TABLE 1.
Summary of relevant clinical findings and investigations
| Patient 1 | Patient 2 | Patient 3 | |
|---|---|---|---|
| Gender | Female | Female | Male |
| Onset of symptoms and history | 7 days after vaccination. Dysaesthesias and altered temperature sensation on hands and feet extending proximally | 10 days after vaccination. Bilateral neuropathic pain and paraesthesias in the hands and feet. Cheeks, nose and tongue numbness and paraesthesias | 15 days after vaccination. Dysaesthesias and altered temperature sensation on hands and feet |
| Neurological examination | Reduced vibration sensation at right toe. No other abnormal findings | Bilateral pinprick hyposensitivity in feet. No other abnormal findings | Bilateral pinprick hyposensitivity up to 15 cm proximal to malleoli |
| Laboratory tests | ANA 1:80, speckled, IgA mildly elevated, contextually a non‐specific finding | ANCA and ANA positive, but PR3 and MPO titers low (atypical pattern) | No abnormalities |
| Clinical neurophysiology a | |||
| Sural nerve (sensory) | |||
| Amplitude | 8.4 μV (≥5 μV) | 7.9 μV (≥5 μV) | 7.6 μV (≥5 μV) |
| Conduction velocity | 44 m/s (≥39 m/s) | 48 m/s (≥39 m/s) | 47 m/s (≥39 m/s) |
| Radial nerve (sensory) | |||
| Amplitude | 22.7 μV (≥15 μV) | 26.1 μV (≥15 μV) | 25.8 μV (ulnar antidromic) (≥15 μV) |
| Conduction velocity | 64 m/s (≥49 m/s) | 57 m/s (≥49 m/s) | 52 m/s (≥49 m/s) |
| Peroneal nerve (motor) | |||
| Amplitude | 9.4 mV (≥2 mV) | 2.5 mV (≥2 mV) | 4.8 mV (≥2 mV) |
| Conduction velocity | 47.0 m/s (≥39 m/s) | 49.7 m/s (≥39 m/s) | 43 m/s (≥39 m/s) |
| F wave (min latency) | 54.5 ms (≥58 ms) | 54.3 ms (≥58 ms) | Not done |
| Median nerve (motor) | |||
| Amplitude | 10.0 mV (≥4 mV) | 10.7 mV (≥4 mV) | 10.1 mV (≥4 mV) |
| Conduction velocity | 54.5 m/s (≥49 m/s) | 56.2 m/s (≥49 m/s) | 56 m/s (≥49 m/s) |
| F wave (min latency) | 27.8 ms (≥32 ms) | 27.0 ms (≥32 ms) | Not done |
| Sympathetic skin response | Present | Present | Present |
| Electromyography | Normal | Normal | Chronic bilateral L5, left C6 radiculopathies |
| Thermal thresholds (mean ± SD) | |||
| Warm detection b | 45.4 ± 0.4°C (45°C) | 38.0 ± 1.9°C (44°C) | 45.2 ± 2.2°C (45°C) |
| Cold detection b | 24.9 ± 0.5°C (27°C) | 30.1 ± 0.2°C (27°C) | 26.2 ± 1.1°C (27°C) |
| MRI head and spine | Multiple perineural cysts attached to bilateral L5‐S2 nerve roots deemed incidental. Cystic dilatation of the distal spinal cord central canal, no change from previous imaging | Prominent central canal within the spinal cord from C4/C5 to mid T1 vertebral level | Not performed |
| Intraepidermal nerve fiber density | 3.0 fibers/mm | 3.4 fibers/mm | 8.0 fibers/mm |
| 0.05 quantile (median) for age and gender | 3.2 (7.6) fibers/mm | 4.3 (9.8) fibers/mm | 8.7 (9.3) fibers/mm |
a
Reference range included in parentheses for each neurophysiological measure.
b
Age and gender warm and cold detection thresholds are included in parentheses for each patient.