Table 1

Demographics, results, treatments and clinical outcomes

Case12345
GenderMaleMaleMaleFemaleMale
Age6643517153
Days from vaccine to symptom onset7117128
Days from vaccine to facial weakness1717141514
CSF protein (0–0.5 g/L)1.992.815.140.961.22
CSF white cells (0–5/cumm)223110
CSF viral PCR*NegativeNegativeNegativeNegativeNegative
Lyme serology (IgM and IgG)NegativeNegativeNegativeNegativeNegative
Anti-ganglioside antibodies†NegativeNegativeGM3 positive
GM4 borderline
NegativeNot tested
CMV serology (IgM and IgG)IgM negative
IgG not tested
NegativeNegativeNegativeNot tested
Brain imagingMRI pre and post GAD contrast: normal except for bilateral smooth contrast enhancement along whole facial nerveNormal MRI. No post contrast study performedNormal CT
Sensory NCSUL and LL: reduced SNAP amplitudeUL: absent SNAPs
LL: normal
UL: reduced SNAP amplitudes
LL: normal
UL and LL: reduced/absent SNAP amplitudes and velocitiesNot tested
Motor NCSUL and LL:
Prolonged DMLs, and F-wave latencies
Slow CV
Dispersed CMAPs and CB
UL and LL:
Prolonged DMLs, and F-wave latencies
Slow CV
Dispersed CMAPs and CB
UL and LL:
Dispersed CMAPs
Tibial F wave latencies prolonged
UL and LL:
Prolonged DMLs
Dispersed CMAPs
Not tested
Facial NCSProlonged DMLsAbsentNormal except blink reflexes absentNot testedNot tested
Facial EMGNot testedFew fibrillations, no volitional motor unitsVery reduced volitional motor unitsNot testedNot tested
Chest X-rayNormalNormalNormalNormalNormal
TreatmentIVIgIVIgNilNilNil
Outcome10 weeks from symptom onset9 weeks from symptom onset10 weeks from symptom onset12 weeks from symptom onset7 weeks from symptom onset
Facial weakness resolved.
Pain and paraesthesia improving.
Intact reflexes including right ankle jerk.
20% improvement in facial weakness.
Ataxic gait and pain static. Areflexia persists.
No longer in urinary retention.
95% improvement in facial weakness.
Ataxic gait 80% better.
25% improvement in pain and paraesthesia.
Residual mild facial weakness, proximal leg weakness and mild paraesthesia.
Reflexes regained.
95% resolution of facial weakness, pain and paraesthesia.
  • Abnormal laboratory results are highlighted in bold.

  • *CSF viral PCR: Enterovirus PCR, Herpes simplex virus type 1 PCR, Herpes simplex virus type 2 PCR, Parechovirus PCR, Varicella zoster PCR.

  • †Anti-ganglioside antibody subtypes (GD1a, GD1b, GD2, GD3, GM2, GM3, GM4, GT1a, GT1b, GM1, GQ1b).

  • CB, conduction block; CMAP, compound muscle action potential; CMV, Cytomegalovirus; CSF, cerebrospinal fluid; CV, conduction velocities; DML, distal motor latency; GAD, Gadolinium; IVIg, intravenous immunoglobulin; LL, lower limb; NCS, nerve conduction studies; SNAP, sensory nerve action potential; UL, upper limb.