Acute transverse myelitis and acute motor axonal neuropathy developed after vaccinations against seasonal and 2009 A/H1N1 influenza.
ABSTRACT Acute transverse myelitis (ATM) has been described as an uncommon complication of vaccinations and is rarely accompanied by inflammatory peripheral neuropathy. We report a case of a 77-year-old woman who developed ATM and acute motor axonal neuropathy (AMAN) following vaccinations against seasonal and 2009 A/H1N1 influenza. She manifested ophthalmoplegia, quadriparesis and sensory impairment. MR imaging showed a longitudinally-extensive spinal cord lesion, and nerve conduction study revealed motor axonal polyneuropathy. Despite prompt treatment, her symptoms poorly recovered. While concurrent ATM and AMAN may suggest the presence of a common antigen, their scarcity indicates the importance of other factors causing immunologic disruptions.
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ABSTRACT: Guillain-Barre syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are clinically distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of viral infection or vaccination. Concurrent GBS and ADEM are uncommon with few reported cases. Our patient is a 10-year-old girl who presented with acute quadriparesis, areflexia, and urinary retention. Lumber puncture revealed mild pleocytosis and elevated protein. She required mechanical ventilation and failed to improve after intravenous immunoglobulins. She subsequently developed double vision and disturbed level of consciousness. Brain MRI revealed multiple white matter lesions suggestive of ADEM. Based on the temporal association and exclusion of alternative etiologies, we made a diagnosis of GBS and ADEM. She improved remarkably after intravenous methylprednisolone. We conclude that co-morbid GBS and ADEM is an uncommon entity presenting with severe neurological morbidity. Prompt recognition and treatment can hasten the recovery and therefore improve the neurological outcome.Neurosciences 04/2013; 18(2):166-8. · 0.32 Impact Factor
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ABSTRACT: To predict the number of selected outcomes temporally associated but not caused by vaccination, to aid causality assessment of adverse events arising after mass immunisation in a paediatric population. Nationwide population based cohort study. Denmark. All liveborn infants delivered after 1 January 1980. Study population was followed from date of birth until hospital admission for selected outcome diagnoses, death, first emigration, age 18 years, or 31 December 2009. The study population was subject to vaccines used in standard childhood immunisation in Denmark, with 82-93% vaccine coverage. Incidence of acute infectious and post-infectious polyneuritis (Guillain-Barré syndrome), acute transverse myelitis, optic polyneuritis, facial nerve palsy, anaphylactic shock, seizure, multiple sclerosis, autoimmune thrombocytopenia, type 1 diabetes mellitus, juvenile and rheumatoid arthritis, narcolepsy, and death of unknown cause stratified by sex, age, and season. We predicted the number of events for a hypothetical vaccine cohort of 1 000 000 people for follow-up periods of up to 182 days. The study included 2 300 227 liveborn infants, yielding 37 262 404 person years of follow-up; median follow-up was 16.8 person years. Incidence of outcome diagnoses spanned from 0.32 per 100 000 patient years for autoimmune thrombocytopenia to 189.82 per 100 000 patient years for seizure. Seasonal differences were most pronounced for anaphylactic shock, seizure, and multiple sclerosis. Even for rare outcomes, numerous events were predicted in the hypothetical vaccine cohort. We predicted that 20 cases of type 1 diabetes mellitus, 19 of juvenile or rheumatoid arthritis, eight of facial nerve palsy, and five of multiple sclerosis per 1 000 000 children would occur within 42 days after vaccination. Incorporating exact background rates of disease based on age, sex, and seasonal distribution could strengthen vaccine safety assessment, and provides an evidence based focus for discussing the incremental risk of newly introduced vaccines.BMJ (online) 01/2012; 345:e5823. · 17.22 Impact Factor
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ABSTRACT: To illustrate that acute, even dramatic, demyelination of the central nervous system and encephalitis can occur after viral i.e. influenza A/H1N1 vaccination or infection.Clinical neurology and neurosurgery. 06/2014; 124C:8-15.