title: Yellow fever vaccine-associated neurological disease, a suspicious case.
abstract: 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,Coxiella burnetti,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.
authors.affiliation: Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Beirão
authors.affiliation: Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Department of Internal Medicine, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Andreia
authors.initials: A
authors.lastname: Nunes
authors.affiliation: Endocrinology department of the Portuguese Oncology Institute, Lisbon, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Antunes
mesh_terms: D000368:Aged; D001927:Brain Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000276:immunology; D004569:Electroencephalography; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood / Q000134:cerebrospinal fluid; D008297:Male; D022341:Yellow Fever Vaccine / Q000009:adverse effects*
chemical_list: D007074:Immunoglobulin G; D022341:Yellow Fever Vaccine