Combined central and peripheral demyelination after COVID-19 vaccination

Abstract

Combined central and peripheral demyelination (CCPD) is a rare neurological entity that afects both the central and peripheral nervous system with demyelinating lesions. The pattern of involvement of the central nervous system (CNS) includes frequent bilateral optical neuritis, involvement of grey matter and occasional longitudinally extensive transverse myelitis (LETM) in the absence of oligoclonal bands (OCB) or antibodies such as antiaquaporin-4 (AQP4) and anti-myelin oligodendrocyte glycoprotein (MOG). Peripheral nervous system (PNS) involvement occurs mainly as a chronic infammatory demyelinating polyneuropathy (CIDP)-like disease. Infections and vaccinations are known triggers. CCPD typically evolves aggressively with progressive cumulative neurological impairment despite immunosuppression.