Case 4: Girl with truncal ataxia, vomiting, nystagmus

A 16-month-old girl presents with acute onset of truncal ataxia with vomiting, nystagmus and dysarthria. She is afebrile and has no nuchal rigidity. Which of the following historical items would help you to identify a cause of these symptoms?

A. elevated lead level at the age of one year
B. febrile seizure episode at the age of 13 months
C. sore throat with blisters on palate 3 weeks ago
D. febrile illness with rash 2 months ago
E. first MMR vaccination 1 month ago