Age: 28.0
Sex: M
Vaccine: COVID19, COVID19, COVID19
Symptoms: Fibrin D dimer, Full blood count, International normalised ratio increased, Magnetic resonance imaging head abnormal, Metabolic function test
Clinical narrative: ED NOTE is as follows...from 4/21/21 @ 21:47    a 28 y.o. male who to the emergency room with reports of a headache for the last 48 hours.  He reports this as being one of the worst headaches he has ever had.  He was seen at urgent care and given Toradol, Zofran and Benadryl and still rates his pain an 8 out of 10.  He does feel pressure behind his eyes.  And reports vomiting in the parking lot at urgent care.  He denies abdominal pain back pain, neck pain, shortness of breath, chest pain, numbness or tingling or any other worsening concerns.  Reports that he did receive a recent Johnson & Johnson vaccination.  Patient states he does vape.  He occasionally drinks alcohol he denies any illicit drugs.  Patient denies any head trauma.   Diagnosis management comments: This is a 28-year-old male arrives to the emergency room with reported migraine headache for the last 48 hours.  He did report that he was go to urgent care in which he received a migraine cocktail of Zofran, Benadryl and Toradol.  Patient reported that his headache was not resolved so urgent care sent him on for further evaluation.  Patient upon arrival had a negative neurological exam however he did report that he had pressure behind his eyes.  Was unable to see any papilledema on funduscopic exam.  Check patient's pressures bilaterally and they were 21 and 18.  Patient did report to me that this was the worst headache of his life.  I did administer IV fluids here as well as Tylenol and morphine.  Patient did report some improvement.  Patient did report in his past medical history had a recent Johnson & Johnson vaccination.  A CBC and CMP was obtained.  Did have thrombocytopenia with a count of 66.  Since my exam was PERRL with normal extraocular movements.  He had no eye redness or eye pain.  Of low concerns for any iritis or uveitis.  Patient's patient CT of his head did show a abnormal CT that had a dense appearing superior sagittal sinus that was representing a venous thrombosis.  Radiologist did recommend a MRI MRV.  An MRI and MRV was ordered.  Patient MRI MRv did show findings are consistent with a venous thrombosis involving the right jugular right transverse sinus and superior sagittal sinus there is also a patchy edematous change within the subcortical white matter areas bilaterally and symmetrically.  There was no CVA.  With patient's reported migraine headache.  Reported blurred vision, low platelets, recent vaccination I do believe patient has vaccine induced thrombotic thrombocytopenia.  With this finding I did converse with my overseeing physician Calls were made out to neurology and then a call out did prefer to have patient started on IVIG at 1 g/kg daily for 2 days and blood thinner Xarelto 15 mg p.o. twice daily.  These orders were initiated.  Internal med services was consulted and with conversations of family, internal med services out possible transfer that an interventionalists could be available if patient needed it.  Report was given at 2100 upon my end of shift.