Age: 12.0
Sex: F
Vaccine: HPV4, HPV4
Symptoms: Muscle twitching, Musculoskeletal stiffness, Neck pain, Oropharyngeal pain, Photophobia
Clinical narrative: Dx-encephalitis etiology unkonwn. Five weeks after administration pt experienced stiffness of neck. Neck pain, back pain, lethargy, no appetite fever for 7 days then began having seizures which lead to respiratory failure. 1 1/2 yr later seizures are ongoing & numerous developmental problems due to brain atrophy.  5/13/2009-records received-ER visit 9/22/07 presented with C/O one day history of fever, sore throat and right-sided neck pain. DX: Viral pharyngitis, right cervical adenopathy most likely due to viral etiology. Office visit 9/26/07-Fever and sore throat, stiff back and shoulders for 4 days. Tiredness, decreased appetite. No neck pain.Office visit 6/8/07-immunization visit received Gardasil, Menactra and Varicella.  Assessment: viral infection, pharyngitis.   5/20/09 - ICD-9 codes received. 99669 infection and inflammatory reaction due to other internal prosthetic device/implant/graft, 3159 Unspecified delay in development, E8782 Surgical operation, anastomosis/bypass/graft, with abnormal reaction/later complication, no surgical misadventure, V1251 Personal history of venous thrombosis and embolism, Z8981 Primary hypercoagulable state, V1251 Personal history of venous thrombosis and embolism, 78039 Convulsions, 326 Late effects of intracranial abcess/pyogenic infection, 34839 Encephalopathy, 1390 Late effects of viral encephalitis, 27651 Dehydration, 3154 Developmental coordination disorder, 31539 Developmental speech disorder.  5/20/09 ED and hospital records received DOS 9/22/07 to 4/12/09 FINAL DIAGNOSIS: Seizure disorder Post vaccination: Intially presented to ED with one day history of fever, sore throat and right-sided neck pain. Then repeated ED visits due to seizures. Slurred speech, motor delay. Tachycardia. Skin graft anterior right foot, followed by cellulitis. Repeated febrile illness with photophobia. Hit her head several times. Disconjugate gaze. Facial twitching. Temporal lobectomy. Choreoathetoid movements of head. Venous thrombosis and embolism left lower extremity, intracranial abcess, encephalopathy, viral encephalitis, dehydration, developmental speech disorder, ventilator dependent for 2 months.   6/11/09 Hospital records and several discharge summaries recieved DOS 9/27/07 to 12/13/08 Assessment: Epilepsy secondary to encephalitis. Patient transferred from another hospital for management of seizures and respiratory failure. Fever for 4 days, generalized tonic-clonic seizure with rolled back eyes, foaming and the mouth and urinary incontinence. Placed in pentobarbital coma, developed thrombus at site of central line placement, infiltraion left foot. Level of orientation fluctuates, speech slow. Operative proceedures - left frontal craniotomy, intraoperative electrocardiography, tailored left temporal lobectomy, megalo-hippocampectomy. Seizures persisted postoperatively. Readmitted for increased seizure activity beginning as slurred speech, head tilting, sometimes secondary generalization. Readmitted for continued cluster and complex seizures, suicidal ideation. drooling, staring blankly, perioral cyanosis, has fallen during seizures  7/2/09 ICD-9 Codes received.  51881, 5990, 34830, 78039, 7948, 4589, 0414