Age: 20.0
Sex: M
Vaccine: FLUN3, SMALL
Symptoms: Cerebellar syndrome, Coordination abnormal, Dysarthria, Headache
Clinical narrative: Within days of vaccination (smallpox) Pt described constant headache, dysarthria, and incoordination. MRI c/w cerebritis-cerebellitis. Tx IV steroids, Acyclovir, TCN.  11/7/06 Received medical records from 1st hospital which reveal patient admitted 10/12/06 w/bifrontal HA & slurred speech following small pox vax 10/6/06.  Initial CT of brain was WNL.  Then developed left facial weakness & mild asymmetry of reflexes.  MRI then revealed T2 signal in right superior & mid frontal gyri.  Initial labs were WNL.  LP revealed WBC 245, 91% lymphs, protein 194, glucose 58.  Tx for presumptive meningoencephalitis & suspected post vax reaction, viral .  Tx w/steroids, antivirals & antibiotics IV.  Appeared stable x 2 days then abruptly developed worsening speech, ataxia & repeat MRI showed new bilateral cerebellar T2 hyperintensity.   Final/Transfer DX: probable post immunization reaction with meningoencephalitis initially focal & now with bilateral cerebellar involvement.  Transferred to second hospital on 10/18/06. 1/23/07 Received medical records from 2nd hospital which included: 1. Additional progress notes records from community hospital. 2. Medical records from clinic s/p release from second hospital which relate s/s to smallpox vac reaction.  Still had speech difficulty, slow gait, right hand tremors & intermittent vision difficulty.  Was receiving PT/OT/ST.  As of 12/11/06 2-4 more mo of rehab recommended before returning to active duty.  Still having trouble with balance & gait disturbance. Vax records included here reveal patient received FluMist & Smallpox on 9/29/06. 3. D/C summary from 2nd hospital for 10/19-10/25/06 admit as well as H&P. 4. VHC Summary: Patient received anthrax, smallpox, flumist, & Hep A&B in preparation for deployment.  Patient developed frontal HA approx 6 days after receipt of vax which grew progressively worse until awoke 10/12 with slurred speech, difficulty walking, blurred vision, & hand tremors.  Went to Troop Medical Center then to civilian ER & was admitted.  MRI of brain was positive for ill defined abnormal T2 hyperintense signal involving gray & white matter of right superior frontal & right middle frontal gyri with suggestion of cortical thickening.  Admitted 10/12/06-10/19/06 & then transferred to second hospital. FINAL DX: post vaccination cerebellitis. Follow-up: C/O worsening frontal headache behind his eyes for 3-5 days that was not ameliorated with TYLENOL. On 12 Oct 06 he developed slurred speech, difficulty focusing his eyes and unsteadiness in his gait. He was seen and sent to ER. He denied chest pains, fever, SOB, nausea, vomiting, arthralgias, myalgias or any symptoms of a URI. Headache, general Start: 10/06/2006 End: 10/13/2006. Comment: frontal, behind eyes and occipital. Symptom: Gait abnormality Start: 10/12/2006 Comment: trouble with coordination (jumping, running, walking back wards). Symptom: Cognitive deficiency Start: 10/12/2006 End: 10/22/2006. Comment: has trouble with word finding and slurred speech when tired. Symptom: Tremors Start: 10/12/2006 End: 10/22/2006 Comment: of hands.