Diagnosing SARS-CoV-2 vaccination associated rhombencephalitis requires comprehensive work-up and exclusion of differentials.

In this letter we raise several concerns regarding the interesting article by Walter and Krämer about rhomb-encephalitis as a complication two months after the vaccination with an mRNA-based SARS-CoV_2 vaccine. The causal link between the vaccination and encephalitis remained unproven, a SARS-CoV-2 infection, Bickerstaff encephalitis were not excluded, the MRI rather suggests brainstem-encephlaitis than pure rhomb-encephalitis, and the cerebro-spinal fluid was not investigated for cytokines or glial markers. Neurologists are called to make all available effort to convincingly evaluate the etiology and the pathophysiological background of an undetermined condition.