A 35-year-old man, who had received a Tdap vaccination 14 days prior, presented to urgent care with headaches and retro-orbital pain. Initially diagnosed with migraines and prescribed medication, he returned three days later with persistent symptoms, including new-onset urinary retention, visual disturbance, and vertigo. MRI revealed specific lesions, and initial CSF analysis indicated elevated protein and leukocytosis without oligoclonal bands. Treatment with IV methylprednisolone was followed by a discharge, but symptoms worsened, requiring additional IVMP and oral prednisone. As his neurological status deteriorated, he was intubated and transferred to a tertiary care center for further management.

Repeat MRI showed multifocal T2 hyperintensities, associated hemorrhage, thrombosis of internal cerebral veins and venous sinuses.  CSF showed WBC of 87 cells/µl (85% polys), 89 mg/dl protein. MOG-IgG by CBA returned positive with a titer level of 1:1000, and CSF interleukin-6 (IL-6) was 17,904.6 pg/ml. As the patient did not respond to IV steroids, he underwent plasma exchange, and improved. The cerebral sinus venous thrombosis was presumed secondary to inflammation due to MOGAD. To prevent further relapses, he was started on tocilizumab. He has not experienced relapses and has sustained to improvement.