Age: 46.0
Sex: F
Vaccine: COVID19-2
Symptoms: Tricuspid valve incompetence, Troponin normal, Viral infection
Clinical narrative: 1) onset of symptoms Tues pm (3d ago) was reading in bed - suddenly realized she was re-reading the same info over and over and having trouble processing contents of book. Informed her husband that "something was off." Suddenly became "barely functioning." Speaking slowly because she was having trouble getting her words to form; husband agrees she was speaking slowly but to him her speech did not seem as "slothlike" as it seemed to her.  2) severe symptoms x 10 min Husb moved her to bathroom and called EMS Lost equilibrium - slumping off to left side repeatedly Severe nausea - did not vomit Stomach roiling - thought she was going to have BM So weak she could not stand - husband had to support her She thought she had passed out at one point but comparing notes w husb he said she was talking/awake the whole time. By the time paramedics were taking her out of home she had developed some left sided neck/head pain  3) moderate symptoms  Could walk by the time ambulance arrived at the hospital, but did not feel she had complete cognitive function back - still felt "slow" Able to cooperate w intake eval "but I knew I would never have been able to answer the stroke screening questions if they had asked them of me in my bathroom."  4) resolving symptoms. She has read ER notes and says, despite the ER report stating she was back to baseline at time of discharge, she did not feel fully back to normal. Did not have speech difficulty and was able to maintain her posture, but still felt mentally slow and generally weak.  Today: Normal vision, hearing, speech, swallowing, no focal numbness tingling or weakness. +feeling exhausted all over w a mild sense of malaise + L sided head/neck pain No sense of CP, palpitations, sob, or GI symptoms since leaving ER. Had normal BM (never had the diarrhea that stomach cramps led her to believe she was going to have). No urinary symptoms. L sided eye/temple twitch has not recurred since prior to ER visit.  States the past several months have been very stressful in her home health-wise. Husb is disabled vet and requires a lot of assistance from her. Extended and severe respiratory illnesses for all three of them (husb, 5yo son) and they pulled him from K because they felt it was source of infection for household - she is now homeschooling him in addition to caring for husb and FT work.  Did not do PHQ9 but asked her about mood - she does not feel depressed, and feels any mood issues she is having are in proportion to the life stressors.  No prior h/o migraines.  I obtained/reviewed the ER notes, imaging, labs, etc: 1/25/2023 Dr. in ER for altered mental status, transient difficulty speaking, walking  cxr: B perihilar peribronchial cuffing (asthma v viral illness)  Echo EF 60-65%, nl LVSF, nl diast filling, no wall motion abnl, mild TR,  MRI brain wo: nl brain; partial opac posterior ethmoid cells, mucosal swelling inf max sinuses  CTA head/neck: nl brain parench, min sinus dz. No stenosis, dissection or occlusion of CCA, ICA, vertebr art, ant cerebral art, mid cer art, post cer art, basilar art; no venous sinus thrombosis, nl soft tissues, bones. Min DJD c-spine.  EKG: NSR 72 bpm, nl, unchanged  Labs: troponin neg x 2  CBC nl  CMP w glu 113,  Mg 1.8  lipase 40  drug screen: pos for THC (cutoff 50 ng/ml), neg phencyclidne, cocaine, meth, opiates, amphet, bdz, tricyclic, methadone, barbit,  PCR SARS/flu/RSV all neg  Discharged home w Fioricet 50-325 q4h prn #30, asa 81 mg daily.