Abstract Details

Title Combined central and peripheral demyelination syndrome after COVID-19 vaccination with brisk response to plasma exchange and steroids

Topic Autoimmune Neurology

Presentation(s) P18 - Poster Session 18 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-003

Background

Combined central and peripheral demyelination (CCPD) is a rare, immune-mediated disorder that presents with concurrent demyelination in the central and peripheral nervous system. Known clinical course and radiologic/electrodiagnostic features stem only from a limited number of case reports and small case series. The disease course can be monophasic or chronic. Response to immunomodulatory treatment is variable.

Objective

- Report a case of combined central and peripheral combined demyelination (CCPD) syndrome after COVID19 vaccine with brick improvement to steroids and PLEX

- Provide a brief literature review of CCPD etiology and management

Design/Methods N/A

Results 59-year-old female presented with progressive lower extremity pain, weakness and urinary incontinence four weeks after receiving her second COVID-19 vaccine. Exam was notable for mild somnolence, restricted lateral gaze, right eye red desaturation without APD, ocular ataxia, left lower facial weakness, and lower extremity paresis with decreased reflexes. MRI of the brain and spinal cord showed multifocal supratentorial, intratentorial, cervical and thoracic cord white matter signal abnormalities with trace enhancement in combination with marked cauda equina enhancement. CSF showed albuminocytologic dissociation (protein of 184 and 2 nucleated cells). NMO, Anti-MOG and neurofascin-155 antibodies were negative. Electromyelogram and nerve conduction studies were consistent with a demyelinating polyneuropathy. The patient was treated with a 1 gram IV methylprednisolone daily and five treatments of plasma exchange. At six months, the patient had nearly returned to her previous baseline.

Conclusions

CCPD is a rare inflammatory neurologic condition of peripheral and central demyelination. The etiology remains unclear, though viral infections and immunizations have been reported to proceed CCPD in some patients. Limited data is available to guide treatment but PLEX, IVIG and steroids are the most common. Outcomes are heterogeneous and methods to predict long term course remains uncertain. To our knowledge, this is the first reported case of CCPD after the COVID 19 vaccine.

Authors/Disclosures
William Hoffman, MD (United States Air Force) PRESENTER	The institution of Dr. Hoffman has received research support from United States Air Force. Dr. Hoffman has a non-compensated relationship as a Member with United States Air Force that is relevant to AAN interests or activities.
Morgan C. Jordan, DO	Dr. Jordan has nothing to disclose.
	No disclosure on file
John H. Sladky, MD, FAAN (San Antonio Military Medical Center/MCHE MDU)	Dr. Sladky has nothing to disclose.