Age: 15.0
Sex: F
Vaccine: HEP, HPV4
Symptoms: Contraception, Dysmenorrhoea, Menstruation irregular
Clinical narrative: 15 yo GO WF LMP October 2005 presents with her mother to discuss her infrequent menstrual cycles. The pt had her first menstrual cycle in August of 2005. She then had a cycle in September and then October 2005. She has not had a menstrual cycle since that time. She has never been sexually active. She has severe cramping with her menstrual cycles. She denies any weight changes, temperature instability or breast discharge. D/w pt and her mother issues regarding menarche and cycle irregularity. Also d/w the potential for PCOS. Explained to them the reason that cycle regulation is important long term. They agree to OBCP for cycle regulation. Plan to do some lab evaluation and induce menstrual flow w/ course of progestin. D/w pt information regarding HPV and hepatitis B vaccine. Entire patient history reviewed by MD.  9/23/08 Reviewed neuro 2nd opinion of 3/1/07 & subsequent visits. FINAL DX: periodic paralysis Records reveal patient experienced episodic limpness, constant HA.  Tx w/meds.  Developed numbness/tingling in fingers/toes & depression, severe heartburn, pinched nerve, leg/muscle pain & cramping on meds.    10/7/08 Reviewed hospital medical records of 2/14-2/15/2007. FINAL DX: conversion disorder Records reveal patient experienced 4 episodes of sudden unexplained paralysis within a 2 week period starting around 12/25/06 w/migraine HA.  Then developed a cough & sore throat & dx w/mono.  Had decreased energy & increased sleep.  Divides time between parent's homes.  Outpatient CT of head & EEG WNL.  Had been transferred from outlying ER to PICU.  Work up completely WNL.  Parent refused psychiatric eval & referred instead for second neuro opinion at outpatient clinic where was seen 3/1/07. 8/26/08 Reviewed OB/GYN medical records for 10/3/2006-2/19/2007. FINAL DX: Records reveal patient experienced good health on 10/3/2006 date of 2nd vaccinations.  Returned to clinic 2/5/2007 for f/u after d/cing contraception which she had been on for cycle regulation.  Stopped due to severe HAs.  HAs did not improve off BCP.  Seen in ER prior to this visit for sudden onset of paralysis.  ER dx w/possible myasthenia gravis & referred to neurologist.  Final vaccinations had been planned for this visit but were postponed due to these health issues.  Patient RTC 2/19/07 for vaccines & denied concerns at that time.  9/2/08 Reviewed ER medical records of 6 different 2007 dates: 2/3/07 FINAL DX: transient weakness Records reveal patient experienced sudden onset of generalized weakness.  Had been dx w/Mono 1 week prior & was being w/u for migraines.  2/9/07 FINAL DX: episodic weakness Records reveal patient experienced sudden onset weakness, fatigue, lethargy, malaise, excessive sleeping, HA.  2/14/07 FINAL DX: generalized weakness Records reveal patient experienced partial numbness & weakness.  Phone neuro consult done & transferred to higher level of care.  2/27/07 FINAL DX: fatigue; episodic weakness of uncertain cause Records reveal patient experienced sudden onset of weakness.  Neuro consult done.  Patient missed 6 weeks of school.  3/28/07 FINAL DX: chest pain, resolved   12/18/07 FINAL DX: viral illness Records reveal patient experienced sore throat, fatigue, rhinorrhea, nausea, anorexia, arthralgias, myalgias, dizziness, fever & HA x 1 week.