What recommendations do you have for patients with post-vaccination neurologic amyotrophy (Parsonage-Turner syndrome) regarding their future vaccinations?

Neuralgic amyotrophy (NA), acute brachial neuritis (ABN), or PTS are, inter alia, several names for an inflammatory microvasculitic plexopathy. Its broad presentation can range from a highly restricted “fasciculopathy” to a pan-plexopathy.

The decision of whether to vaccinate after post-vaccinational NA depends on whether, as a physician, you are concerned with an error of commission or omission. To make an evidence-informed decision, the following data are required:

1. Incidence of vaccine-induced NA (1st episode)
2. Incidence of recurrent vaccine-induced NA (2nd episode)
3. Incidence of wild-type (WT) infection-induced NA
4. Vaccine efficacy (probability of prevention).

There may be data on #4 but not for #1-3. As such, since we cannot provide evidence-informed recommendations, the question becomes, “what is the probability of recurrent NA from the vaccine vs. WT infection?” I generally recommend avoidance of the vaccine if the patient is immunologically healthy and continuing with a second vaccine if there are any concerns about serious morbidity with the WT infection. Au fond, this matter is an insoluble dilemma and devolves to a preference of avoiding an error of omission or commission.