Age: 70.0
Sex: F
Vaccine: FLU3
Symptoms: Coma, Cough, Delirium, Diplopia, Disorientation
Clinical narrative: This patient's family indicates that she is now being transferred to the rehabilitation unit to continue her recovery from her neurological illness. The patient was originally transferred to medical Center on 01/01/01. The patient's symptoms actually began on 12/26/00 when she began a syndrome of nausea, emesis, and a productive cough. The patient deteriorated until 12/31/00 when her husband noticed that she was very disoriented, that she was unable to sit up, she was unable to transfer without the patient's help. Because of this and the continuing complaint of headache the patient was seen at another Hosp where she was admitted. The patient was initially given Rocephin and a lab work up was done. The patient's admitting physician noted her to be stuporous, but responsive until the night time hours when she gradually became less responsive. It was also noticed by the Physician that she was having difficulty with movement of her right eye, the right eye coming to the midline. The patient was also having a tendency to keep her head deviated to the left side, though she was moving her arms and legs. With this history she was transferred to Medical Center. Her initial physical examination revealed her to be mildly febrile, temp of 100F, with snoring respiration's and upper airway noise. She would open her eyes with pain stimulation and when deep suctions, though her eyes would not attempt to follow any commands. Her oral airway mildly compromised with oral secretions. Her neurologic exam revealed her to be unresponsive but would open her eyes briefly with pain and with strong verbal stimulation. The patient's moved both arms and legs after passive range of motion. The patient's reflexes were one to two plus and symmetrical. Plantar stimulation was flexor on the right, questionably up going on the left. It was felt that the sixth nerve palsy was a false localizing sign and so the patient under went diagnostic studies. Ct scan of the brain and an MRI of the brain was done. The MRI showed areas of abnormality in the floor of the fourth ventricle at the pontomedullary junction. Lumbar puncture was done, routine diagnostic studies showed an elevated spinal fluid protein, but more impressively showed marked elevated fluid IGG synthesis. The patient developed respiratory distress and had to be intubated to protect her airway. She was treated with antibiotics in addition to the Rocephin. Over the next several days the patient was maintained on a ventilator, then she became more arousable was able to be extubated; the released from intensive care. The patient was moved to a regular room more alert but at times confused and disoriented. The patient has finally become aware of diplopia as the right sixth cranial nerve palsy has persisted. The neuro team has been seeing the patient and has noted she is unable to sit , stand or transfer unsupported.  All medication were discontinued as felt necessary as the patients spinal fluid cell count was 0. Further  history from the patient has indicated that she had a Flu vaccine two weeks before the onset of these symptoms. The patient has been referred for a comprehensive rehabilitation program; length of stay two weeks.