Abstract: B/Ann Arbor) he had a generalised seizure, and a few hours later he noticed severe dysaesthesia and weakness in both legs.Over the next 8 h he became quadriplegic with urinary retention and during this period he had a second seizure. 12h after the onset of the symptoms he was alert with a normal mental status.There was a flaccid quadriplegia with a level for all modalities of sensation at C5..All reflexes were absent.CSF examination disclosed 40 white cells, 90% neutrophils, with normal glucose and protein levels.A CT scan with contrast of the cervical spine demonstrated a low-density lesion within the spinal cord.A CT scan of the head and magnetic resonance imaging of the head and spinal cord were normal.He was treated with dexamethasone and plasmapheresis without any improvement.On the tenth day he died of a sudden cardiac arrest.At necropsy the spinal cord was swollen in several segments.Transverse sections of these areas disclosed a massive necrosis that on the edges of the lesions affected only the white-matter of the posterior columns.The necrotic areas were full of lipid-laden macrophages and some neutrophils.There was a thickening of the wall of small blood vessels and few of them were thrombosed.Perivascular cuffing was not observed.Neurons were still visible in the areas where the necrosis was most severe.Microscopic examination of the cerebral hemispheres and brainstem was normal.The clinical and pathological findings are typical of ANM.l,2The seizures suggested an associated encephalopathy but there did not seem to be any abnormality in the cerebral hemispheres or brainstem.The cause of ANM is unknown but the association with preceding viral illness, the predilection for white-matter, and the occurrence in patients with typical multiple sclerosis3 favour autoimmunity.Neurological autoimmune disorders reported after influenza vaccination have included Guillain-Barre syndrome, acute transverse myelitis, brachial plexus neuropathy, and optic neuritis 45 The incidence of these complications is very low, and except for the Guillain-Barre syndrome associated with A/New Jersey vaccination in 1976,4 it is not possible to be sure whether either the other syndromes recorded or the case reported here were chance occurrences or the result of an idiosyncratic reaction to a vaccine.These reports suggest that immunisation against influenza may be followed by severe neurological disorders, but this should not be taken as an argument against the annual vaccination of patients at high risk of complications of influenza: the benefits of immunisation outweigh the theoretical risk of neurological complications.However, the possibility of severe adverse reactions does constitute a further objection to the indiscriminate use of the vaccine in healthy people at very little risk of serious complications of influenza.
Publication Year: 1987
Publication Date: 1987-06-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 9
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