Demographics, results, treatments and clinical outcomes
| Case | 1 | 2 | 3 | 4 | 5 |
| Gender | Male | Male | Male | Female | Male |
| Age | 66 | 43 | 51 | 71 | 53 |
| Days from vaccine to symptom onset | 7 | 11 | 7 | 12 | 8 |
| Days from vaccine to facial weakness | 17 | 17 | 14 | 15 | 14 |
| CSF protein (0–0.5 g/L) | 1.99 | 2.81 | 5.14 | 0.96 | 1.22 |
| CSF white cells (0–5/cumm) | 2 | 23 | 1 | 1 | 0 |
| CSF viral PCR* | Negative | Negative | Negative | Negative | Negative |
| Lyme serology (IgM and IgG) | Negative | Negative | Negative | Negative | Negative |
| Anti-ganglioside antibodies† | Negative | Negative | GM3 positive GM4 borderline | Negative | Not tested |
| CMV serology (IgM and IgG) | IgM negative IgG not tested | Negative | Negative | Negative | Not tested |
| Brain imaging | MRI pre and post GAD contrast: normal except for bilateral smooth contrast enhancement along whole facial nerve | Normal MRI. No post contrast study performed | Normal CT | ||
| Sensory NCS | UL and LL: reduced SNAP amplitude | UL: absent SNAPs LL: normal | UL: reduced SNAP amplitudes LL: normal | UL and LL: reduced/absent SNAP amplitudes and velocities | Not tested |
| Motor NCS | UL 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 NCS | Prolonged DMLs | Absent | Normal except blink reflexes absent | Not tested | Not tested |
| Facial EMG | Not tested | Few fibrillations, no volitional motor units | Very reduced volitional motor units | Not tested | Not tested |
| Chest X-ray | Normal | Normal | Normal | Normal | Normal |
| Treatment | IVIg | IVIg | Nil | Nil | Nil |
| Outcome | 10 weeks from symptom onset | 9 weeks from symptom onset | 10 weeks from symptom onset | 12 weeks from symptom onset | 7 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.