Print version ISSN 0004-282X
Arq. Neuro-Psiquiatr. vol.70 no.7 São Paulo July 2012
IMAGES IN NEUROLOGY
Transverse myelitis with Brown-Sèquard syndrome after H1N1 immunization
Mielite transversa manifesta por síndrome de Brown-Sèquard após vacinação contra H1N1
Marcelo Adriano da Cunha e Silva VieiraI; Carlos Henrique N. CostaII; Chrystiany Plácido de B. VieiraII; Maria do Amparo S. CavalcantiII; Sebastião P. Ferreira-FilhoIII
INeurologist of Nathan Portella Tropical Diseases Institute, Federal University of Piauí, Teresina PI, Brazil
IINathan Portella Tropical Diseases Institute, Federal University of Piauí, Teresina PI, Brazil
IIIFaculdade NOVAFAPI, Teresina PI, Brazil
A 52-year-old female had acute urinary hesitancy, constipation, crural spastic asymmetric paraparesis and sensory level at T6 (hypopalesthesia left and thermo-algesic hypoesthesia on the right mainly on sacral dermatomes) one week after H1N1-trivalent immunization.
Magnetic resonance imaging showed thoracic intramedullary lesion (Figure) and absence of brain findings. Cerebrospinal fluid was normal including electrophoresis, viral polymerase chain reactions and cultures. HIV-serology, VDRL, and anti-nuclear antibodies were nonreactive.
Brown-Sèquard syndrome commonly results from traumatic or tumor injury and is rarely found in other etiologies1,2. Myelitis constitute possible adverse event temporally related to immunization and his notification contribute to post-marketing studies on the safety of immunobiological extensively used in population3.
1. Durrant DH, True JM. Spinal cord syndromes and guide to neurological levels. In: Durrant DH, True JM (Eds). Myelopathy, radiculopathy and peripheral entrapment syndromes. Washington, DC: CRC Press, 2002:139-157. [ Links ]
2. Sheerin F, Collison K, Quaghebeur G. Magnetic resonance imaging of acute intramedullary myelopathy: radiological differential diagnosis for the on-call radiologist. Clin Radiol 2009;64:84-94. [ Links ]
3. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Agência Nacional de Vigilância Sanitária. Protocolo de vigilância epidemiológica de eventos Adversos pós-vacinação: estratégia de vacinação contra o vírus Influenza pandêmico (H1N1). Brasília: Ministério da Saúde, 2010. [ Links ]
Marcelo Adriano da Cunha e Silva Vieira
Rua São Pedro 2.133
64001-380 Teresina PI - Brasil
Received 10 January 2012
Received in final form 09 March 2012
Accepted 16 March 2012.
Conflict of interest: There is no conflict of interest to declare.