PMC8847228_01
(A) Time course and therapy in case 1 (first row), case 2 (second row), and case 3 (third row). "V", vaccination timepoint; "B", Biopsy and hemicraniectomy timepoint in case 3; "IVMP", intravenous methylprednisolone; "PLEX", Plasma exchange. Encircled numbers indicate days after admission. (B-D) Magnetic resonance imaging (MRI) findings. (B) Case 1, day 2 after admission; brain axial T2 FLAIR (i) and T2 haem-sensitive sequence (ii); follow-up brain MRI at day 7 after admission, after methylprednisolone pulse regimen; brain axial T2 FLAIR (iii) and T2 haem-sensitive sequence (iv). (C) Case 2, day 1 after admission; brain axial T2-FLAIR (i); sagittal cervico-thoracic spinal T2 (ii); sagittal thoraco-lumbar spinal T2 (iii, iv). White arrowheads indicate FLAIR-hyperintense lesions (i-iii), the dashed white circle in iv highlights a region of spinal hemorrhage. (D) Case 3, day 2 after admission; brain axial T2 FLAIR (i, iii) and SWI (ii, iv) sequences. (E) Hematoxylin and eosin-stained section from right temporal cortical biopsy of case 3 (day 6), displaying perivascular immune cell infiltrates including neutrophilic granulocytes (black arrow heads), tissue edema, and perivascular hemorrhage (white arrow heads). Scale bar 100 mum.
fneur-12-820049-g0001.jpg
PMC8847228_03_fneur-12-820049-g0001.jpg
F1
Brain MRI revealed multiple FLAIR-hyperintense and hemorrhagic lesions in the right parietal and temporal lobes, bilaterally in fronto-temporal distribution as well as in the right occipital lobe and left fronto-basal region (Figure 1D). A brain cortex biopsy from the affected right temporal lobe revealed perivascular predominantly granulocytic infiltrates and hemorrhages (Figure 1E). The patient was put on a high dose steroid treatment (1 g methylprednisolone intravenously per day over 5 days) with subsequent tapering over 10 days (beginning with 100 mg via nasogastric tube per day and subtracting 20 mg every 2 days), which led to significant improvement of vigilance and motor function (Figure 1A).
PMC8847228_02
(A) Time course and therapy in case 1 (first row), case 2 (second row), and case 3 (third row). "V", vaccination timepoint; "B", Biopsy and hemicraniectomy timepoint in case 3; "IVMP", intravenous methylprednisolone; "PLEX", Plasma exchange. Encircled numbers indicate days after admission. (B-D) Magnetic resonance imaging (MRI) findings. (B) Case 1, day 2 after admission; brain axial T2 FLAIR (i) and T2 haem-sensitive sequence (ii); follow-up brain MRI at day 7 after admission, after methylprednisolone pulse regimen; brain axial T2 FLAIR (iii) and T2 haem-sensitive sequence (iv). (C) Case 2, day 1 after admission; brain axial T2-FLAIR (i); sagittal cervico-thoracic spinal T2 (ii); sagittal thoraco-lumbar spinal T2 (iii, iv). White arrowheads indicate FLAIR-hyperintense lesions (i-iii), the dashed white circle in iv highlights a region of spinal hemorrhage. (D) Case 3, day 2 after admission; brain axial T2 FLAIR (i, iii) and SWI (ii, iv) sequences. (E) Hematoxylin and eosin-stained section from right temporal cortical biopsy of case 3 (day 6), displaying perivascular immune cell infiltrates including neutrophilic granulocytes (black arrow heads), tissue edema, and perivascular hemorrhage (white arrow heads). Scale bar 100 mum.
fneur-12-820049-g0001.jpg
PMC8847228_03_fneur-12-820049-g0001.jpg
F1
Brain MRI revealed multiple FLAIR-hyperintense and hemorrhagic lesions in the right parietal and temporal lobes, bilaterally in fronto-temporal distribution as well as in the right occipital lobe and left fronto-basal region (Figure 1D). A brain cortex biopsy from the affected right temporal lobe revealed perivascular predominantly granulocytic infiltrates and hemorrhages (Figure 1E). The patient was put on a high dose steroid treatment (1 g methylprednisolone intravenously per day over 5 days) with subsequent tapering over 10 days (beginning with 100 mg via nasogastric tube per day and subtracting 20 mg every 2 days), which led to significant improvement of vigilance and motor function (Figure 1A).
PMC8847228_03
(A) Time course and therapy in case 1 (first row), case 2 (second row), and case 3 (third row). "V", vaccination timepoint; "B", Biopsy and hemicraniectomy timepoint in case 3; "IVMP", intravenous methylprednisolone; "PLEX", Plasma exchange. Encircled numbers indicate days after admission. (B-D) Magnetic resonance imaging (MRI) findings. (B) Case 1, day 2 after admission; brain axial T2 FLAIR (i) and T2 haem-sensitive sequence (ii); follow-up brain MRI at day 7 after admission, after methylprednisolone pulse regimen; brain axial T2 FLAIR (iii) and T2 haem-sensitive sequence (iv). (C) Case 2, day 1 after admission; brain axial T2-FLAIR (i); sagittal cervico-thoracic spinal T2 (ii); sagittal thoraco-lumbar spinal T2 (iii, iv). White arrowheads indicate FLAIR-hyperintense lesions (i-iii), the dashed white circle in iv highlights a region of spinal hemorrhage. (D) Case 3, day 2 after admission; brain axial T2 FLAIR (i, iii) and SWI (ii, iv) sequences. (E) Hematoxylin and eosin-stained section from right temporal cortical biopsy of case 3 (day 6), displaying perivascular immune cell infiltrates including neutrophilic granulocytes (black arrow heads), tissue edema, and perivascular hemorrhage (white arrow heads). Scale bar 100 mum.
fneur-12-820049-g0001.jpg
PMC8847228_03_fneur-12-820049-g0001.jpg
F1
Brain MRI revealed multiple FLAIR-hyperintense and hemorrhagic lesions in the right parietal and temporal lobes, bilaterally in fronto-temporal distribution as well as in the right occipital lobe and left fronto-basal region (Figure 1D). A brain cortex biopsy from the affected right temporal lobe revealed perivascular predominantly granulocytic infiltrates and hemorrhages (Figure 1E). The patient was put on a high dose steroid treatment (1 g methylprednisolone intravenously per day over 5 days) with subsequent tapering over 10 days (beginning with 100 mg via nasogastric tube per day and subtracting 20 mg every 2 days), which led to significant improvement of vigilance and motor function (Figure 1A).