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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report I SESSIONE
“NEUROLOGIA AL TEMPO DEL COVID-19”

An unusual case of post-COVID-19 vaccine
meningoencephalitis

L. FUSI*, G. MAININI**, L. PERINI*, G. GRAMPA*

* Neurology Ward and Stroke-Unit, “S. Anna” Hospital, Como, Italy
** Neurology, University of Milano-Bicocca, Italy

INTRODUCTION (facial nerve) and he showed spatial and temporal
disorientation. Also, he referred pain to neck forward
Nowadays, warnings about anti-COVID vaccines are flexion.
widely frequent. In clinical practice became very dif- Lumbar puncture presented increased leucocytes, de-
ficult to distinguish between side-effects/adverse re- creased glucose levels and increased proteins; cyto-
action of vaccine injection or other not-vaccine or logic analysis was negative, also all neurotropic virus-
COVID related acute manifestations. es essay (included SARS-CoV-2) were negative; mag-
Moreover, it could be a real challenge identifying netic resonance was performed (Figure 1, 2 and 3).
subacute and chronic disease. In fact it is possible that We started a multiple-line therapy, in agreement with
COVID signs (or vaccine related signs) can be misdi- infectious disease department, for meningoencephali-
agnosed and other “classical” pre-pandemic diseases tis of uncertain etiology.
go underrated. We also considered mycobacterial infection and start-
ed anti-tubercular therapy. However, because of the
negativity of all cultural sample and the worsen clin-
CASE REPORT ical condition of the patient, we stopped the drugs.
Auto immunity and neuronal receptors antibodies es-
We present a case of a 65-old man, who accessed at says were negative.
E.R. of our Hospital, with focal signs after the second Unfortunately, after two months of hospitalization,
dose of anti-COVID Astra-Zeneca vaccine. His clini- our patient died.
cal history showed only arterial blood hypertension We required a postmortem examination dissection to
under treatment and NVAF in novel oral anticoagu- determinate the cause of death. Macroscopic exam
lants therapy (Apixaban). was not diriment, but the histological analysis
Our patient developed headache, diplopia, dizziness showed a disseminated ependymoma (according to
and minor cerebellar signs. Standard blood test did not the 2021 WHO Classification of Tumors of the
show any substantial alterations, excepted for minimal Central Nervous System) with major localization at
white blood cells count. CT scan was negative. left periventricular sites, cerebellar parenchyma and
During hospitalization, the man developed fever, thoracic cord.
akathisia, amnesia, new cranial nerve involvement

Corrispondenza: Dr. Gabriele Mainini, UOC di Neurologia, Ospedale S. Anna, via Colonna 3, 22100 Como (CO), e-mail : g.mainini1@
campus.unimib.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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