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      Parsonage-Turner Syndrome Following COVID-19 Vaccination: MR Neurography

      research-article
      , BA 1 , , MD 2 , , MD, MBA 3 , , MD 4 , , MD 1 ,
      Radiology
      Radiological Society of North America

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          Abstract

          Vaccination is one of the several known triggers of Parsonage-Turner syndrome (PTS). This report describes 2 individuals with clinical presentations of PTS whose symptoms began 13 hours and 18 days following receipt of the Pfizer-BioNTech BNT162b2 and Moderna mRNA-1273 COVID-19 vaccine, respectively. The diagnosis of PTS was confirmed using both electrodiagnostic testing and 3 Tesla magnetic resonance (MR) neurography. While research is needed to understand the association between PTS and COVID-19 vaccination, MR neurography may be used to confirm suspected cases of PTS as COVID-19 vaccines continue to be distributed worldwide.

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          Most cited references22

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          Is Open Access

          Neurological Complications of COVID-19: Guillain-Barre Syndrome Following Pfizer COVID-19 Vaccine

          Since the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was reported in Wuhan, China, in December 2019, Coronavirus - 19 (COVID-19) has become a global pandemic with multiple neurological complications. In December 2020, two vaccines have been approved in the United States for the prevention of COVID-19. We report a case of Guillain-Barre Syndrome (GBS) after receiving the first dose of Pfizer - COVID-19 vaccine.
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            The clinical spectrum of neuralgic amyotrophy in 246 cases.

            We investigated the symptoms, course and prognosis of neuralgic amyotrophy (NA) in a large group of patients with idiopathic neuralgic amyotrophy (INA, n = 199) and hereditary neuralgic amyotrophy (HNA, n = 47) to gain more insight into the broad clinical spectrum of the disorder. Several findings from earlier smaller-scale studies were tested, and for the first time the potential differences between the hereditary and idiopathic phenotypes and between males and females were explored. Generally, the course of the pain manifests itself in three consecutive phases with an initial severe, continuous pain lasting for approximately 4 weeks on average. Sensory involvement was quite common and found in 78.4% of patients but was clinically less impairing than the initial pain and subsequent paresis. As a typically patchy disorder NA can affect almost any nerve in the brachial plexus, although damage in the upper and middle trunk distribution with involvement of the long thoracic and/or suprascapular nerve occurred most frequently (71.1%). We found no correlation between the distribution of motor and sensory symptoms. In INA recurrent attacks were found in 26.1% of the patients during an average 6 year follow-up. HNA patients had an earlier onset (28.4 versus 41.3 years), more attacks (mean 3.5 versus 1.5) and more frequent involvement of nerves outside the brachial plexus (55.8 versus 17.3%) than INA patients, and a more severe maximum paresis, with a subsequent poorer functional outcome. In males the initial pain tended to last longer than it did in females (45 versus 23 days). In females the middle or lower parts of the brachial plexus were involved more frequently (23.1 versus 10.5% in males), and their functional outcome was worse. Overall recovery was less favourable than usually assumed, with persisting pain and paresis in approximately two-thirds of the patients who were followed for 3 years or more.
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              Guillain-Barre syndrome following the first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1

              Prevention strategies for COVID-19 transmission are at the forefront of healthcare paradigms worldwide, the main emphasis of which is vaccination. We present an interesting case of a 37-year-old man who, 3 weeks following his first dose of the chimpanzee adenovirus-vectored COVID-19 vaccine, ChAdOx1, presented to hospital with a rapidly progressive ascending muscle weakness and back pain in the absence of any other triggers. He also had a negative COVID-19 swab during admission. A diagnosis of Guillain-Barre syndrome was confirmed by correlating the clinical features with cerebrospinal fluid analysis, nerve conduction studies and MRI of the brain and whole spine. The patient received treatment with 5 days of intravenous immunoglobulin and did not require any respiratory support. He was also regularly reviewed by a multidisciplinary team consisting of neurologists, speech and language therapists, and physiotherapists and is on the course to a recovery.
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                Author and article information

                Contributors
                Journal
                Radiology
                Radiology
                Radiology
                Radiology
                Radiological Society of North America
                0033-8419
                1527-1315
                17 August 2021
                : 211374
                Affiliations
                [1] 1Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
                [2] 2Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
                [3] 3Department of Spine and Sports Medicine, Hospital for Special Surgery, New York, NY
                [4] 4Blue Star Radiology Associates, Frisco, TX
                Author notes
                Corresponding Author: Darryl B. Sneag, M.D. Associate Attending Radiologist Director, Magnetic Resonance Neurography Director, MRI Research Hospital for Special Surgery Associate Professor of Radiology Weill Medical College of Cornell University 535 E. 70th St. New York, NY 10021 E-mail: sneagd@ 123456hss.edu
                Author information
                https://orcid.org/0000-0003-4966-4580
                https://orcid.org/0000-0003-1729-5071
                https://orcid.org/0000-0003-1451-2368
                https://orcid.org/0000-0002-9105-5415
                Article
                211374
                10.1148/radiol.2021211374
                8488809
                34402669
                aa8c4059-3ef7-4cc4-92f6-d09b1c6bdd87
                2021 by the Radiological Society of North America, Inc.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Funding
                Funded by: National Center for Advancing Translational Sciences of the National Institutes of Health (NIH)
                Award ID: 1R21TR003033-01A1
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                Case Series

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