Still undetermined diagnosis

Summer Vacation in Vermont

Today Aidan has another Spinal Tap to test the proteins in his spinal fluid, the test was inconclusive; it did not confirm GBS.

He also had an EEG (brain scan) it was the same results as last week.  Because he's so sedated it is difficult to interpret the findings, so essentially its inconclusive.

He is presenting a rash on his hand and foot so they are testing Rocky Mountain Spotted Fever, it's

He did lose all of the excess fluid he was retaining, in fact he lost a pound. 

His eyes are tracking when manually opened to the sound of his voice. 

They reduced the pressure in his lungs to allow excess fluids to seep out.  We have seen signs that he is trying to breath on his own. 

They are planning on repeating another MRI, they are looking in the white matter which is higher up on the nerves in the brain stem.

They are still considering ADEM (Acute Disseminated Encephalomyelitis) which is classically described as a uniphasic syndrome occurring in association with an immunization or vaccination (postvaccination encephalomyelitis) or systemic viral infection (parainfectious encephalomyelitis). Pathologically, there is perivascular inflammation, edema, and demyelination within the CNS. Clinically patients present with the rapid development of focal or multifocal neurologic dysfunction. Prototypical illness arises after acute measles infection or rabies vaccine administration. Uncertainty regarding the diagnosis occurs when patients with clinical features of ADEM occur in the background of viral infections or vaccine administration not significantly linked with the syndrome by epidemiological criteria. (See "Acute disseminated encephalomyelitis in children").

Neurologic sequelae complicate 1 in 400 to 1 in 1000 cases of measles infection . Multiple subgroups of patients have been described, including those with diffuse cerebral features, focal or multifocal cerebral findings, cerebellar dysfunction, and spinal cord abnormalities; patients do not develop peripheral nerve damage or relapses of disease.

In addition to measles, a wide array of other viral and bacterial infections have tentatively been associated with ADEM, including rubella, mumps, herpes zoster, herpes simplex, influenza, Epstein-Barr virus, coxsackievirus, Borrelia burgdorferi, Mycoplasma, and Leptospira. Acute encephalomyelitis occurring in the background of nonspecific viral illness is difficult to diagnose with certainty and to distinguish from episodes of MS.

The occurrence of neuroparalytic accidents as a consequence of the Pasteur rabies vaccine prepared from spinal cords of rabbits inoculated with fixed rabies virus was recorded soon after introduction of the treatment: the incidence of encephalomyelitis associated with the original Pasteur rabies vaccine prepared in rabbit brain has been estimated at 1 per 3,000 to 35,000 vaccinations. Similar neurologic complications were observed as a consequence of the Jenner vaccine used for the prevention of smallpox. Postvaccination ADEM does not appear to be due to the direct cytopathic effects of the virus, but rather to immune-mediated mechanisms directed against specific components of the CNS [78].

ADEM also has been associated with other vaccines, including pertussis, rubella, diphtheria, and measles. The association between influenza vaccination, particularly the swine flu vaccine, and ADEM has been the subject of medicolegal controversy.

ADEM has been reported after the administration of some drugs. These drugs include sulfonamides and para-aminosalicylic acid (PAS)/streptomycin.

All of these associations can only be substantiated by strong epidemiological evidence or by the development of a pathognomonic laboratory finding for ADEM. However, neither of these circumstances currently exists.