The availability of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provides hope towards mitigation of the coronavirus disease 2019 (COVID-19) pandemic. Vaccine safety and efficacy has not been established in individuals with chronic autoimmune diseases such as multiple sclerosis (MS). Anecdotal reports suggest that the vaccines may be associated with brain, spinal cord, peripheral nervous system, and cardiac inflammation. Based on the high morbidity and unpredictable course of COVID-19, and the need to achieve herd immunity, vaccination has been recommended for patients with MS. We report clinical and MRI features of seven individuals who received the Moderna (n = 3) or Pfizer (n = 4) SARS-CoV-2 mRNA vaccines. Within one to 21 days of either the first (n = 2) or second (n = 5) vaccine dose, these patients developed neurologic symptoms and MRI findings consistent with active CNS demyelination of the optic nerve, brain, and/or spinal cord. Symptoms included visual loss, dysmetria, gait instability, paresthesias, sphincter disturbance, and limb weakness. Age ranged from 24 to 64 (mean 39.1) years; five were woman (71.4%). The final diagnosis was exacerbation of known stable MS (n = 4, two were receiving disease-modifying therapy at the time of vaccination), new onset MS (n = 2), or new onset neuromyelitis optica (n = 1). All responded to corticosteroid (n = 7) or plasma exchange (n = 1) therapy, with five returning to baseline and two approaching baseline. Large prospective studies are required to further investigate any possible relationship between COVID-19 vaccines and acute CNS demyelination.

针对严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 的疫苗的可用性为缓解 2019 年冠状病毒病 (COVID-19) 大流行提供了希望。尚未在患有慢性自身免疫性疾病（例如多发性硬化症 (MS)）的个体中确定疫苗的安全性和有效性。轶事报告表明，疫苗可能与大脑、脊髓、周围神经系统和心脏炎症有关。基于 COVID-19 的高发病率和不可预测的病程，以及实现群体免疫的需要，建议 MS 患者接种疫苗。我们报告了接受 Moderna ( n =  3) 或辉瑞 ( n = 4) SARS-CoV-2 mRNA 疫苗。在第一剂 ( n =  2) 或第二剂 ( n =  5) 疫苗接种后的 1 至 21 天内，这些患者出现了与视神经、大脑和/或脊髓的活动性 CNS 脱髓鞘一致的神经系统症状和 MRI 发现。症状包括视力丧失、距离障碍、步态不稳、感觉异常、括约肌障碍和肢体无力。年龄范围为 24 至 64（平均 39.1）岁；五人是女性（71.4%）。最终诊断为已知稳定型 MS 恶化（n =  4，2 人在接种疫苗时正在接受疾病缓解治疗）、新发 MS（n =  2）或新发视神经脊髓炎（n =  1）。均对皮质类固醇有反应（n = 7) 或血浆置换 ( n =  1) 治疗，其中 5 人回到基线，2 人接近基线。需要进行大型前瞻性研究来进一步研究 COVID-19 疫苗与急性中枢神经系统脱髓鞘之间的任何可能关系。