PT - JOURNAL ARTICLE AU - Pedro Beirão AU - Patrícia Pereira AU - Andreia Nunes AU - Pedro Antunes TI - Yellow fever vaccine-associated neurological disease, a suspicious case AID - 10.1136/bcr-2016-218706 DP - 2017 Mar 02 TA - BMJ Case Reports PG - bcr2016218706 VI - 2017 4099 - http://casereports.bmj.com/content/2017/bcr-2016-218706.short 4100 - http://casereports.bmj.com/content/2017/bcr-2016-218706.full AB - 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.