Polyneuritis cranialis (PNC) or cranial polyneuropathy are terms used to describe a single disease process which affects several cranial nerves at once. Causes may be attributed to processes based on the meninges; lesions affecting nerves at the skull base, carcinomatous, infectious or inflammatory processes within nerves. Guillain-Barre sydndrome has been recognised as a rare cause of PNC for many years. From 1950 to 2016, there were 15 cases of PCN published in the literature in which a diagnosis of GBS was made. 13 of these were preceded by infectious cause (respiratory tract/gastrointestinal infection), 1 was post-partum and 2 had no preceding symptoms. Our case is unique as the patient developed facial and limb symptoms post flu-vaccination.Case
We report a 36 years old woman who developed progressive sensory symptoms 2 days after receiving a flu vaccine. She presented with worsening numbness over the left face in the trigeminal nerve distribution, neck pain and paresthesiae in the hands and feet. Several days later she developed hoarse voice and ataxia. MRI brain showed contrast enhancement in portions of the trigeminal and facial nerves, bilaterally. MRI of the whole spine showed mild enhancement along the lower nerve roots within the cauda equina. CSF examination revealed raised protein and albuminocytological dissociation. Nerve conduction studies showed prolonged motor latencies in the median nerves, partial ulnar motor conduction block and reduction in sensory SNAP amplitude in the upper limbs. She was admitted University Hospital Geelong and was treated with 5 days of intravenous immunoglobulin. She responded well to treatment and made a good recovery. Repeat nerve conduction study 3 months later showed improvement in motor amplitude, sensory amplitude and latency parameters.