Hemiparesis following influenza vaccination.

Accepted 10 March 1998 A 72-year-old woman presented with subacute, non-progressive weakness ofher left hand 2 weeks after receiving an influenza vaccination. Her spouse had noticed that she was walking unsteadily, with a tendency to fall to the left side. She also drooled from the left angle of the mouth. She denied any headache, fever, neck pain, alteration in consciousness or seizures. She had no other medical illnesses. She worked as a hair stylist and had stopped smoking 27 years ago. She took no medications. On clinical examination, she was afebrile. Her higher mental functions including speech and language were normal. Her left lower face was weak. Other cranial nerves were normal. Her left arm strength was (MRC) 4-/5 with her left leg being 4+/5. She had normal strength in her right side. Deep tendon reflexes were 3+ in her left arm and leg, and 2+ on the right side. Babinski's sign was present on the left side. She had no sensory loss and her cerebellar functions were intact. There were no signs of meningeal irritation. Her other systems examination was normal. Brain magnetic resonance imaging (MRI) was carried out (figure 1).