Linda H., 48, is a partner at an accountancy firm, married with no children. She presents with paresthesiae following vaccination for COVID-19. She has no history of medical or neurological conditions and no pertinent family history.
Two weeks after receiving a first dose of the BNT162b2 (Pfizer-BioNTech) mRNA vaccine, Linda noticed a loss of sensation around her right breast, with subsequent paresthesiae of the right leg and left leg. Symptoms evolved over 1 week. There was no motor involvement. The patient was afebrile. She reported no bladder or systemic symptoms. Paresthesiae resolved after 5-6 weeks without treatment.
C-spine MRI revealed 1 lesion at C7-T1, right posterior; the lesion crossed the midline with some gadolinium enhancement. There was no longitudinal extension of the lesion. A subsequent brain MRI (without Gd) showed multiple deep hyperintense T2 lesions; 2 of the lesions abutted the corpus callosum.