key: cord-0843804-v0xdvlj6
authors: Finsterer, Josef
title: No need for brain biopsy in acute disseminated encephalomyelitis after first Sputnik-V jab
date: 2022-05-05
journal: Brain Behav Immun Health
DOI: 10.1016/j.bbih.2022.100464
sha: 3c08d486ea6ed44097a17dadc2f0d283f0d55548
doc_id: 843804
cord_uid: v0xdvlj6

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Surprisingly, the index patient had undergone brain biopsy, showing perivascular demyelination and reactive astrocytosis (Lazaro et al., 2022) . We should be informed about the indication for brain biopsy. Before indicating an invasive diagnostic procedure with a risk of significant complications, it would have been appropriate to start ex juvantibus with steroids.

Since ADEM can also manifest with myelitis it is crucial that patients with ADEM not only undergo cerebral MRI but also spinal MRI with contrast medium.

Cerebral lesions in the index patient manifested with vasogenic edema (Lazaro et al., 2022) . Vasogenic edema on magnetic resonance imaging (MRI) is characterised by hyperintensity on diffusion weighted imaging and hyperintensity on apparent diffusion coefficient (ADC). However, the DWI mode in the index patient was normal (Lazaro et al., 2022) . This discrepancy should be clarified.

A limitation of the study is that no information was provided if the patient was tested for SARS-CoV-2 in the blood or cerebrospinal fluid (CSF). We should be told if the patient was SARS-CoV-2 positive or negative, as SARS-CoV-2 infections can be complicated by ADEM as well (Rossi et al., 2022) .

A further limitation of the study is that table 1 does not included reference limits.

Overall, the interesting review has some limitations and inconsistencies which challenge the results and their interpretation. Addressing these issues would strengthen the conclusions and could increase the status of the study. Before carrying out brain biopsy, extensive work-up by means of non-invasive methods and eventually ex juvantibus treatment should be promoted.

Abbreviations: ADEM, acute disseminated encephalomyelitis; AHEM, acute hemorrhagic encephalomyelitis; AZV, AstraZeneca vaccine; EMA, European medicine agency; FLAIR, fluid attenuated inversionrecovery; MOG, myelin oligodendrocyte glycoprotein; MRI, magnetic resonance imaging; OCB, oligoclonal bands.

Case series: acute hemorrhagic encephalomyelitis after SARS-CoV-2 vaccination

Acute disseminated encephalomyelitis following vaccination against SARS-CoV-2: a case report

ADEM anti-MOG antibody-positive after SARS-CoV2 vaccination

Bilateral optic neuritis as the presenting sign of post SARS-CoV-2 acute disseminated encephalomyelitis

None.