key: cord-0865421-blsg777f authors: Salari, Mehri; Etemadifar, Masoud title: Two Cousins with Acute Hemichorea after BBIBP‐CorV (Sinopharm) COVID‐19 Vaccine date: 2022-03-09 journal: Mov Disord DOI: 10.1002/mds.28979 sha: b403935da39bdbcd9ca273e95770b11c652a0116 doc_id: 865421 cord_uid: blsg777f nan Case 2: A paternal cousin of the first, who was an 18-years-old man, received BBIBP-CorV (Sinopharm) 1 week after case 1 and after 7 days developed left-sided hemichorea. His past medical history was negative, and he was also born to nonconsanguineous parents. On examination, he had choreic movements that mainly affected the left upper limb and shoulder (Video S2) but also involved the left lower limb. His face was not affected, and he did not have abnormal tongue movements or speech impairment. The remainder of the examination was normal. Extensive laboratory investigations of the blood and cerebrospinal fluid were carried out in both patients and were unremarkable (Table 1) . Brain MRI (magnetic resonance imaging) of case 1 showed multiple white matter lesions, one of them enhanced with gadolinium (Fig. 1) . Patient 2 had few nonspecific white matter lesions (not shown). Both were treated with intravenous methylprednisolone (1 g/d) for 3 days followed by oral prednisolone (50 mg/d) and tetrabenazine (25 mg/d), which caused moderate improvement after a 2-week follow-up (Video S1-B). At 1-month follow-up, patient 1 improved, and patient 2 still had mild choreic movements. This is a description of hemichorea in two adolescents after Sinopharm vaccination, which is one of the most widely used COVID-19 vaccines globally. Three cases with hemichorea have been reported previously, 2 after AZD1222 vaccination and 1 after Pfizer-BioNTech COVID-19 vaccination, but all reported patients were in their 80s. 2, 3 The pathophysiology of hemichorea in these cases is not clear, but several theories have been described for hemichorea after COVID-19 vaccination. These include focal immune-mediated endotheliopathy induced by the spike protein 2 and functional disturbance in contralateral thalamus, which was confirmed by single-photon emission computed tomography. 3 On the contrary, Decio et al reported an 11-year-old girl who developed chorea after the human papillomavirus vaccine. She responded to steroids, which supported an autoimmune mechanism as the pathophysiology. 4 In addition, a 62-year-old man has been reported with acute chorea after getting a Sars-Cov-2 infection, and the authors concluded that inflammation may have played a role in the development of chorea in this patient. 5 Presentation of hemichorea in our patients suggests an inflammatory mechanism, as the first patient had inflammatory white matter changes on brain MRI, but the occurrence in the two cousins may indicate the possibility of a genetic predisposition as a factor for developing this phenomenon. Although COVID-19 vaccines are generally safe, and neurological complications are rare and self-limited, these 2 cases suggest that movement disorders can be a complication of vaccines. Data is available on request. Mehri Salari, MD, 1 * and Masoud Etemadifar, MD 2 1 Additional Supporting Information may be found in the online version of this article at the publisher's web-site. COVID-19 vaccine causing Guillain-Barre syndrome, a rare potential side effect Acute Hemichorea-Hemiballismus following COVID-19 (AZD1222) vaccination A case of hemichorea following administration of the Pfizer-BioNTech COVID-19 vaccine Acute chorea in a child receiving second dose of human papilloma virus vaccine Sars-Cov-2 in a patient with acute chorea: innocent bystander or unexpected actor? This study was approved by the ethical committee of Shahid Beheshti University of Medical Science (IR. SBMU.RETECH.REC.1400.387). We hereby confirm that the present study conforms to the ethical standards and guidelines of the journal. The patient has given written and informed consent for online publication of his videos. None.