Michigan - Oakland County woman remains unconscious, isolated with unknown medical condition

[Pathfinder]

Oakland County woman remains unconscious, isolated with unknown medical condition

on August 12, 2015 at 3:05 PM, updated August 12, 2015 at 4:37 PM

PONTIAC, MI -- A woman found unconscious on the ground in Oakland County's Independence Township remains in the McLaren Oakland Hospital in Pontiac.

Stephanie Lynn Yeider, 38, of Waterford, has been in the hospital since Friday evening, not long after a bystander found her dazed and vomiting along the road and called 911. By the time Oakland County sheriff's deputies arrived, Yeider was unconscious.

"We do not have any verification at all that this patient has any communicable or infectious disease," McLaren Hospital spokeswoman Christina Miller said in a statement. "We're doing everything clinically possible to rule out various medical conditions...

http://www.mlive.com/news/detroit/index.ssf/2015/08/oakland_county_woman_remains_u.html

[Emily]

Doctors mystified by condition of woman found unconscious on side of road Author: Shawn Ley, Local 4 Reporter, @ShawnLeyLive, sley@wdiv.com

Published On: Aug 10 2015 10:42:26 PM EDT Updated On: Aug 10 2015 11:25:57 PM EDT


"She's kind of out of it and she says she hasn't taken anything but I beg to differ," a 9-1-1 caller said Friday when they saw a woman stumbling along Andersonville Road. "She's out of it puking, foaming, need someone soon."
...
But the woman still hasn't woken up and she's not breathing on her own. The only drug her system is a small level of Xanax.

http://www.clickondetroit.com/news/doctors-mystified-by-condition-of-woman-found-unconscious-on-side-of-road/34643456

This is somewhat like the other 2 recent cases in TX and GA. AHLE is the only thing I can find that could progress that fast. The only virus factor identified so far in some cases is influenza A virus. Fortunately it is rare, so maybe small amounts of OTC or Rx meds are a co-trigger of the reaction.

Am J Forensic Med Pathol. 2010 Mar;31(1):7-11. doi: 10.1097/PAF.0b013e3181c6be92.
Acute hemorrhagic leukoencephalitis: a critical entity for forensic pathologists to recognize.
...
Thus, AHLE can clinically mimic a direct central nervous system infection or a toxic ingestion. AHLE has a very poor prognosis, with rapid deterioration and death usually occurring within days to one week after onset of symptoms. The cause for AHLE is unclear. An autoimmune pathophysiology is likely, with immune cross-reactivity between myelin basic protein moieties and various infectious agent antigens.

http://www.ncbi.nlm.nih.gov/pubmed/20010289

[alert]

What drew my attention was the word "foaming" in the above article. We don't typically isolate influenza A cases (unless a novel strain is suspected). But foaming at the mouth is a classical symptom of human rabies infections, something that would trigger an isolation. While unlikely, rabies is probably the reason why her doctors isolated her.

A wide variety of infectious and non-infectious conditions might be at work here, however. We will see what test results show (and if any other similar cases are found).

I am slightly concerned that they apparently tested for drugs (which is why we know about Xanax) before they tested for infectious explanations, especially once they made the decision to isolate her.

[Emily]

I didn't even think of rabies, Alert, but foaming at the mouth can be a sign. I hope not in this case. The autoimmune treatments are getting better and better, so that would be much more hopeful. I wondered about anti-NMDA receptor encephalitis in the other 2 cases, but since doctors had said they already suspected autoimmune causes there, I would have expected a better outcome and not so quick a decline even if first line treatments were not successful.

The disease can mimic rabies, so hope this current case gets quick diagnosis and treatment for whatever it is.

By Dr. Daniela J. Lamas Globe Correspondent May 27, 2013
...
Some speculate anti-NMDA receptor encephalitis could be behind historical descriptions of what was believed to be demonic possession. Cahalan described her first seizure in a book about her experience, ?Brain on Fire?: ?My arms suddenly whipped straight out in front of me, like a mummy, as my eyes rolled back and my body stiffened. I was gasping for air. . . . Blood and foam began to spurt out of my mouth through clenched teeth.?

Even though anti-NMDA receptor encephalitis has been a known condition for several years, I just read a complaint by a psych unit intake nurse that she could not get AB testing authorized. Seems insurance companies do not want to pay for it.