Age: 63.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Angiogram cerebral abnormal, Arteriogram carotid abnormal, Bell's palsy, Computerised tomogram head normal, Dysarthria
Clinical narrative: DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM:  Stroke-like symptoms [R29.90] HOSPITAL COURSE:  A 63 y.o. male who presented with chief complaint of left facial droop, left forehead droop and slurred speech.  Patient reports his symptoms started on Saturday and failed to improve.  He contacted his PCP and he was recommended to go to the ER for evaluation.  Patient had his COVID-19 vaccine-1st dose 2 weeks prior and was concerned that he might be having 1 of the rare side effects from the vaccine. On admission patient had normal vitals.  His labs were within normal limits.  Patient's presentation was discussed with Neurology who recommended admission for stroke workup given his comorbidities-hypertension, hyperlipidemia, diabetes and obesity.  Patient received 1 dose of prednisone 80 mg in the emergency department for treatment of Bell's palsy (patient's symptoms more consistent with Bell's palsy presentation).  Patient was admitted to medicine service for workup of stroke with MRI brain without contrast and monitoring for any worsening of neurological symptoms.  Patient's CT head on admission was negative for any acute abnormality.  CTA head and neck showed near occlusion of intracranial left vertebral artery.  MRI brain without contrast was negative for acute infarct.  Patient's facial paralysis slightly improved with 1 dose of 80 mg prednisone.  Patient's presentation was consistent with Bell's palsy.  Patient worked with PT OT and speech therapy and was recommended outpatient physical therapy and speech therapy.  He was discharged home in stable condition on oral prednisone 80 mg daily for 7 days and valacyclovir 1000 mg 3 times a day for 7 days.  Patient was recommended to follow-up with Ophthalmology as outpatient for possible left eye patch if his symptoms fail to improve.  Patient's Lipitor dose was increased to 40 mg daily from 10 mg daily due to finding of atherosclerotic changes on CT head and neck. Active Issues Requiring Follow-up Issue:  Bell's palsy and abnormal finding on CT head and neck. Recommended follow-up provider/specialty:  PCP What is needed: 1. Referral to Ophthalmology for an eye patch if symptoms fail to improve. 2. Referral to neurovascular surgery for CT head and neck findings.    63-year-old male with history of hypertension, hyperlipidemia and diabetes mellitus admitted for workup of stroke-like symptoms.         * Stroke-like symptoms Assessment & Plan Patient presented with left-sided facial droop, left forehead droop and slurred speech. - CT head on admission showed no acute intracranial process. - CTA head and Neck shows near occlusion of intracranial left vertebral artery.  Patient reports his symptoms started 3 days ago. Patient's presentation appears similar to Bell's palsy.  He received 80 mg of prednisone in the emergency department.  Patient's symptoms were discussed with stroke Neurology who recommended MRI brain without contrast to rule out possible stroke given his underlying comorbidities-hypertension, hyperlipidemia and obesity. Plan: - will obtain MRI brain w/o contrast. - Check A1c and Lipid profile - continue Aspirin and statin. - monitor on tele - Neurochecks q4h     Bell's palsy Assessment & Plan Patient has loss of left forehead wrinkles, left eyelid droop, droop of his left corner of the mouth. Patient's presentation more consistent with Bell's palsy. Patient reports that he had COVID 19 vaccine 2 weeks prior to developing symptoms and read it as one of the rare side effects online.  Patient received one dose of Prednisone 80 mg in the ED. Will continue with Prednisone taper until MRI results are back.  SLP ordered.  Patient advised on following with ophthalmology for eye patch.