Age: 88.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: CSF protein increased, CSF red blood cell count positive, CSF white blood cell count increased, Cognitive disorder, Computerised tomogram
Clinical narrative: PT. HAD MILD REACTION TO SHOTS (SORENESS IN ARM AND SOME ACHES AND FATIGUE) ON FEB 3 AND MARCH 10, 2021. APPROX. 6.5 MONTHS LATER ON AUG 25, SHE BECAME MILDLY ILL WITH COMMON COLD AND FLU SYMPTOMS. She had a very adverse reaction to her blood pressure med (losartan aka COZAAR) on 8-29-21 and WAS TAKEN TO HER LOCAL DOCTOR EARLY THE NEXT MORNING. THEY TOLD HER TO GO TO A AFFILIATED CLINIC FOR COVID TESTING, BUT BY THAT TIME HER CONDITION HAD DETERIORATED SIGNIFICANTLY AND THE CLINIC RECOMMENDED SHE GO TO THE ER IMMEDIATELY. The ER doc quickly determined that she had A UTI and her sodium levels were extremely low, AND THEY SCHEDULED A CT SCAN FOR LATER THAT AFTERNOON ANOTHER ONE THE FOLLOWING DAY WHICH DOCTORS EVALUATED AND THOUGHT COULD HAVE BEEN A STROKE. HOWEVER, HER NEUROLOGIST WAS RELUCTANT TO MAKE THAT DIAGNOSIS UNTIL FURTHER TESTING AND ANALYSIS COULD BE DONE. HE ACTUALLY INITIALLY DIAGNOSED HER ILLNESS ON AS HERPES ENCEPHALITIS ON THE RIGHT LOBE ON SEPT. 2ND,  BUT STILL CONDUCTED FURTHER TESTING (MRI'S, CT SCANS, LUMBAR PUNCTURES, ETC.) UNTIL HIS FINAL DETERMINATION OF HERPES ENCEPHALITIS. HE HAD PUT HER ON THE ANTI-VIRAL valACYclovir HCl (1000 MG) EARLY ON HER 1ST HOSPITALIZATION. HER CONDITI0N WORSENED SIGNIFICANTLY ON BETWEEN AUGUST 31ST AND WHEN SHE STARTED PULLING OUT OF A DEEP SLEEP ON SEPT 2ND. HER COGNITIVE AND MOTOR SKILLS IMPROVED OVER THE NEXT WEEK AND SHE WAS DISCHARGED ON SEPT 10. JUST PROR TO THE DISCHARGE, A DOCTOR EVALUATED HER AND NOTED SOME SWELLING IN HER LEFT LEG. THEY DID A ULTRASOUND AND FOUND A SMALL BLOOD CLOT BEHIND HER KNEE. THEY PUT HER ON A BLOOD THINNER (ELOQUIS). SHE WAS AT HOME FOR THE NEXT 2 DAYS AND HER CONDITION WORSENED SUDDENLY AGAIN (GETTING UP TO URINATE ON THE HOUR ALL NIGHT AND COMPLAINING OF BACK AND LEG PAIN). ON THE MORNING OF SEPT 13, SHE RETURNED TO THE ER AND THEY CONDUCTED FURTHER TESTS AND MOVED HER INTO ANOTHER HOSPITAL ROOM. THE NEXT NIGHT AT 5:30 PM, SHE HAD A 5-MIN SEIZURE WITH FOAMING,  SHAKING AND BIT HER LIP. THEY IMMEDIATELY PUT HER ON KEPPRA AND SHE WAS STABLE BUT HER CONDITION CONTINUED TO WORSEN OVER THE NEXT WEEK AND THEN SHE STARTED SLOWLY RECOVER REGAINING HER MOTOR AND COGNITIVE SKILLS. DOCTORS CONTINUED TO PERFORM A NUMBER OF TESTS AND CONTINUALLY EVALUATE AND RE-EVALUATE HER CONDITION. Repeat spinal tap was done on 09/21/2021. CSF findings were after a week of anti viral/anti microbial therapy. CSF WBC count 38, red cell count 6625; lymphocytes 39%, eosinophils 36%. CSF glucose was 40, CSF protein 249. CSF HSV PCR again negative. CSF cytology negative for malignancy or viral inclusions. As indicated previously BY THE DOCTOR, a negative HSV PCR on treatment does not rule out herpes encephalitis, and definitely cannot rule in HSV encephalitis. THE DOCTOR EXPECTED a significant response to treatment after 10 days of IV acyclovir. Pt. improved after four days and plateaued over the NEXT week (neither better nor worse). DR RECOMMENDED continued speech therapy occupational therapy and physical therapy. 0N SEPT 30, Dr indicated they could cut THE KEPPRA dosage in half. He indicated that since all test results were in except for 2 of the Auto Immune (which he believed would also be negative), her recovery would be long but told us to continue to encourage her, stimulate both her mind and emotions, and be patient with the process. OVER THE NEXT WEEK (TO OCT 4), gradual progress day to day with slightly increased appetite, awareness, clearer speech n cognition. SHE HAD STILL BEEN sleeping much, but WAS STAYING awake for 3-4 hours. HER NEUROLOGIST RECOMMENDED THAT SHE BE TRANSFERRED TO A LOCAL ACUTE REHAB HOSPITAL / REHAB FACILITY SPECIFICALLY FOR PATIENTS WITH NEUROLOGICAL ISSUES, BUT SHE WAS DENIED 3X. THE HOSPITAL SET A DISCHARGE FOR OCT 6 FOR PT. TO BE TRANSFERRED to A LOCAL REHAB facility SINCE HER AM-PAC SCORES WERE LOW (Basic ADL and Instrumental ADL) SCORES WERE: Total Raw Score (Calculated): 6 AND t-Scale Score (Calculated): 17.07.    ON OCT 6, 2021, PT. WAS DISCHARGED. DESPITE HAVING 2 FALLS AND 2 ER VISITS WITHIN THE 1ST 30 DAYS, SHE IMPROVED HER COGNITIVE AND MOTOR SKILLS SIGNIFICANTLY OVER THE NEXT 10 WEEKS. SHE TESTED POSITIVE FOR COVID ON DEC 10 AND WAS PUT INTO AN ISOLATED WING OF THE FACILITY ALL BY HERSELF. HER MILD COVID SYMPTOMS (RUNNY NOSE AND SLIGHT COUGH) DISSIPATED WITHIN 36 HOURS, BUT HER CONDITION SEEMED TO GET WORSE BECAUSE OF THE ISOLATION AND LACK OF SOCIAL INTERACTION. SHE WAS PULLED OUT OF THE REHAB FACILITY ON DEC 17 AND TRANSFERED INTO HOMECARE UNTIL DEC 31 WHERE SHE SEEMED STABLE WITH COGNITIVE AND MOTOR SKILLS. SHE ENTERED AN ASSISTED LIVING HOME ON JAN 2, 2022 AND HER CONDITION REMAINS SOMEWHAT STABLE EXCEPT FOR PERIODS OF PRE-DEMENTIA (STRUGGLING WITH SOME MEMORY ISSUES AND CONFUSED WITH HER SURROUNDINGS).