Symmetric DWI hyperintensities in CMT1X patients after SARS-CoV-2 vaccination should not be classified as stroke-like lesions

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.