Age: 77.0
Sex: F
Vaccine: COVID19
Symptoms: Cerebellar ischaemia, Cerebrovascular accident, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal
Clinical narrative: Patient is a 77 y.o. female who presented from her Neurologist's office on 1/31/2023 for urgent work-up of progressive dyspnea. Initial concern for myasthenia crisis however NIF within goal on admission. CXR on admission with small amount of atelectasis vs scarring in the right lung base, with elevation of the right hemidiaphragm. She was started on steroids and antibiotics for concern for AECOPD. Respiratory panel significant for COVID positivity 2/01/23. Neurology was consulted and obtained and MR and MRA Brain 1/31 significant for acute lacunar infarct of left cerebellar hemisphere and chronic microvascular ischemic changes. The patient did not present with any neurologic deficits. She then had a CTA head 2/01 that revealed no evidence of flow significant stenosis and was started on lipitor 10mg daily. A CT chest was obtained 2/02/23 given a history of pulmonary nodules in th setting of shortness of breath that revealed indeterminate cystic-appearing lesions with soft tissue nodules particularly in the left upper lobe with a ground-glass density laterally in the left upper lobe. The patient remained stable without oxygen requirements and was recommended to follow up with her Neurologist and Pulmonologist. She is stable for discharge.   Comments/Problems to be Addressed after Discharge 1. Abnormal CT chest: Patient with history of lung nodules, CT chest on admission with cystic lesions of unclear etiology. Recommend follow up with Pulmonology and consideration of repeat imaging.  2. Myasthenia gravis: Recommend follow up with Neurology for outpatient steroid dosing titration   Dyspnea COVID-19 - Dyspnea likely due to COVID-19 infection. S/p 5-day course of prednisone and azithromycin for COPD exacerbation 1/04-1/09 - COVID-19 positive on respiratory PCR panel 2/01. CT chest 2/02 revealed indeterminate cystic-appearing lesions with soft tissue nodules particularly in the left upper lobe with a ground-glass density laterally in the left upper lobe - Discharge on prednisone 10mg as stated below. Encouraged to continue home quarantine until 2/06 even with symptom improvement. Follow up with Pulmonology for abnormal lung imaging   CVA - Etiology unclear, no acute neurologic deficits  - MR and MRA Brain 1/31 significant for acute lacunar infarct of left cerebellar hemisphere and chronic microvascular ischemic changes. CTA head 2/01 that revealed no evidence of flow significant stenosis. Echo 2/01 with EF 64%, s/p TAVR, mild LV hypertrophy - Neurology followed, recommend continuing home eliquis and ASA. Initiating Lipitor 10mg daily. Follow up with Neurology   Seronegative Myasthenia Gravis - Per history, follows with outpatient Neurology and Ophthalmology - Respiratory parameters within normal limits while admited - Neurology followed, recommends 10mg Prednisone PO daily   Abnormal Imaging - Previous chest imaging with indeterminate pulmonary nodules - Chest CT 2/02/2023 significant for indeterminate cystic-appearing lesions with soft tissue nodules particularly in the left upper lobe with a ground-glass density laterally in the left upper lobe, prominent right pulmonary artery likely associated with pulmonary HTN - Consider interval follow up imaging, follow up with Pulmonology