Abstract
Botulinum toxin type A has been approved for spasticity management in poststroke patients. The adverse effects are generally of twotypes: those related to local injection; and those related to the systemic effects from spread of the toxin. Contralateral weakness afterbotulinum toxin A treatment is a rarely reported adverse effect. We report the case of a 33-year-old female who had been receivingregular injections of incobotulinum toxin A due to spasticity of the right limbs after a hemorrhagic stroke. A switch was made to abobotulinumtoxin A with an overall conversion ratio of 1:3.83. The patient presented contralateral upper limb paresis, especially of the deltoidmuscle, in the second week post-injection. The electroneuromyography showed neuromuscular block due to botulinum toxin A. Sherecovered completely after eight months. A switch between different formulations of botulinum toxin type A should prompt caution whencarrying out unit conversions. Distant side effects may appear, including paresis in the contralateral limbs.
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