Immune-mediated encephalitis following SARS-CoV-2 vaccinations

Area of Science:

• Neurology
• Immunology
• Vaccinology

Background:

• SARS-CoV-2 vaccinations can rarely cause neurological side effects.
• Immune encephalitis is a recognized neurological complication.
• Understanding SARS-CoV-2 vaccination-associated encephalitis (SC2VIE) is crucial for patient management.

Purpose of the Study:

• To review the frequency, clinical presentation, diagnosis, treatment, and outcomes of SC2VIE.
• To summarize current findings on SC2VIE following SARS-CoV-2 vaccination.
• To provide insights into managing this rare neurological complication.

Main Methods:

• A narrative review of eligible articles published between January 2021 and January 2024.
• Inclusion criteria focused on studies reporting on SC2VIE.
• Data extraction included patient demographics, vaccine type, latency, treatment, and outcomes.

Main Results:

• 21 patients with SC2VIE were identified across 18 articles.
• AstraZeneca, Biontech Pfizer, Moderna, CoronaVac, and Sinopharm vaccines were implicated.
• Latency ranged from 1 to 56 days; treatments included steroids, IVIg, plasmapheresis, and rituximab, with mixed recovery outcomes.

Conclusions:

• SC2VIE is an uncommon but significant complication of SARS-CoV-2 vaccination.
• Clinical presentation and treatment align with other autoimmune encephalitis cases.
• Early evaluation for SC2VIE is recommended, especially in post-vaccination psychosis cases, as outcomes depend on immune response and comorbidities.