Peripheral Nervous System Complications after COVID-19 Vaccination

Seyed Sepehr Khatami; Samaneh Ghorbani Shirkouhi; Poul Flemming Høilund-Carlsen; Mona-Elisabeth Revheim; Abass Alavi; Morten Blaabjerg; Sasan Andalib

doi:10.31083/JIN26632

Peripheral Nervous System Complications after COVID-19 Vaccination

J Integr Neurosci. 2025 Mar 25;24(3):26632. doi: 10.31083/JIN26632.

Authors

Seyed Sepehr Khatami¹, Samaneh Ghorbani Shirkouhi², Poul Flemming Høilund-Carlsen^{3

4}, Mona-Elisabeth Revheim^{5

6}, Abass Alavi⁷, Morten Blaabjerg^{8

9}, Sasan Andalib^{8

9}

Affiliations

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.

PMID: 40152570
DOI: 10.31083/JIN26632

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: COVID-19; SARS-CoV-2; neurological complications; peripheral nervous system; vaccination; vaccine safety.

Publication types

Review

MeSH terms

COVID-19 Vaccines* / adverse effects
COVID-19* / prevention & control
Humans
Peripheral Nervous System Diseases* / diagnosis
Peripheral Nervous System Diseases* / etiology
Peripheral Nervous System Diseases* / therapy
Vaccination* / adverse effects

Substances

COVID-19 Vaccines