Α RELAPSE OF “RECURRENT PAINFUL OPHTHALMOPLEGIC NEUROPATHY” AFTER COVID-19 VACCINATION, CASE REPORT AND REVIEW OF THE LITERATURE.

Abstract

The purpose of this paper is to describe the first case report of a relapse of “Recurrent Painful Ophthalmoplegic Neuropathy” (RPON), formerly known as “Ophthalmoplegic Migraine”, after covid-19 immunization. RPON is a rare form of neuropathy characterized by repeated attacks of paresis of one or more ocular cranial nerves with ipsilateral headache. While headache and ocular cranial nerve palsies alone have been described after vaccination, especially after covid-19 immunization, there are only minimal reports of RPON in children, or painful ocular cranial nerve palsies in adult population. We hereby present the first case report of a patient with RPON, who had a recurrence after the 3rd dose of an mRNA vaccine against SARS-Cov-2. In addition, as far we know, this case is also the first case report of a relapse of known RPON after immunization in adult population. The rarity of these cases can be explained by the fact, that since recently adult vaccination was not common, and RPON is also a rare entity. In our opinion, this article will add significant knowledge not only into the study field covid-19 vaccination and its side effects, but also into the field that investigates the pathogenesis of RPON. This paper comes to strengthen the current opinion, that RPON is actually a neuropathy, while headache could be a secondary event that takes place in some individuals whose anatomy and physiology endeavor the earlier triggering of an ipsilateral headache.