LAUSR

BACKGROUND Population-based studies suggest SARS-CoV-2 vaccines may trigger immune-mediated thrombotic thrombocytopenia (VITT) raising concerns for other autoimmune responses. We aimed to characterize neurological autoimmunity after SARS-CoV-2 vaccinations. METHODS In this single-center prospective case study we report patients with neurological autoimmunity in temporal association (≤6 weeks) with SARS-CoV-2 vaccinations and without other triggers. Clinical, laboratory, and imaging data were collected with a median follow-up of 49 days. RESULTS In the study period 232,603 inhabitants from the main catchment area of our hospital (Rhein-Neckar-Kreis, county) received SARS-CoV-2 vaccinations. We identified 21 cases (new onset n=17, flares n=4), diagnosed a median of 11 days (range: 3-23) following SARS-CoV-2 vaccinations (BNT162b2 n=12, ChAdOx1 n=8, mRNA-1273 n=1). Cases included VITT with cerebral venous sinus thrombosis (n=3), central nervous system demyelinating diseases (n=8), inflammatory peripheral neuropathies (n=4), myositis (n=3), myasthenia (n=1), limbic encephalitis (n=1) and giant cell arteritis (n=1). Patients were predominantly female (ratio: 3.2:1) and median age at diagnosis was 50 years (range: 22-86). Therapy included administration of steroids (n=15), intravenous immunoglobulins in patients with Guillain-Barré syndrome or VITT (n=4), plasma exchange in cases unresponsive to steroids (n=3) and anticoagulation in VITT. Outcomes were favorable with partial and complete remissions achieved in 71% and 24%, respectively. Two patients received their second vaccination without further aggravation of autoimmune symptoms under low-dose immunosuppressants. CONCLUSIONS In this study we characterize various neurological autoimmune disorders encountered following SARS-CoV-2 vaccinations. Given assumed low incidence and mostly favorable outcome of autoimmune reponses, benefits of vaccinations outweigh the comparatively small risks.