Age: 40.0
Sex: F
Vaccine: HEP
Symptoms: Hypoaesthesia, Neuropathy, Paraesthesia, Polyneuropathy, Sensation of heaviness
Clinical narrative: Post vaccine polyneuritis/neuropathy. Still undergoing treatment and remains disabled. Patient is more than two months into this illness and still unable to see patients or do any substantive work due to the neuropathy which affects upper and lower extremities and 8th cranial nerves. The day priori to the sudden onset of this illness, pt ran a 5K and has always been in excellent health. This severity of this adverse reaction has been devastating. Numbness of arms and legs as well as heaviness. Patient is a 40 year old female with increasing lower extremity numbness as well as spread on numbness into her arms as well as face who is here for evaluation. She had been in her usual state of health up until March 15. She apparently developed right leg numbness progressing into pain on the lateral aspect of the right leg and numbness and tingling across the sacral region and the top of her left foot. It is noted that she had hepatitis B vaccination on Feb 25. She did have prior hepatitis vaccinations. However, many years have elapsed and her titers were non existent so she had a second series. She saw a M.D. for these symptoms on March 21 and was diagnosed with scaitica and an MRI of the lumbosacral spine was ordered. She underwent a course of physical therapy as well as Vioxx. Her symptoms improved and she did stretching exercises of the right pyriformis muscle. However, on April 6 she had recurrent pain in her right leg, again deep and lateral, and this continued despite home stretching exercises. Over the next few days she started having hot and cold sensation as well as numbness in both legs, both anterior and posterioir part. She also had developed numbness across her sacrum to her legs bilaterally both anteriorly and posteriorly. She called me for recommendations and recommended a neurological evaluation and M.D was on call that day and did see her. She had a MRI of the brain ordered and B12 and methylmalonic acid levels ordered. She was diagnosed with lower extremity paresthesias of unclear etiology. It was noted that her MRI of the lumbosacral spine was normal. There was minimal disc desiccation at L4 -L 5 and L5 - S 1 without canal or foraminal stenosis. There was also multiple Tarlov cysts which were felt o be clinically occult. She underwent an MRI of the brain which was normal. She was seen in the clinic and nerve conduction studies were done and these were apparently normal. She had sedimentation rate and CPK done which was reported to be normal. She was diagnosed with idiopathic neuralgia, question of viral, and a Medrol Dosepak of six days was ordered. This was started on April 11. She noticed significant reduction in her pain in her legs after first day of prednisone. She still had persistent bilateral leg numbness. As the Medrol dose was reduced over the next few days, her symptoms returned, particularly leg pain. She was to increase her prednisone to 40mgs. yesterday because of increasing pain as well as numbness. This morning she noticed that her arms quite heavy, her legs were quite heavy, she has tingling in her legs. She also has facial numbness, starting in the left ear which she describes as a cold and tingling sensation moving to her forehead and the corner of the left side of her mouth and left part of the scalp. She also noticed some drooling in the left side of her mouth. Today she, at one point, felt like she was going to pass put. She denies having any shortness of breath. She denies having any chest  . There are no fevers pr chills. She did not have any URI symptoms, no vertigo. She denies having any significant headaches, any bowel or bladder disturbances. No dysphagia, no diplopia. She was able to have enough strenght to walk although she feels that this is more difficult. patient had a second hepatitis B vaccination on March 26.