Age: 20.0
Sex: M
Vaccine: SMALL, TYP, SMALL
Symptoms: Gastrointestinal haemorrhage, Gastrointestinal ulcer, Haematocrit, Haemoglobin, Hyperreflexia
Clinical narrative: On 9/30, onset of symmetrical bilateral lower leg numbness. The next morning, pt developed weakness to the point of difficultly walking and experienced urinary retention. There was demonstrable sensation decrease up to nipples, bilateral distal leg weakness (L>R) and hyperreflexia with + Babinski. He was medevaced out of theater. Daily steroids (1 gram solumedrol) were initiated on 10/3. Due to weakening respiratory effort, he was electively intubated and sedated. There is no history of URI's, GI illness, rash, or animal or known arthropod bites. No history of arthralgia, myalgia or arthritis prior to onset of symptoms. On 10/7, service member was started on IVIG infusion at 2 grams/kg over 1 day. On 10/8, discontinuation of high-dose steroids was initiated. There was no significant change in his neurological status. Empiric antibiotics were initiated. While being turned, pt's O2 sats decreased to the 80's. Suctioning and 100%, F102 helped, but when F102 returned to his previously supportive 40%, he again desaturated to the 80's, ABG reportedly showed a PaO2 of 52. PPEEP was increased, F102 was increased, and Lovenox increased to anticoagulant levels. He was stabilized at F102 of 70%. (IVIG was temporarily suspended). After CT, pt's ventilator parameters were back to pre-"desat" levels with SpO2>95%. Steroid levels were decreased to stress-levies. Pt had an acute upper GI bleed with HCT of 17%. He was transfused with 4 units of PRBC's and 4 units of FFP. His HCT stabilized at 24%. On 10/9, GI endoscopy showed 5 ulcers, with some continued oozing which was cauterized successfully. After his endoscopy, pt was noted moving his upper extremities bilaterally. Recommendation to continue IVIG at 0.4gm/kg every 2-4 weeks was made, depending on IgG levels and continued improvement neurologic function. On 10/12/06, pt alert and responding appropriately to environment. Able to move upper extremities on command having fair strength bilaterally (R>L). Able to squeeze hand (R>L). No fine control of fingers or control of lower extremities. Taking prednisone 70mg q day. Plans are to repeat MRI and possibly remove ET tube.02/123/07-records received and reviewed for 10/7-108/06. DC:enchephalitis, postimmunization, acute disseminated encephalomyelitis (ADEM). RX with IVIG and high dose steroids.  Symptoms bilateral lower let numbness followed next day with weakness to point of difficulty walking and experienced urinary retention. Demonstratable sensation decrease up to nipple line bilateral distal leg weakness L>R and hyperrlexia and positive Babinski. Electively intubated and sedated due to weakening respiratory effort. When not sedated able to blink appropirately yes and no but unable to track with eyes. Shoulder shrug intact. Remains hyperrflexic with 2-3 beat clonus and positive Babinski. Acute upper GI bleed. Began to move upper extremities. GI endsocopy:5 ulcers.  MRI:demylination within both brain and spinal cord.  HSV1,2, CMV negative. CTD with ANA and RF negative. Per information received from annual follow up, patient has neurogenic bladder, lower extremiety weakness, using wheelchair for long distances. Currently undergoing medical board/disability evaluation. Per 60 day follow up: I am still waiting on receipt of patient records. I will send a follow-up report after I receive records and speak to the patient again.