Post-vaccination myelitis

Clinical history
This 30-year-old male patient suffered acute pain of the right scapula as well as intense myalgia. Rapid motor loss is observed in the left lower limb extending secondarily to all limbs. Paresthesia of all limbs is observed extending up to the cervical region. Motor and sensory deficit occurred in a very short time of less than one hour. The patient is admitted to the emergency department of the hospital.

Neurological examination
Neurological examination disclosed motor and sensory disturbances. The plantar reflex were in flexion bilaterally. Dysesthesia were present up till the upper thoracic level. There was also urinary dysfunction. CSF examination was normal. Occurrence of respiratory problems necessitated transfer to the intensive care unit.

MRI findings
Image 1: Sagittal T2WI. Ill delineated hyperintense area is shown within a mildly enlarged cervical spinal cord (arrows).
Image 2: Axial T2WI confirm the central location of this hyperintense lesion.

Sagittal T1WI (not shown here) demonstrated minimal cord expansion only, without any intramedullary abnormal signal. No contrast enhancement was seen after Gadolinium injection.

Clinical diagnosis
Transverse myelitis secondary to vaccination against tetanus performed 3 weeks previously.

Clinical evolution
Progressive but only partial recovery of the motor deficit occurred. The patient remained tetraparetic. Persistent reduction of sensation below C5. Persistent sphincter disturbances.

Search also:
- Transverse myelitis

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