![]() Her headaches disappeared, and steroids were tapered five months later. She was started on IV methylprednisolone 1 g/day for five days, followed by oral prednisolone 40 mg and mycophenolate 1 g/day. CSF examination showed 25 cells, all lymphocytes with normal protein and sugar, and oligoclonal bands. MRI of the brain showed bilateral optic neuritis. She was treated symptomatically and referred to neurology after two months when she developed limb paraesthesia and sequentially decreased vision in both eyes over two weeks. A repeat serum MOG IgG was moderately positive.Ī 26-year-old woman developed a severe headache 10 days after her first dose of the ChAdOx1 vaccination (Visual Analog Scale (VAS) score, 8/10). She remained asymptomatic at the two-month follow-up. Two weeks later, her headache recurred and she was started on IV methylprednisolone 1 g/day for three days and two doses of rituximab 1 g IV one month apart. At this point, serum was highly positive for MOG IgG antibody by indirect immunofluorescence on transfected cells. The features were consistent with tumefactive demyelination. Myelin (Luxol fast blue) stains highlighted demyelinated areas with macrophages displaying cytoplasmic myelin debris. Histopathology showed cores of neuroparenchyma with dense interstitial and perivascular infiltrates of macrophages and foamy histiocytes admixed with lymphocytes. This time MRI of the brain showed a right temporal heterogeneously enhancing lesion with mass effect for which underwent a right temporal craniotomy and excision. Bacterial and fungal cultures did not show any growth. One week later, she presented with a worsening headache. When her headaches improved after a week she was discharged. She was treated with steroids (intravenous (IV) dexamethasone 4 mg BD for seven days) and antibiotics (ceftriaxone) with a presumptive diagnosis of aseptic meningitis. Her serum COVID-19 anti-spike antibody was strongly positive. Magnetic resonance imaging (MRI) of the brain showed scattered areas of sulcal and leptomeningeal enhancement in the frontotemporal areas. Antinuclear antibody (ANA) profile and routine workup were negative. Cerebrospinal fluid (CSF) examination was normal. On admission, 15 days later, she was noted to have terminal neck stiffness and grade I papilledema. Six days later, she started developing severe bifrontal headaches and photophobia. ![]() A 43-year-old woman received her first dose of the ChAdOx1 vaccination.
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