Age: 9.0
Sex: M
Vaccine: FLUN(H1N1), FLUN(H1N1)
Symptoms: Myoclonus, Pituitary cyst, Skin warm, Somnolence, Tremor
Clinical narrative: Appeared tired around 2:45 PM.  Did not eat dinner and went to bed at 5:00 PM.  Woke up at 6:00 PM complaining of dizziness, not feeling good, and of shaking. I (mother of patient) noticed that patient exhibited what appeared to be myoclonic jerks.  I noticed this as he was sitting and walking.  Temperature was 97.5 axillary.  Pulse 75.  No sweating.  Forehead felt slightly warm to the touch.  He was awake and oriented to person, place, and time, but stated he did not feel good.  He looked tired.  I (patient's mother) called the pediatrician's office and was told to take him to the emergency room.  Taken to the emergency room at 7:00 PM.  While patient was sitting in the emergency room waiting to be seen by the physician, I (patient's mother) noticed what appeared to be myoclonic jerks again, accompanied by patient's complaint that he felt very sleep.  He started to close his eyes and I physically stimulated him to keep him awake by talking to him and massaging his head and shoulders. Patient was examined by emergency physician at approximately 7:30 PM.  Pulse was 65 according to emergency room automatic blood pressure machine.  By 8:15 PM, patient stated that his dizziness was decreased and that he felt better, but he said that he still did not feel "right" like his usual self.  I (patient's mother) noticed that he no longer exhibited any jerky movements by this time. I took his pulse by palpation and it was 60. Emergency physician noted that while patient was "distracted" by activity, such as standing and sitting, there were no jerks.  Patient was sent home without treatment and was told to follow up with primary care provider in the morning.  Patient has intense burning feeling inside body, feels like volcano internally.  When walking very uncoordinated, leans forward abnormal gait flailing arms and legs. Follow-up: These symptoms have persisted for 1 month and 3 days as of this writing. On 01/08/2010, 0548 am: Several parietal headache, severe dizziness to the point of not being able to get out of bed. Apical pulse 47 with a galloping rhythm. Treated at home with oral fluids. 0704: Headache gone. Dizziness decreased. Ataxic gait suddenly reappears. (First episode of ataxic gait has previously beet reported to VAERS system for inclusion as an update to VAERS 372246-1.) Apical pulse 56. Approximatel 11:00 A.M.: Myoclonic jerking, lethargic, shallow breathing in pediatrician's office during urgent visit. Taken to emergency room for possible seizure . Afternoon: CT done in ER and negative. Patient transferred to hospital and hospitalized for close observation to rule out a rare variat of Guillain Barre syndrome. 1/9/2010: Pediatric neurologist examines patient and concludes that patient does not have cerebellar ataxia but has conversion disorder. Pediatric neurologist says patient will walk again on 1/10/2010. Parents disagree and have patient undergo-MRI. MRI shows pituitary cyst, which pediatrician in the hospital says will be monitored by endocrinologist after discharge. Plan was to discharge paitent on 1/10/2010. 1/10/2010: Patient still unable to walk. Parietal headache and a feeling of being hot inside returns. MRI specialist is consulted and no definitive treatment plan has been developed as of this writing. Today is day #3 of hospitalization.  Hospital records rec'd for DOS 1/8-12/2010 with D/C DX:  8 mm Intrasellar lesion; adenoma vs cyst.  Abnormal movements, likely conversion disorder.  Hx of bradycardia. Pt presented from local hospital. Transported from PCP's office after episode of ataxia, jerking of extremities and difficulty awakening. Pt had been in usual state of good health un 12/8/09 when pt received H1N1 vaccine st school.  That PM pt was excessively sleepy, dizzy and had some jerking of extremities.  Seen in ER and d/c.  Pt has had multiple episodes of bradycardia to the 40-60's. Cardiology w/u (-) except for bradycardia. Pt had increasing sx of fatigue, H/A, sweating, feeling hot and dizziness.  Being seen for episode of ataxia when pt was transported to hospital for eval. PE (+) for Non-convergence of L eye, truncal ataxiaon sitting and severe ataxia; unable to stand, DTRs 1+. Some dysautonomia present.  Neuro consult with dx of conversion d/o.  Neurologically intact.  Psych consult c/w conversion d/o. Parent is not in agreement with this dx. Neurosurgery consults of 1/10/10 and 1/28/10 dx:  Cerebral Cyst-Incidental finding of tiny sellar lesion, no-operative at this time. Initially seen in hospital while pt was admitted for multiple sx following H1N1 vaccination and r/t MRI finding of sellar lesion.  Parent reports pt still with c/o dizziness,  cough, and some personality changes.  Pt repeatedly slumping over in chair with flat affect.  Will watch lesion and repeat testing in 6 months. Ophth exam 2/5/10 for c/o blurry vision.  No evidence of optic neuropathy. Chiropractic exam (+) for cervical and thoracic subluxations. Cardiology consult dated 2/18/2010 with impression:  1. Bradycardia noted at baseline and with sleep.  Low average HR in the 60's.  Structurally normal heart. 2. Symptom complex of dizziness, H/A, cognitive changes and fatigue.  Abnormality on MRI with intrasellar lesion. Pt presented after episodes of dizziness which began following H1N1 vax. Prominant vagal tone persists represented by resting bradycardia, but unsure if causing all pt's sx. Pt to be seen by autonomic specialist in future.