Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Metabolic function test, Metabolic function test abnormal, Mucosal hypertrophy, NIH stroke scale score increased, Neurological examination
Clinical narrative: Hospitalized /Observation status (11.15.21 - 11/16/21); COVID-19 positive (11.12.21); Fully vaccinated     Pre-Existing Active Problems   Diagnosis Date Noted POA ? Presence of Watchman left atrial appendage closure device 07/12/2019 Unknown ? Ankylosing spondylitis (HCC) 02/03/2020 Unknown ? History of transient ischemic attack (TIA) 10/30/2019 Unknown ? Elevated liver enzymes   Unknown ? Post concussion syndrome 06/26/2019 Unknown ? Venous insufficiency of both lower extremities   Unknown ? History of motor vehicle accident - 10/29/18 10/29/2018 Unknown ? COPD (chronic obstructive pulmonary disease) (HCC) 06/06/2018 Unknown ? Iron deficiency - De novo after the addition of coumadin 11/05/2017 Unknown ? Calcification of abdominal aorta - without AAA - (HCC) 11/03/2017 Unknown ? Asthma   Unknown ? Morbid obesity with body mass index of 50 or higher (HCC)   Unknown ? Diabetes mellitus, type II (HCC)   Unknown ? Nonischemic cardiomyopathy (HCC)   Unknown ? Left bundle branch block   Unknown ? Chronic combined systolic and diastolic congestive heart failure (HCC)   Unknown ? Coronary artery disease with angina pectoris (HCC)   Unknown ? Hx of Bell's palsy   Unknown ? OSA on CPAP   Unknown ? Hyperlipidemia   Unknown ? Fatty liver   Unknown ? HTN (hypertension)   Unknown   Assessment/Plan    ASSESSMENT / PLAN:   1. Right facial numbness: resolved ? Bells palsy ? TIA ? Anxiety     NIH Stroke scale is 1.      MRI brain - No infarct     Lipid levels and A1C Pending.     Neurology following     Neuro checks q4hours     Admit as obs. On asa and statin. 2. COVID 19 Infection: On room air.     Symptom onset 3 days ago.       Tested positive 11/12/2021          Fully vaccinated.     D/W Monoclonal antibody team - patient will be a candidate. He is consented and MAB is ordered. 3. COPD: Stable. Continue home inhalers. Not needing oxygen. 4. Type 2 Diabetes Mellitus: 24 hour corrective insulin and await a1c. 5. H/o Atrial Fibrillation: s/p cardioversion in the past. Has a watchman device. On amiodarone and asa. 6. H/o Coronary Artery Disease: On asa, betablocker and acei. Stable. 7. H/o CHF: Systolic and diastolic: EF: 45% on a recent echo in 9/2021. On asa, betablocker and acei. Stable. Compensated. 8. Depression: On Zoloft and Effexor. 9.h/o Hypertension: On metoprolol and lisinopril. 10: h/o PFO   11. H/o Hyperlipidemia: On Zetia and Crestor. Continue.   Full code Heparin Sub q Diabetic Diet. Likely could be discharged tomorrow morning if stable.  Hospital Course Patient is a 74 y.o. male patient who originally presented to the hospital on 11/15/2021 with history of type 2 diabetes, TIA, triple agent, Bell's palsy, chronic obstructive pulmonary disease.  Presented with left-sided facial numbness.  He also has been recently tested for COVID due to family members with COVID symptoms.  Patient tested positive on 11/12.  He has been very anxious since he tested positive.  The patient is fully vaccinated.   Patient came to emergency department with hand left-sided facial numbness.  Someone thought he might have facial weakness but by the time he was seen in the emergency department, no facial weakness was noted.  Full neurological exam was normal.  NIH stroke scale was 1. CT of the head and MRI brain were negative for stroke.  Symptoms thought to be likely due to his Bell's palsy or anxiety.   Patient did received monoclonal antibody for his COVID infection.  He will be discharged to home today as he is back to his baseline.     Consultations During Hospital Stay: Neurology   REASON FOR CONSULT: Signs and symptoms of acute stroke     ASSESSMENT/PLAN: Patient is a 74 y.o. male with a history of Afib s/p Watchman device, HTN, HLD, T2DM, OSA on CPAP, Bell's Palsy with residual left facial droop, CHF, Asthma, Anemia, COPD and TIA who was recently diagnosed with COVID-19 on 11/12/2021. He presents to the ED on 11/15/2021 after developing sudden onset right facial droop and right facial numbness. LKW 11:00am, initial NIHSS 1.   Transient right facial droop Transient right facial numbness Symptoms completely resolved shortly after arrival to the ED. Given hypercoagulable state in the setting of COVID-19 infection, TIA is of high concern. Known Afib with watchman in place. With Echo completed within the past 3 months (9/7/2021), no need to repeat at this time. Plan: - MRI Brain without contrast - Daily NIHSS until stroke ruled out with MRI - Lipid Panel and A1c pending - Cardiac telemetry - q4hr Neuro checks - NPO until Bedside Swallow - PT/OT/SLP The above information was discussed with my attending physician.  Please see their attestation for further information.