Age: 35.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Angiogram cerebral normal, Anti-cyclic citrullinated peptide antibody negative, Antinuclear antibody positive, Antithrombin III, Arteriogram carotid normal
Clinical narrative: 35 YF with h/o hemochromatosis and leukopenia, admitted 1/3/22 with acute, cryptogenic multifocal CVA 3 weeks after booster wtih Pfizer COVID-19 Vaccine. Received Moderna for first 2 doses, and Pfizer 3 weeks ago. Now w/ unexpected VA for age and comorbidities.   Excerpt from Neurology Consultation which includes this statement "The etiology of these infarcts remains unclear."  on January 03, 2022  REASON FOR CONSULTATION:  Right-sided paresthesias.  HISTORY OF PRESENT ILLNESS:  Patient is a 35-year-old woman.  She has a past medical history significant for hemochromatosis and she is apparently homozygous for this and sees her oncologist, on a regular basis.  She donates blood several times per year and monitors her iron and ferritin levels. She presents to the hospital with a sudden onset of headache associated with right-sided paresthesias. She was sitting at her computer at approximately 1700 hours yesterday 1/2/22 when she developed a sudden onset of left orbital headache.  This was associated with photophobia and phonophobia.  She also noticed some blurring on the right side of her vision and also noticed numbness on her right face, arm, and leg.  She went to a dark room and laid down. She has also felt photophobia. Her headache started to resolve after that and now has essentially resolved; however, her right-sided paresthesias continued. She woke up this morning with continued paresthesias.  She talked to her neighbor who is a nurse, as well as her father-in-law who is a physician.  They recommended that she come to the emergency department for further evaluation. She did not have any drooping of her face or any slurring of her speech, no diplopia, no vertigo, no difficulty with balance or coordination. She has never had similar symptoms in the past.  She does not have a history of migraine headaches.  She occasionally will get headaches that she has attributed to tension.  She has never had any paresthesias in the past.  She does not have a diagnosis of multiple sclerosis. She is fully vaccinated against COVID-19 and got her booster less than a month ago. Over the last few days, she has been experiencing a cough, as well as sinus congestion and body aches.  She has been tested for COVID twice and both tests have been negative.  IMPRESSION:  1. Acute ischemic infarcts, left thalamus, left temporal lobe. 2. Right-sided paresthesias. 3. Headache, now resolved. 4. Hemochromatosis.  PLAN:  I spoke with patient. ..  She has 2 small areas of restricted diffusion which are consistent with ischemia.  It is possible that these ischemic events are embolic in etiology.  Her vessels are unremarkable.  There is no evidence of vasospasm or dissection noted on CT angiogram. **The etiology of these infarcts remains unclear. - I would recommend that she be admitted to the hospital for additional workup.  I have recommended a transthoracic echocardiogram.  I think she will also need a transesophageal echocardiogram.  I will recommend dual-antiplatelet therapy with aspirin 81 mg daily, plus Plavix 75 mg daily for a period of 21 days.  After 21 days, she can be transitioned to aspirin monotherapy.  I will also monitor her on telemetry.  If no evidence of arrhythmias are found on telemetry, she may need event monitor or a loop recorder.  I think she will also benefit from a hypercoagulable panel which can be performed as an outpatient after more time has passed from her thrombotic event.  She will be evaluated by PT, OT, as well as Speech Therapy.     1/4/22 Discharge Note Discharge Disposition  Home. Discharge Condition  Stable, improved Patient Instructions  You have had a small stroke, likely from a pretty rare condition called Lambl Excresences on one of your heart valves...