Age: 51.0
Sex: F
Vaccine: DT, FLU3, HEPA, FLU3, HEPA, TD, TYP, FLU3, HEPA, TD
Symptoms: Muscle twitching
Clinical narrative: Fluzone vaccine on 11/8/2006  Hepatitis A vaccine Havrix on 11/8/2006  Td vaccine on 11/8/2006  Vivotif (Live oral Typhoid) Started 11/15/06 and took one capsule every other day x four capsules.  Lariam generic (Mefloquine Hydrochloride) 250 mg. Started 12/21/06 and took one pill each week for a total of four weeks. Symptoms of dysphagia started about 1/1/2007 along with slurred speech(dysarthria), tongue twitch, and generalized weakness which have been present to varying degrees since 1/1/2007.  The other intermittent symptoms she has experienced over the course of the last six months are R occipital and parietal throbbing type pain, R ear pain, general headaches, R cheek droop once x 15 min, L facial numbness, balance/coordination difficulty, L arm numbness once x 15 min (like rubber band on it), tongue/cheek twitching, and a very, very mild L lower branch Bell's Palsy.  The symptoms are stable at this point in time. Currently the renaining symptoms are the dysphagia, tongue twitch, slurred speech and fatigue. She has been worked up from the ENT and Neurological perspective. Neuro initially thought neurologic paraneoplastic syndrome and then the ALS center gave her the diagnosis of amyotrophic lateral sclerosis (progressive bulbar palsy). She is being looked at now from the immunologic perspective since her symptoms seem temporally related to the vaccines and Lariam. Currently she is treating with a foriegn physician for paraneoplastic syndrome with reinfusion of her own Natural Killer cells, dendritic cells, phenylase and Rapakine plus some type of vaccine.She is also conferring with and being tested for immune dysregulation and possible mercury toxicity. Those results are not back yet. She has not been classified as permanently disabled as yet but her work has been affected. 7/5/07-records received for DOS 11/8/06-4/19/07-seen on 1/26/07- for C/O right ear pain times one week and slurred speech times 3-4 weeks. Symptoms consist of diplopia, slurred speech, numbness on left side of face, balance/coordination difficulty, swallowing difficulty, left lower facial weakness. Headaches localized in right occipital area, right parietal area. Recent travel to India. Patient had a cough and headache in India and returned feeling very weak. PMH: back apin, migraines and neck pain. Slightly elevated liver enzymes and elevated ESR could be thre tail end of viral illness acquired in India which is resolving. Seen on 4/2/07- C/O cough and cold. Dyspnea worse with moderate exertion. Neurology consult 4/13/07-Neuro exam demonstrated dysarthria accompanied by emotional lability, highly suggestive of bilateral corticobulbar tract lesion. Pseudobulbar palsy remains unexplained probably due to upper motor neuron degenerative disease. Seen by neurologist on 4/3/07-indicated that upon arrival in India on 12/26/06 family noticed her speech had changed. Two episodes of emotional upset that were accompanied by drooping left side of face. Laughs inappropriately during conversation with others. Fatigue, difficultly with swallowing. Seen on 4/18/07-Impression:unmistakable clinical features of bulbar amyotrophic lateral sclerosis (ALS).