Abstract
To the Editor.— Swine influenza vaccination has been implicated as a possible cause of the Guillain-Barre syndrome.1-3 Encephalomyelitis following bivalent influenza vaccine was reported in a patient in 1972 by Yahr and Lobo-Antunes.4 We recently saw a patient with probable brain stem encephalitis 18 days after receiving swine flu vaccine. His clinical findings were compatible with a brain stem lesion and included the locked-in syndrome and downward gaze. This state was present for one month and then the patient began to improve. His eye movements returned to normal. He can now move all limbs volitionally. The clinical improvement plus investigative studies tended to rule out mass lesion or vascular lesions. Until recently all cases of locked-in syndrome have been reported with structural lesions.5,6 However, there was a recent case report without the structural change of tumor or vascular damage.7 Our patient may be the first

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