Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Aaron Sacheli, Raymond Bauer
Cracchiolo Inpatient Rehabilitation Center, St. John Hospital & Medical Center, Detroit, USA
Am J Case Rep 2014; 15:368-373
There are several categories of primary inflammatory demyelinating disorders, which comprise clinically similar neurologic sequelae. Of interest, clinically isolated syndrome (CIS) and acute disseminated encephalomyelitis (ADEM) are 2 demyelinating conditions of the central nervous system (CNS), whose clinical similarity pose a significant challenge to definitive diagnosis. Yet, both remain important clinical considerations in patients with neurologic signs and symptoms in the context of recent vaccination.
Case Report: We report a case of a 50-year-old Caucasian male with a course of progressive, focal, neurologic deficits within 24 h after receiving the influenza vaccine. Subsequent work-up revealed the possibility of an acute central nervous system (CNS) demyelinating episode secondary to the influenza vaccine, best described as either CIS or ADEM.
Conclusions: Case reports of CNS demyelination following vaccinations have been previously noted, most often occurring in the context of recent influenza vaccination. This report serves to document a case of CNS demyelination occurring 24 h after influenza vaccination in a middle-aged patient, and will describe some salient features regarding the differential diagnosis of CIS and ADEM, as well as their potential management.
Keywords: Diagnosis, Differential, Angiography, Encephalomyelitis, Acute Disseminated - diagnosis, Follow-Up Studies, Influenza Vaccines - adverse effects, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Ultrasonography, Doppler, Duplex, Vaccination - adverse effects