Beirão Pedro, Pereira Patrícia, Nunes Andreia, Antunes Pedro
Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.
Endocrinology department of the Portuguese Oncology Institute, Lisbon, Portugal.
BMJ Case Rep. 2017 Mar 2;2017:bcr2016218706. doi: 10.1136/bcr-2016-218706.
A 70-year-old man with known cardiovascular risk factors, presented with acute onset expression aphasia, agraphia, dyscalculia, right-left disorientation and finger agnosia, without fever or meningeal signs. Stroke was thought to be the cause, but cerebrovascular disease investigation was negative. Interviewing the family revealed he had undergone yellow fever vaccination 18 days before. Lumbar puncture revealed mild protein elevation. Cultural examinations, and neurotropic virus serologies were negative. Regarding the yellow fever virus, IgG was identified in serum and cerebrospinal fluid (CSF), with negative IgM and virus PCR in CSF. EEG showed an encephalopathic pattern. The patient improved gradually and a week after discharge was his usual self. Only criteria for suspect neurotropic disease were met, but it's possible the time spent between symptom onset and lumbar puncture prevented a definite diagnosis of yellow fever vaccine-associated neurological disease. This gap would have been smaller if the vaccination history had been collected earlier.
一名70岁男性，有已知的心血管危险因素，表现为急性起病的表达性失语、失写症、失算症、左右定向障碍和手指失认症，无发热或脑膜刺激征。起初认为病因是中风，但脑血管疾病检查结果为阴性。询问家属后发现他在18天前接种了黄热病疫苗。腰椎穿刺显示蛋白轻度升高。培养检查和嗜神经病毒血清学检查均为阴性。关于黄热病病毒，血清和脑脊液（CSF）中检测到IgG，CSF中IgM和病毒PCR均为阴性。脑电图显示脑病模式。患者逐渐好转，出院一周后恢复正常。仅满足疑似嗜神经疾病的标准，但症状出现与腰椎穿刺之间的时间间隔可能妨碍了对黄热病疫苗相关神经系统疾病的明确诊断。如果更早收集疫苗接种史，这个时间间隔会更短。
