Age: 57.0
Sex: M
Vaccine: FLUX
Symptoms: Diplopia, Disorientation, Encephalitis, Extensor plantar response, Facial palsy
Clinical narrative: Patient developed acute disseminated encephalomyelitis.  Flu vaccination received on October 6, 2005.  Symptoms began 9 days post flu vaccination, on October 14, 2005.  Patient had high blood pressure, weakness in the left hip and a left facial palsy.  The symptoms progressed and on day October 16, 2005 he presented to the ER in the morning.  By the evening he was admitted later that eventing he was completely paralyzed from the chest down on the left side, including complete foot drop.  He was positive for Babinski on the left.  He was admitted to the neuro critical care unit at hospital.  He received 5 days of IV solumedrol, 1000mg (October 17-21, 2005).  He was discharged home on October 21, 2005 day.  He began physical therapy for the left leg.  On November 3, 2005 he began complaining of double vision.  This was initially attributed to the Pred taper, however, was diagnosed with optic neuroitis within the next week.  Within the next week he also began to repeat himself and became increasingly confused.  His symptoms progressed and he was ultimately taken to the ER for and emergent MRI on November 21, 2005.  That MRI revealed new inflammatory lesions in the cervical cord and in the right parietal lobe of the brain.  He was oriented to person and place but not to time.  He was admitted to the medical ICU and was started on another course of IV solumedrol, 1000 mg for 9 days.  He was disoriented, had short term memory loss and could not walk on his own.  Later in the ICU stay he was evaluated by physical, occupational and speech therapists. Each found that he had moderate impairment.  He remained in the medical ICU until November 25, 2005 when he was transferred to the neuro critical care unit.  He had improved somewhat on the solumedrol.  On November 26, 2005 he was transferred to the neurology step-down unit.  He remained in the neuro step-down unit until November 29, 2005 when he was transferred to the rehab unit at hospital.  He received one hour per day of each, speech, occupational and physical therapies.  He continued to improve physically, however, the cognative impairment of short term memory loss, confusion and organization problems persisted.  On December 1, 2005 it was found that he had developed HIT Syndrome and was transferred back to the neuro step-down unit for seven days of treatment with an alternative anticoagulant.  He continued to improve physically and mentally and was deemed stable for discharge on December 9, 2005.  On that date he was discharged home with orders for physical and speech therapies.  His medications are Prednisone 100 mg QD, Zoloft 50 mg QD, Neurontin 300 mg TID, Protonix and Coumadin.  On December 12, 2005 it was determined that the Coumadin therapy was not necessary and it was discontinued.  The patient will remain on all other medications until March 1, 2005 at which time he has a follow up appointment with doctor. Per 60 day follow up report-Patient's vision in the left eye has recovered to 70/20 with a 95% visual field. He continues to recover his mental status however still struggles with math/numbers and is not as mentally "sharp" as he was prior to the the injury. He is expected to make a full recovery, however, it is anticipated that it will take 6 months or more. He has not yet returned to work.  Per annual follow-up: Continued cognitive deficits include difficulty with sequencing expression, urinary reasoning and attention. He also continue to have significant visual problems as a result of persistent optic nuritis. The patient has been unable to return to his career as a physician/surgeon. It is unknown whether he will ever recover sufficiently such that he can return to work.