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CLINICAL CASES IN MS – CASE 1: Neurological symptoms after COVID-19 vaccination


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.

Question 1: Do you believe that COVID-19 vaccination…

Question 2: Would you recommend that Linda not receive a second COVID-19 vaccination?

Question 3: What further investigations would you perform? (maximum of 4) (% represents the proportion of all tests chosen)

Question 4: What is your diagnosis?

Question 5: What would be your preferred starting treatment for this patient?

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A recent debate in the literature addressed the question of whether all cases of multiple sclerosis are progressive. The discussion highlighted some of the challenges of diagnosing secondary-progressive MS (SPMS) and the limitations of viewing the MS disease process as distinct phenotypes. Read More