Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Magnetic resonance imaging head abnormal, Magnetic resonance imaging spinal, Muscle spasms, Pain, Paraesthesia
Clinical narrative: PT is a 16-year-old female with a history of dysmenorrhea and dyslexia who is otherwise healthy, and is presenting after various neurologic symptoms after second Covid vaccine on 6/9/21.  PT was in her usual state of health until she had her second Covid vaccine on June 9 around 2:30 PM.  She reported that initially about 10 to 15 minutes after the vaccine she began experiencing a headache and blurry vision.  However this resolved after 10 to 15 minutes of resting, and patient did not think much of it at the time.  She thought it was likely either due to dizziness or to anxiety around the shot.  For the rest of the day she felt like her typical self.  On June 10 she woke up feeling normal and went to school.  Around 1:30 PM she began experiencing a severe headache that she described as pounding.  She did feel like this was the worst headache of her life and rated it about a 7 out of 10.  This headache continued and she began experiencing also some numbness and tingling in her right thumb that then spread to her hand.  During the symptoms she suddenly had an episode of abnormal speech.  She was attempting to talk to friends when she began and having difficulties forming words.  She remembers being able to think logically and could think about what sentence she wanted to say, but when she tried to speak the words came out as nonsensical sounds.  Eve was confused and scared by this and immediately went to the school nurse.  This lasted for about 2 minutes where she was having complete aphasia.  The school nurse monitored her and suspected she was having a panic attack.  After 2 minutes she began being able to form words properly but was still having difficulty forming sentences that were sense of call in finding words.  This lasted for about 10 minutes, and then patient returned back to baseline.  School nurse called mom and mom picked patient up and immediately took her to the pediatrician.  Pediatrician saw her about an hour after this episode and by the time they examined her she was completely back to her baseline.  Pediatrician then referred her to neurology.   Since this episode on June 10 pt has experienced intermittent symptoms including: Periodic headaches, numbness and tingling of right forearm and thumb, muscle cramping and pain.  She has not had any further events of blurry vision or aphasia.  She has not had any weakness or clumsiness.  She has been able to engage in normal life activities.  However her intermittent symptoms have persisted and have been concerning to family.  She was seen by neurology outpatient on June 11 who evaluated her and at that time suspected that her vaccine may have triggered a hemiplegic migraine.  They recommended brain MRI to rule out other intracranial abnormalities.  Family was waiting for this MRI but her symptoms were continuing and were concerning to family.  Today on June 14, Eve was experiencing muscle cramping in bilateral lower extremities and upper extremities and continuing to experiencing numbness and tingling of bilateral forearms and thumbs intermittently.  The pain from cramping was more severe today than prior days, and because of this family felt more comfortable presenting to the ED for further evaluation and not waiting for outpatient MR.   PT has never had a blood clot or bleeding disorder that family is aware of.  She does take OCPs.  There is no family history of blood clots or strokes.  She otherwise has been well.  She has been afebrile emesis, diarrhea, URI symptoms, abdominal pain.  Briefly, 16yoF otherwise generally healthy who p/w persistent HA and paraesthesias following 2nd COVID vaccine. Initially evaluated on Monday this week by Neuro who recommended outpt brain imaging, but presented tonight due to persistence of symptoms. Has been neurologically intact here, asymptomatic aside from mild HA that resolved with tylenol. Labs wnl. Neuro consulted in the ED, ddx cerebral venous sinus thrombosis vs. post-vaccine GBS vs. COVID vaccine-associated neuropathy. MRI/MRV brain w/ contrast and MRI entire spine w/ contrast revealed "Punctate principally bifrontal T2/FLAIR hyperintensities, of indeterminate significance at this point in time. This could relate to demyelination, migraine, or be nonspecific. Follow-up MRI may clarify as clinically desired. No evidence of prior or acute ischemic insult. Unremarkable intracranial MRV. No cerebral venous thrombosis. No significant abnormality seen of the spine." Per Neurology, these lesions are not in a pattern that would be consistent w/ MS, and more likely represent an incidental finding with no correlate on neurologic exam. They recommend follow-up MRI in 6 mos to 1 yr to evaluate for any interval change. They will also continue to follow her for headache management as needed. Discussed this plan with patient and family and they expressed understanding and agreement with this plan for discharge and follow-up. Patient was discharged to home in stable condition.