Post-COVID-19 vaccine acute hyperactive encephalopathy with dramatic response to methylprednisolone: A case report

Background: Since introducing the SARS-CoV-2 vaccination, different adverse effects and complications have been linked to the vaccine. Variable neurological complications have been reported after receiving the COVID-19 vaccine, such as acute encephalopathy.

Case presentation: In this report, we describe a 32-year-old previously healthy man who developed acute confusion, memory disturbances, and auditory hallucination within 24 hours from getting his first dose of the COVID-19 Moderna vaccine.EEG showed features of encephalopathy, CSF investigations were nonspecific, and MRI head did not depict any abnormality. He received five days of ceftriaxone and acyclovir without any benefit.

Discussion: Extensive workup for different causes of acute encephalopathy, including autoimmune encephalitis, was negative. Also, Our patient improved dramatically after receiving methylprednisolone, supporting an immune-mediated mechanism behind his acute presentation. Accordingly, we think the COVID-19 vaccine is the only possible cause of our patient presentation, giving the temporal relationship and the absence of other risk factors for encephalopathy.

Conclusion: the clinician should be aware of the possible neurological complications of the different COVID-19 vaccines. Further research is needed to clarify the pathophysiology of such complications.