Age: 26.0
Sex: F
Vaccine: ANTH
Symptoms: Speech disorder, Tongue oedema, Vision blurred, Vomiting
Clinical narrative: Complex migraine headache syndrome secondary to possibility antiphospholigrid AB syndrome temporarely associated with the AVA vaccine in Nov 02- Pt is a 26 year old female active duty who was referred to the service while an impatient on the neurology service. On 26 Jan 2003 while shopping , the pt noticed a numbness in her left thumb that proceeded to spread throughout her left arm, left neck, and left jaw. She developed posterior tongue swelling and disturbed speech. blurred vision bilaterally and some dizziness. She experienced no weakness in the left arm. Within minutes she had the abrupt onset of sharp bitemporal and occipital headache, 10/10 pain and sensitivity to light and sound. She drove home (2 blocks) and called the ER who advised her to call an ambulance. She drove to the ER with admitted difficulty in vision and constant straining to focus. She was immediately transferred to hospital for r/o CVA. No records are available from that ER visit, however the pt reports being given morphine and having a negative head CT scan. She was released. the headache had not improved and her weakness persisted to some degree over the next day. She was unable to work on Monday 27 Jan and stayed at home with the headache, the numbness had passed. Resolution of the numbness had occurred within 24 hours. On 28 Jan she returned to the ER with persistent headache and dizziness. She was given Imitrx without improvement  and DHE which caused vomiting, controlled by phenergan. She had some improvement in the headache and was able to sleep. MRI was performed which showed no structural abnormalities. With the headache almost gone, she was discharged home from the ER on 29 Jan with follow up scheduled for that afternoon. By the afternoon of the 29th, the headache was returning with photophobia, phonophobia and kinesiophobia, but no nausea or vomiting. At that time she was admitted to the community hospital for r/o meningitis. LP was performed with normal opening pressure and unremarkable cell studies. Stains were negative for organisms. Complete metabolic profile was normal and CBC was normal except for slight leukopenia of 4.16. ESR was 4. Anticardiolipin Ab was IgM was positive at 25. ANA was positive at 1.320 and phosphatidylserine IgM Ab were also positive. Her lupus anticoagukant was negative prior to the start of anticoagulation. MRI and MRA were obtained and showed no structural abnormalities. She was released with plavix, aspirin, prednisone taper, depakote, and trazadone with follow up to Hemetology Onocology. She was seen by Heme Onc who decided to readmit her for anticoagulation with heparin and coumadin given the positive anticardiolipin Ab and her symptoms. She was successfully anticoagulated with coumadin on 28 Feb and heparin was stopped. INR goal 2.5. Pt was then transferred to neurology service. During her hospitalizations the following medications were tried to control her headaches: toradol 30mg IV Q6. indomethacin SR 75mg BID, Depacon 500mgm IV q 8h, decadron 10mg IV q 12 hours, DHE 45 1.0mg IV up to doses of 1.5mg, Benadryl 75 mg IV q 6 h, droperidol 2.5 mg IV q 30 min x 3 to induce sleep, morphine 10mg IV (minimal relief), duragesic 25 patch, thorazine 50mg (induced deep sleep) imitrex 6mg sq