Letter to the Editor
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3929-3931
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3929
Symmetric DWI hyperintensities in CMT1X patients after SARS-CoV-2 vaccination should not be classified as stroke-like lesions
Josef Finsterer
Josef Finsterer, Department of Neurology, Neurology & Neurophysiology Center, Vienna 1180, Austria
Author contributions: Finsterer J was responsible for everything.
Conflict-of-interest statement: There are no conflicts of interest to report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Josef Finsterer, MD, Adjunct Associate Professor, Medical Assistant, Department of Neurology, Neurology & Neurophysiology Center, Postfach 20, Vienna 1180, Austria. fifigs1@yahoo.de
Received: February 20, 2023
Peer-review started: February 20, 2023
First decision: March 14, 2023
Revised: April 12, 2023
Accepted: April 25, 2023
Article in press: April 25, 2023
Published online: June 6, 2023

The interesting case report by Zhang et al on a 39 years-old male with Charcot-Marie-Tooth disease type 1X has several limitations. The causal relation between the two episodes of asyndesis, dysphagia, and dyspnea 37 d after the second dose of the inactivated severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) vaccine (Beijing Institute of Biological Products Co., Ltd., Beijing, China) remains unproven. SARS-CoV-2 vaccination cannot trigger a genetic disorder. It also remains unsupported that the patient had a stroke-like episode (SLE). SLEs occur in mitochondrial disorders but not in hereditary neuropathies. Because of the episodic nature of the neurological symptoms, it is critical to rule out seizures. Overall, the causal relation between vaccination and the neurological complications remains unsupported and the interpretation of symmetric diffusion-weighted imaging lesions on cerebral magnetic resonance imaging should be carefully revised.

Keywords: Stroke-like episode, Stroke-like lesion, SARS-CoV-2, Vaccination, Side effect

Core Tip: Symmetric diffusion-weighted imaging hyperintensities in charcot-marie-tooth type 1X patients after severe acute respiratory syndrome-coronavirus-2 vaccination should not be classified as stroke-like lesions.