Cytotoxic lesion of corpus callosum after COVID-19 vaccination: case report

Cytotoxic lesions of corpus callosum (CLOCCs) are associated with many disease entities. Serious neurological complications after coronavirus disease 2019 (COVID-19) vaccination are rare.

A 20-year-old man presented with severe headache for 2 days. He had received the first dose of ChAdOx1nCoV-19 COVID-19 vaccine 5 days ago. Persistent dull headache occurred on the third day after vaccination and intensified gradually to awaken him from sleep at night. No neck stiffness was observed. Brain magnetic resonance angiography (MRA) 9 days after vaccination revealed an oval-shaped diffusion-weighted restriction lesion at the splenium of corpus callosum with a mildly high signal intensity on T2-weighted images (T2WI) and low signal intensity on apparent diffusion coefficient (ADC) imaging but without enhancement after contrast injection. A COVID-19 polymerase chain reaction test was negative. A blood test revealed slight leukocytopenia, thrombocytopenia, and hyponatremia. Further autoimmune and hematological studies were normal. A cerebrospinal fluid study revealed normal intracranial pressure. The patient's headache improved gradually. Follow-up brain MRA 5 weeks after vaccination revealed complete disappearance of the diffusion-weighted restriction lesion of the splenium.

CLOCCs are rare transient adverse effect of COVID-19 vaccination possibly related to a cytokine storm. The splenic lesion might disappear spontaneously with a good prognosis.