To discern the central (CNS) and peripheral nervous system (PNS) manifestations associated with COVID-19 vaccines from individual case studies and describe their clinical and imaging findings, management, and outcomes.

With ten vaccines approved by the World Health Organization (WHO) and nearly 64% of people fully vaccinated worldwide, we have observed several neurological presentations post-COVID-19-vaccination, such as acute disseminated encephalomyelitis (ADEM), which have been reported in the Vaccine Adverse Event Reporting System (VAERS) and the Medicines and Healthcare products Regulatory Agency (MHRA).

A thorough literature search of Google Scholar and PubMed was conducted from December 2020 to October 2021, which included case reports of neurological complications with the following COVID-19 vaccines: Pfizer-BioNTech, Moderna, J&J/Janssen, AstraZeneca, Sinovac-CoronaVac, Sputnik V, and COVAXIN. 

Among the 51 cases, AstraZeneca was the most frequently administered vaccine (28, 55%), followed by Pfizer-BioNTech (8, 16%), Moderna (2,4%), Janssen (2,4%), Sputnik (1, 2%), and COVAXIN (1, 2%). The most common CNS manifestation was cerebral venous sinus thrombosis (CVST) (n=14) in females (64%) younger than 50 years (71%) after the first AstraZeneca dose (93%). Others included CNS demyelinating disorders [transverse myelitis, ADEM, multiple sclerosis, and neuromyelitis optica] (n=9), encephalopathy/encephalitis (n=3), seizures (n=3), and aseptic meningoencephalitis (n=1). The most common PNS manifestation was Guillain–Barré syndrome (GBS) (n=14) in males (71%) older than 50 years (79%), followed by Bell’s palsy (n=5), small fiber neuropathy (n=1), and phantosmia (n=1); most of these occurred with AstraZeneca (28.55%) and Pfizer-BioNTech (9.18%). IVIG and steroids were the treatment of choice. Nine out of the 14 patients with CVST (64%) died. However, most cases overall (42 out of 51) were non-fatal (82%).