Introduction/Aims

We aimed to determine whether specific SARS-CoV2 vaccines may be associated with acute-onset polyradiculoneuropathy and if they may result in particular clinical presentations.

Methods

We retrospectively reviewed records of all persons presenting with acute-onset polyradiculoneuropathy from January 1, 2021 to June 30, 2021, admitted to two Neuroscience centers, of the West and North Midlands, United Kingdom. We compared subjects with previous SARS-CoV2 vaccine exposure with a local cohort of persons with acute-onset polyradiculoneuropathy admitted between 2005-2019 and compared admission numbers for the studied time frame with that of the previous three years.

Results

Of 24 persons with acute-onset polyradiculoneuropathy, 16 (66.7%) presented within 4 weeks after first SARS-CoV2 vaccine. Fourteen had received the AstraZeneca vaccine and one each, the Pfizer and Moderna vaccines. The final diagnosis was Guillain-Barré syndrome (GBS) in 12 and acute-onset chronic inflammatory demyelinating polyneuropathy in 4. Amongst AstraZeneca vaccine recipients, facial weakness in 9 persons (64.3%), bulbar weakness in 7 (50%), and the bifacial weakness and distal paresthesias GBS variant in 3 (21.4%), were more common than in historical controls (p =0.01; p=0.004 and p=0.002, respectively). A 2.6-fold (95% C.I: 1.98-3.51) increase in admissions for acute-onset polyradiculoneuropathy was noted during the studied time frame, compared to the same period in the previous three years.

Discussion

Despite a low risk, smaller than that of SARS-CoV2 infection and its complications, exposure to the first dose of AstraZeneca SARS-CoV2 vaccine may be a risk factor for acute-onset polyradiculoneuropathy, characterized by more common cranial nerve involvement.