A brain CT showed "no acute disease," and a cerebral spinal fluid (CSF) analysis showed no white blood cells, no growth, no organisms, and protein within normal limits. Id. at 18, 37; Pet. Ex. 24 at 109, 283. A blood chemistry test revealed elevated AST and ALT, as well as abnormal glucose, calcium and salicylate levels. Pet. Ex. 7 at 33. A.M. was taken by helicopter to Miami Children's Hospital ("MCH") for continued care.
Upon arrival at MCH, A.M. was "[c]hemically paralyzed and sedated, unarousable to painful stimuli[,]" intubated and ventilated. Pet. Ex. 4 at 478. Her temperature was recorded at 102.2° F. Id. A September 28, 2007 EEG was abnormal—showing "diffusely slow activity for [her] age, [and] diffuse cerebral dysfunction, without focality." Id. at 266. An MRI of her brain showed no intracranial pathology; although, the study was limited due to her dental braces. Id. at 422. A.M. was treated unsuccessfully with medications to control the seizure activity.
On September 29, 2007, after being extubated, A.M. continued to experience seizure activity with facial twitching. Id. at 483-85. The neurology assessment on that day noted a febrile illness, new onset of seizures, and elevated AST and ALT. Pet. Ex. 18 at 62. A.M.'s treating physicians suspected encephalitis. Id. at 62-63. An October 1, 2007 EEG was "very abnormal," showing an awake (but sedated) state, diffusely slow background, and diffuse cerebral dysfunction, without focality. Id. at 189. The EEG findings were consistent with encephalopathy. Id.