Age: 41.0
Sex: M
Vaccine: COVID19
Symptoms: Angiogram cerebral normal, Angiogram pulmonary abnormal, Arteriogram carotid normal, Blood cholesterol increased, COVID-19
Clinical narrative: Narrative: PRINICIPAL DIAGNOSIS (Reason for admission after study): 1). Typical Migraines characterized by headache, visual impairment, paresthesia of the right face and hand 2). COVID-19 w/Viral Pneumonia 3). Neutropenia 4). Possible TIA 5). Hyperlipidemia the patient is a 40 y/o male with a PMH of CAD and sarcoidosis who presented to ED complaining of neurological changes. The patient states that when he woke up this morning he noted blurry vision, right-sided facial numbness, confusion, and slurred speech. He states that when he went to work he had difficulty spelling and speaking. The patient states that his last known normal was at approximately 12:30AM this morning. He denies overt weakness, ataxia, and coordination difficulties. He states he has been vaccinated against COVID-19. Upon arrival in the ED the patient was found to be COVID-19 positive. CTA of head and neck showed No significant cervical or intracranial vascular disease and biapical parenchymal opacities concerning for pneumonia. WBC was 2.7. presented with blurry vision, right-sided facial numbness, confusion, and slurred speech after waking up. His head/neck CTA was unremarkable except for lungs, apical opacities c/w pneumonia. He is COVID-19 (+) which he is asymptomatic after getting his COVID vaccination. He was seen by Neurology today and he feels his symptoms are c/w Typical Migraines. He admits to being back to baseline except for slight slurred speech. He will be d/c'ed home with home quarantine x 10 days per guidelines. ASSESSMENT/RECOMMENDATIONS: Patient had one of his typical migraines characterized by headache, visual impairment, paresthesia of the right face and hand; all of the symptoms have resolved at this stage. He takes Topiramate 100 mg prn for acute headache, which can cause transient difficulty with attention/focusing, and for word finding. TIA would be less likely for the given presentation. Discussed at length with him. He has been advised against taking Topiramate on prn basis, the medicine is for migraine prophylaxis, either he should take it daily or avoid using it. If he decides to take it every day, then it should be started at 25 mg qhs and gradually increased to 100 mg daily over the span of few weeks. ASSESSMENT/PLAN: COVID-19 Pneumonia Neutropenia - Imaging showed biapical parenchymal opacities concerning for pneumonia - The patient does not require supplemental oxygen - Discussed risks and benefits of convalescent plasma and remdesivir; the patient declines both of these therapies - COVID severity is currently mild; consider dexamethasone if condition worsens - Albuterol PRN Possible TIA Possible neurologic sequalea of viral infection - CTA of head and neck showed no significant cervical or intracranial vascular disease Hx of sarcoidosis Hx of CAD Hx of systolic heart failure last ECHO, 5/1/19-EF 30-35%, -pacemaker placement - Continue atorvastatin 40mg daily - Continue sotalol 40mg BID Hyperlipidemia: -Chol/LDL 200/128 - Restart Atorvastatin 40mg qhs, possible noncompliant