A Case of Inflammatory Demyelinating Disease of the Central Nervous System Presenting with Clinical Manifestation of Multiple Sclerosis Following SARS-CoV-2 mRNA Vaccination

A 57-year-old woman presented with abnormal sensations and muscle weakness in the left upper and lower limbs and difficulty in walking four days after coronavirus disease 2019 (COVID-19) vaccination. The patient had deep sensation deficits and increased tendon reflexes in the left upper and lower limbs. Her head and cervical spinal cord magnetic resonance imaging showed a ring-shaped contrast-enhancing lesion. Cerebrospinal fluid examination showed a mildly elevated cell count, myelin basic protein, and IgG index, and positive oligoclonal bands. The patient was diagnosed as inflammatory demyelinating diseases of the central nervous system (IDDCNS) due to vaccination and was treated with pulse steroids. Her symptoms improved to a greater degree compared to previously reported cases of IDDCNS after COVID-19 vaccination. The disease course of this case was monophasic, but was more similar to multiple sclerosis than to acute disseminated encephalomyelitis (ADEM) according to their diagnostic criteria. Careful long-term observation is necessary because vaccination, as in this case, may lead to relapses in multiple sclerosis (MS) patients who have not received disease-modifying drugs

A Case of Idiopathic Scoliosis with Intraoperative Neurophysiological Monitoring Abnormalities Leading to the Diagnosis of Charcot-Marie-Tooth Disease 1B

The current case report describes the clinical and genetic characteristics of a 16-year-old female proband. She did not have any subjective neurological symptoms preoperatively and who was incidentally diagnosed due to abnormal intraoperative neurophysiological monitoring (IONM) using transcranial electrical stimulation motor evoked potentials (TES-MEP) and somatosensory evoked potentials (SEP) for idiopathic scoliosis, leading to the diagnosis of Charcot-Marie-Tooth disease (CMT) 1B. There was no similar disease in her family history. Nerve conduction velocity testing revealed decreased conduction velocity of the median nerve, and genetic testing indicated myelin protein zero (MPZ) mutation (c242A > G), leading to the diagnosis of demyelinating type CMT1B. The parents had no genetic mutation, and this was a case of de novo mutation. CMT1B is an important differential diagnosis because, similar to our case, there may not be any clinical symptoms. The disease was discovered during a careful evaluation of the patient's scoliosis and other complications. TES-MEP was more useful than SEP for IONM of scoliosis with CMT1B