srjcmsSRJCMSSRJCMS2788-8851https://doi.org/10.47310/srjcms.2021.v01i01.007Diagnosing AMSAN Triggered By a SARS-Cov-2 Vaccination Requires Comprehensive Work-UpJosefFinstererWith interest we read the article by Tutar et al. about a 76 years old male who developed fatigue, myalgia, and mild fever immediately after the second dose of the Sinovac vaccine, which lasted for a few days and progressive quadruparesis starting five days after the vaccination [1]. Based upon the clinical presentation and nerve conduction studies (NCSs), the patient was diagnosed with Guillain-Barre syndrome (GBS) subtype acute, motor and sensory, axonal neuropathy (AMSAN) and treated with intravenous immunoglobulins (IVIGs), which resulted in almost complete recovery of the clinical abnormalities  [1]. The study is appealing but raises the following comments and concerns.  There is a discrepancy regarding the onset of quadruparesis. In the first sentence of the case description the authors state that the patient presented with quadruparesis since nine days but in the third sentence of the case description they state that progressive quadruparesis started 8 days after the vaccination.  Since he received the vaccination 14 days prior to presentation, suggesting that quadruparesis started 6 days prior to presentation [1]. This obvious inconsistency should be clarified. A second discrepancy refers to the sensory abnormalities. In the first paragraph of the case presentation the authors mention that the patient complained about  progressive, ascending paresthesias in the lower limbs [1].  In the second paragraph of the case presentation they state that the patient had no sensory disturbances. The authors should clarify this inconsistency.  A third discrepancy concerns the absence of abnormal spontaneous activity on needle electromyography (EMG). Since the patient was diagnosed with an axonal lesion, one would expect that the affected muscles are denervated which usually shows up on EMG as spontaneous activity. Absence of spontaneous activity in the presence of an axonal lesion should be clarified. A limitation of the study is that no reference limits of the blood chemical values were provided [1], which prohibits assessing which value was inside or outside the normal range. Applying our own reference limits, the patient had an elevated D-dimer [1]. We should be told if this was due to the infection, due to deep venous thrombosis, due to pulmonary embolism, or due to venous sinus thrombosis. A further limitation of the study is that the patient was diagnosed with AMSAN without application of the Brighton criteria. GBS is usually diagnosed according to the Brighton criteria, which requires not only a clinical exam and NCSs but also cerebro-spinal fluid (CSF) investigations, to assess if there was a dissociation cyto-albuminique or not.  We do not agree that only two patients with SARS-CoV-2 vaccination related GBS in addition to the index case have been reported. In a recent review about the prevalence of SARS-CoV-2 vaccination related GBS, 19 patients with post-vaccination GBS were identified when collecting data as per the end of July 2021 [Finsterer, submitted].  Overall, the elegant study has several limitations which challenge the results and their interpretation. These objections should be met to reassess the data and thus strengthen the conclusions.