar and brainstem symptoms with temporal relationship to ChAdOx1 nCov-19, CSF investigations showed lymphocytic pleocytosis. They received five days of 1 gm. methylprednisolone with variable response.

Discussion: Extensive workup for different causes of acute encephalopathy, including autoimmune encephalitis, was negative. Also, one patient improved dramatically after receiving methylprednisolone, supporting an immune-mediated mechanism behind his acute presentation. Accordingly, we think the COVID-19 vaccine is the only possible cause of our patient’s presentation, giving the temporal relationship and the absence of other risk factors for encephalopathy.

Conclusion: The clinician should be aware of the possible neurological complications of the different COVID-19 vaccines. Further research is needed to clarify the pathophysiology of such complications. Large pooled data from observational epidemiologic studies are necessary to verify causality.

Keywords: COVID-19; Encephalitis; Romboencephalitis; lymphocytic pleocytosis; Pathophysiology