Hyperacute reversible encephalopathy related to cytokine storm following COVID-19 vaccine

We describe the first case of hyperacute reversible encephalopathy following COVID-19 vaccination. A patient presented with acute onset encephalopathy, mainly characterized by agitation and confusion, rapidly responsive to high dosage steroid therapy and complete remission within 3 days from onset. The clinical manifestation was related with systemic and CSF cytokine hyperproduction, responsive to steroid therapy. Although the occurrence of encephalopathy after vaccination may be just a casual temporal association, we speculate that the cytokinestorm could be the result of an excessive innate immune response against the vaccine, in a predisposed patient susceptible to autoimmunity.

Automated summary

The first case of hyperacute reversible encephalopathy following COVID-19 vaccination is described, with the patient presenting with acute onset encephalopathy characterized by agitation and confusion. High dosage steroid therapy led to rapid response and complete remission within 3 days from onset, indicating a potential association between the clinical manifestation and systemic/CSF cytokine hyperproduction responsive to steroid therapy. The occurrence of encephalopathy after vaccination may be attributed to an excessive innate immune response against the vaccine, particularly in predisposed patients susceptible to autoimmunity.