Objective: To describe movement disorder and cognitive impairment in two patients following COVID-19 vaccination.

Background: The manifestation of neurological complications have been increasingly evidenced following the global spread of SARS-CoV-2. However, very few cases of covid-19 associated encephalopathy with basal ganglion involvement have been reported to date. The literature also shows that association exists between vaccines and nervous system autoimmune syndromes. Here, we report two cases of covid-19 vaccine induced acute necrotizing encephalopathy presenting with symptoms similar to post-encephalitic parkinsonism involving basal ganglia

Method: Case 1:
Male 17 year with history of covid-19 vaccination presented with behavior changes and choreiform movements. Neuropsychological assessment revealed poor motor speed, impaired executive functions along with impairment in learning and memory.
Case 2:
Young female with history of covid vaccination presented with visual impairment and bradykinesia with memory impairment. She had bilateral optic neuritis. Speech was slurred. MOCA score was 20. She had executive dysfunction.
Both patients had initial bilateral basal ganglia hyperintensity followed by gliosis within two weeks.
All other biochemical, haematological investigations were normal. Neuroviral panel and autoimmune profile was negative.
The possibility of vaccine induced immune mediated parkinsonism with executive dysfunction was considered and both patients were managed with immunotherapy.

Results: Both patients were treated with methylprednisolone and immunoglobulins followed by oral steroids for two weeks. Abnormal movements and bradykinesia improved subsequently. Executive functions also improved. Neurorehabilitation further facilitated the recovery.

Conclusion: These cases represent vaccine induced rare instances of adverse effects with atypical presentation of parkinsonism and cognitive dysfunction due to basal ganglia involvement. Such cases should not discourage patients to receive vaccines as benefits outweighs risks.

References: 1. Schneider SA, Hennig A, Martino D. Relationship between COVID-19 and movement disorders: A narrative review. Eur J Neurol. 2022 Apr;29(4):1243-1253. doi: 10.1111/ene.15217. Epub 2021 Dec 31. PMID: 34918437.

2. Garg RK, Paliwal VK, Gupta A. Encephalopathy in patients with COVID-19: A review. J Med Virol. 2021 Jan;93(1):206-222. doi: 10.1002/jmv.26207. Epub 2020 Jul 11. PMID: 32558956.

3. Morassi M, Palmerini F, Nici S, Magni E, Savelli G, Guerra UP, Chieregato M, Morbelli S, Vogrig A. SARS-CoV-2-related encephalitis with prominent parkinsonism: clinical and FDG-PET correlates in two patients. J Neurol. 2021 Nov;268(11):3980-3987. doi: 10.1007/s00415-021-10560-3. Epub 2021 Apr 21. PMID: 33884450; PMCID: PMC8059684.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/covid-vaccine-induced-parkinsonism-and-cognitive-dysfunction/