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NIH team documents various types of neuropathy after COVID vaccination


Senior Member
In a recent study posted to the medRxiv* preprint server, researchers investigated if coronavirus disease 2019 (COVID-19) vaccination could result in neuropathic symptoms.

Vaccines against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) essentially reduce morbidity and mortality and are crucial tools to contain the COVID-19 pandemic. FDA-approved vaccines are associated with a relatively small number of post-immunization adverse effects.

In the United States (US), reports to the Vaccine Adverse Event Reporting System (VAERS) consist of various systemic and neurologic manifestations. These adverse events are observed after mass vaccination programs and might have similar immunologic mechanisms with post-infection neurologic complications. Although rare, immune-mediated neurologic complications are less severe than after infection.

About the study

In the current observational study, researchers clinically evaluated patients with new-onset paresthesia regardless of autonomic symptoms incident to COVID-19 vaccination. From January to September 2021, 23 patients were assessed for new onset of polyneuropathic symptoms within a month of SARS-CoV-2 vaccination. Medical records of the patients were abstracted to collect data. Excluded persons were those with recurrent neurologic symptoms or having non-neurologic complications and those at risk of developing dysautonomia and neuropathy.

Those with autonomic symptoms were subjected to standard autonomic nervous system (ANS) testing. Variability in heart rate after six to eight slow deep breaths per respiratory cycle was assessed. Tilt table tests were performed for 10 minutes following 20 minutes of supine rest. Postural orthostatic tachycardia syndrome (POTS) was defined as the sustained increase of 30 beats per minute or higher from the baseline after 10 minutes in the upright position without orthostatic hypotension. Two skin biopsies were removed from the lower leg to evaluate small fiber neuropathy (SFN).


The median age of the 23 subjects was 40 years, and a majority were women (21). None of the patients had prior neurologic illnesses. Five patients reported tachycardia, skin-flushing, and elevated blood pressure after administration of the COVID-19 vaccine, which lasted for 30 minutes or less and resolved entirely. All patients showed neurologic symptoms in at least 21 days following COVID-19 vaccination. Subjects were vaccinated with Pfizer’s BNT162b2, Moderna’s mRNA-1273, AstraZeneca’s ChAdOx1, or Janssen’s JNJ-78436735 vaccine. Fourteen patients showed neurologic symptoms after the first dose, while nine developed after receiving the second.

All subjects complained of moderate to severe paresthesia and burning sensation in upper or lower limbs. About 60% of the participants developed autonomic symptoms, including new-onset Raynaud’s phenomenon, episodic tachycardia, and heat intolerance. Of the 12 patients undergoing ANS testing, abnormal findings were observed for 11 of them and six fulfilled the criteria for POTS. Seven subjects had diminished length-dependent sweat production, a characteristic feature of SFN. Magnetic resonance imaging (MRI) of the brain or spine available for 16 patients revealed no significant abnormalities.


The authors observed that all patients experienced neuropathic symptoms within three weeks of vaccination. However, referral bias limits the findings given the study’s observational nature, and the lack of a control group precludes attributing a causative role despite the temporal association of vaccines to symptoms.

Notably, oligoclonal bands in two of the five tested patients’ cerebrospinal fluid, deposition of immune complexes (C4d), and response to immunotherapy suggest a possible immune association. Although some patients responded positively to corticosteroids or IVIg treatment, their use should be cautiously monitored or viewed in the context of clinical trials. Further research is necessary, however, to determine whether the SARS-CoV-2 vaccine causes neuropathies.

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Senior Member
What are the 15 types of dysautonomia?
Postural Orthostatic Tachycardia Syndrome, Orthostatic Hypotension, Vasovagal Syncope, Inappropriate Sinus Tachycardia, Autoimmune Autonomic Ganglionopathy, Baroreflex Failure, Familial Dysautonomia, Pure Autonomic Failure, and Multiple System Atrophy.

What is the difference between POTS and dysautonomia?
What is POTS? POTS is a form of dysautonomia — a disorder of the autonomic nervous system. This branch of the nervous system regulates functions we don't consciously control, such as heart rate, blood pressure, sweating and body temperature.