IMR Press / JIN / Volume 24 / Issue 3 / DOI: 10.31083/JIN26632
Open Access Review
Peripheral Nervous System Complications after COVID-19 Vaccination
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Affiliation
1 Department of Neurology, University of California Irvine, Irvine, CA 92617, USA
2 Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, 3614773943 Shahroud, Iran
3 Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark, 5000 Odense, Denmark
4 Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
5 The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, 0450 Oslo, Norway
6 Institute of Clinical Medicine, University of Oslo, 0313 Oslo, Norway
7 Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
8 Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
9 Department of Neurology, Odense University Hospital, 5000 Odense, Denmark
*Correspondence: sasan.andalib@health.sdu.dk (Sasan Andalib)
Co-first authors contributed equally.
J. Integr. Neurosci. 2025, 24(3), 26632; https://doi.org/10.31083/JIN26632
Submitted: 3 May 2024 | Revised: 14 November 2024 | Accepted: 4 December 2024 | Published: 25 March 2025
Copyright: © 2025 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

While vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains crucial, neurological complications have been detected following the coronavirus disease 2019 (COVID-19) vaccination. The neurological complications of COVID-19 vaccination can be seen in both the central nervous system (CNS) and the peripheral nervous system (PNS). In this study, we reviewed PNS complications after COVID-19 vaccination, their underlying mechanisms, diagnosis, and management. Inflammatory polyneuropathy, small fiber neuropathy, Parsonage-Turner syndrome (PTS), cranial mononeuropathies, and myasthenia gravis (MG) have been reported following COVID-19 vaccination. Inflammatory polyneuropathy following COVID-19 vaccination should be diagnosed early based on clinical presentation and treated with supportive care, and immunoglobulin or plasmapheresis to prevent respiratory distress if required. It is important to differentiate peripheral from central facial paralysis after COVID-19 vaccination to rule out upper motor neuron damage, including stroke. Diagnosis of small fiber neuropathy in the setting of COVID-19 vaccination should be suspected in patients with dysesthesia, dysautonomia, and lower extremity paresthesia. A skin biopsy of the proximal or distal lower limb should generally be considered for diagnosing small fiber neuropathy following COVID-19 vaccination. Even though pain at the injection site is one of the most common symptoms after COVID-19 vaccination, shoulder pain lasting more than 3 weeks should raise the suspicion of severe complications such as PTS. In addition to a proper physical examination as a reliable diagnosis tool, needle electromyography can be considered to help the diagnosis of PTS following COVID-19 vaccination. In our opinion, despite complications after COVID-19 vaccination, the benefit of vaccination immunity should not be forgotten.

Keywords
neurological complications
peripheral nervous system
COVID-19
SARS-CoV-2
vaccination
vaccine safety
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