Table 1 Demographic and clinical characteristics of patients with MFS after COVID-19 vaccination (n = 15)
Case No | Authors | Country | Study type | Gender/age | Vaccine/dose | Onset time from vaccine to diagnosis (day) | Ocular manifestation | Affected side | Ataxia | Reflex | LP finding |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Abičić et al. 2021[18] | Croatia | Case report | Female/24 | Pfizer/1 | 18 days | Horizontal diplopia, limited elevation and abduction | Bilateral | - | Normal | Albuminocytological dissociation |
2 | Dang et al. 2021[19] | Australia | case report | Male/63 | AstraZeneca/1 | 14 days | Diplopia, impaired adduction, restricted upward and downward gaze, incomplete eye closure | Bilateral |  +  | Absent | Albuminocytological dissociation |
3 | Kubota et al. 2021 [20] | Japan | case report | Male/65 | Pfizer/2 | 17 days | Ptosis, diplopia, limited adduction, restricted vertical gaze, asymmetric pupils | Right | - | Normal | Albumiocytological dissociation |
4 | Michaelson et al. 2021 [21] | United States | case report | Male/78 | Pfizer/2 | 14 days | Diplopia, limited eye movement | Bilateral |  +  | Absent | Albuminocytological dissociation |
5 | Nishiguchi et al. 2021[22] | Japan | case report | Male/71 | Pfizer/1 | 18 days | Ptosis, ocular pain, absent pupillary reflex | Bilateral |  +  | Normal | Albuminocytological dissociation |
6 | Sansen et al. 2021[23] | Belgium | case report | Male/65 | Pfizer/1 | 35 days | Diplopia, abducens nerve palsy, and restricted abduction | Left |  +  | Absent | Albuminocytological dissociation |
7 | Chen et al. 2022 [24] | United States | Case report | Female/ in the 70s | Pfizer/2 | 14 days | Ptosis, diplopia, ophthalmoparesis, restricted saccade movements, reduced pupils response | Bilateral |  +  | Preserved | Albuminocytological dissociation |
8 | Kaur et al. 2022 [25] | United States | case report | Male/32 | Johnson & Johnson/NR | 18 days | Blurry vision, eye pain, inability to fully close the eyes | Bilateral | NR | NR | Albuminocytological dissociation |
9 | Kim et al. 2022 [26] | South Korea | Case series | Female/84 | Astrazeneca/1 | 8 days | Ptosis, diplopia | Bilateral |  +  | Absent | Albuminocytological dissociation |
10 | Liang et al. 2022 [27] | China | Case report | Male/64 | Sinovac-CoronaVac/2 | 12 days | Diplopia, limited abduction, inability to fully close the right eye | Bilateral, more prominently, right |  +  | Absent | Albuminocytological dissociation |
11 | Loza et al. 2021[28] | United States | Case report | Female/60 | Johnson & Johnson/1 | 10 days | Diplopia, limited abduction | Bilateral | - | Absent | Albuminocytological dissociation |
12 | Nanatsue et al. 2022 [29] | Japan | Case report | Male/72 | Moderna/2 | 7 days | Diplopia and limited binocular abduction | Bilateral |  +  | Absent | NR |
13 | Pirola et al. 2022 [30] | Brazil | Case report | Female/47 | AstraZeneca/1 | 7 days | Absent ophthalmoplegia | - |  +  | NR | Albuminocytological dissociation |
14 | Siddiqi et al. 2022 [31] | Pakistan | Case report | Male/53 | Sinovac-CoronaVac/1 | 8 days | Abducens nerve palsy, inability to fully close the eyes | Right |  +  | Absent | Albuminocytological dissociation |
15 | Yamakawa et al. 2022 [32] | Japan | Case report | Male/30 | Pfizer/2 | 7 days | Diplopia, lateral gaze palsy | Bilateral |  +  | Absent | Normal |
Case No | Antibodies | Imaging | NCS and EMG | Signs, symptoms, or examination findings | Past History of covid infection/ recent infection/non-infectious diseases | Time from symptom onset to treatment | Duration of treatment/hospital stay | Duration to outcome | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
1 |  + anti-GQ1b + anti-PCNA Speckled ANA | Normal | Normal EMG | NR | Negative/ Negative /Negative | NR | 3, and 5 days/NR | 3 weeks (after treatment) | IV methylprednisolone (500 mg daily, with no improvement), IVIG (2 g/kg) | Improved |
2 | - anti-GQ1b | Bilateral facial and oculomotor nerve enhancement in MRI | Axonal neuropathy with reduced amplitude | Lower back pain radiating to the legs, bilateral facial weakness, facial diplegia, lower and upper limb weakness, walking difficulty, paresthesia | NR/NR/ Negative | Three days | 5 days IVIg, 4 weeks rehabilitation/NR | 6 weeks (after onset) | IVIg (2g/kg) and topical lubricating eye drop, inpatient rehabilitation | Improved |
3 |  + anti-GQ1b | Enhanced right oculomotor nerve | Normal | - | Negative/NR/DM, glaucoma, BPPV | 31 days | 5/18 days | 54 days (after onset) | IVIg (0.4 g/kg) | Complete resolution |
4 | Equivocal anti-GQ1b | Normal | NR | Paresthesia and dysmetria | NR/positive/chronic painless diplopia, Inflammatory pseudotumor | 2 weeks | 5 days/NR | 3 days (after treatment) | IVIg (2g/kg) | Improved |
5 | - anti-GQ1b | Minor venous dilation of the middle cranial fossa in MRI, Normal MR angiography | Normal | Headache | Negative/Negative/ DM recovered diabetic ophthalmoplegia | 29 days | 2 × 5 day IVIg/ 51 days | 88 days (after onset) | Two courses of IVIg | Complete resolution |
6 | - anti-GQ1b | Normal | NR | Left deviation of the body | Negative/Negative/DM and prostatic hyperplasia | 2 days | 5 days/NR | 2 weeks (after treatment) | IVIg (0.4 g/kg) | Improved |
7 |  + anti-GQ1b | NR | Acute left facial neuropathy, reduced fibular and tibial motor amplitudes, and a mildly prolonged ulnar F wave relative to the F estimate | Progressive gait imbalance, blood pressure fluctuations | Negative/Negative / HTN, remitting breast cancer | NR | 5 days/NR | Two months (after discharge) | IVIg (0.4 g/kg) | Improved |
8 | - anti-GQ1b | Normal MRI | NR | Dysarthria, facial diplegia, and inability to raise eyebrows and smile | NR/NR/- | NR | NR | NR | IVIg, ICU admitted | Improved |
9 |  + anti-GQ1b | NR | Normal | NR | None/none/HTN | NR | NR | 30 (after onset) | No treatment | Improved |
10 |  + anti-GQ1b + anti-GT1b | Normal | axonal neuropathy, Negative single-muscle-fiber electromyogram | Paresthesia, dizziness, nausea, headache, right facial palsy, dribbling of saliva | NR/negative/cholecystitis and chronic gastritis | 21 days | 2 days IVIg,20 days acupuncture/7 days | 54 days (after onset) | IVIg (0.4 g/kg), acupuncture (once a day) | Complete resolution |
11 | - anti-GQ1b | Cauda equine enhancement | Absent F wave and H wave, neurogenic recruitment | Nausea, vomiting, headache, back pain, leg pain, bilateral facial weakness | NR/negative/migraines | 4 days | 2/10 days | 10 days (after admission) | IVIg (2gr/kg) | Improved |
12 |  + anti-GQ1b | Normal | F wave abnormalities | Right-sided peripheral facial nerve palsy | Negative/Negative/HTN, hyperuricemia, and hyperlipidemia | 2 days | NR/22 days | 1 month (after discharge) | IVIg, steroid, valacyclovir, and mecobalamin | Complete resolution |
13 | NR | Normal head CT at the admission and mineral deposition in the basal ganglia one week prior to the admission | motor and sensory demyelinating polyneuropathy, acute polyradiculoneuritis | Dysphonia, lower and upper limbs weakness, peripheral facial diparesis | Negative/flu/NR | NR | 5 days /NR | At the discharge | IVIg (0.4 g/kg), gabapentin 300 mg BID and motor physiotherapy after discharge | Improved |
14 | Not performed | Normal | Prolonged latency with reduced conduction velocities F wave abnormalities | Paresthesia, lower limbs myalgia, and reduced proprioception, positive Romberg sign, right-sided lower motor neuron facial palsy, and dribbling of saliva | Negative/Negative/HTN, IHD, smoker | 2 days | 6 weeks outpatient physiotherapy/NR | 10 weeks (after discharge) | Pregabalin 50mg and physiotherapy | Complete resolution |
15 |  + anti-GQ1b + anti-GT1a | Normal | Normal | Dizziness, walking difficulty | NR/NR/NR | 5 days | 5 days /NR | 93 days (from treatment) | IVIg (0.4 g/kg/day) for 5 days | Complete resolution |