Age: 39.0
Sex: F
Vaccine: COVID19
Symptoms: Motor dysfunction, Paraesthesia, Partial seizures, Postictal state, Sensory loss
Clinical narrative: Note this was a booster based on J&J given 6APR21 (Lot 041A21A). See additional info, but summary: New onset epilepsy 14 years after 2007 brain abscess and stroke s/p craniotomy with essentially full neurological recovery during the interval. Did self discontinue anticonvulsants (Klonopin, Topamax) > 10 years ago, but no interval seizures.  Resulted in 3 day hospitalization. Now having 3-4 partial seizures daily under the care of neurology. 39 year-old female with a PMH of left sided brain abscess and stroke in 2007 presenting ~ 2 weeks (onset 2/14/2022) after having a what was initially thought to be a left sided MCA stroke based on right-sided numbness and loss of motor function resulting in hemiparesis and hemianesthesia. While at work around 17:30 on 2/14/2022  she started feeling tingling/numbness in her right toe. Because she was seated, she tried repositioning her leg, but the symptoms progressed proximally until she could not feel or move or feel the entire right side of her body. At this time she also reports an expressive aphasia where she was either slurring her words or unable to speak, but understood other what was being said to her. She was evaluated in the emergency room where CT scan showed no acute intracranial hemorrhage/infraction/lesions/hydrocephalus/mid-line shift. She did have 4x2.6x4 cm area described as consistent with chronic left MCA infarction in the posterior frontal lobe from 2007. She was discharged without follow up with her PCP the following day. Instead, she was admitted to local hospital for 3 days (Feb 15-18, 2022) where she underwent EEG, labs, MRI brain, and neurology consultation that showed gliosis consistent with prior surgery and "sporadic irradiative focus in the right temporal region" on EEG. For the last month, she has had 3-4 seizures per day that cause right sided motor and sensory loss that are followed by a postictal state lasting 1-4 hours, but once up to 12 hours. She does not have loss of control of bowel or bladder function. Currently under the care of neurology taking Keppra to 1,000 mg BID and Vimpat 50 mg BID that are not controlling the seizure activity. For things that have changed in her life that could have led to the start of symptoms, she reports Having her 3rd child 4 months ago (Nov 2021) via uncomplicated vaginal delivery. Getting her COVID-19 booster ~1 month prior (1/12/2022); and returning from training and travel (~ 18 hours of flying) on 1/31/2022 and since that time she was "not feeling right" but cannot be any more specific in her description. In the middle of describing her history, she stated to her husband "one is coming." He stood up and maintained her airway as the right side of her body initially went limp, then started shaking in the hand and foot wither the patient's eyes rolling back in her head and the patient being unresponsive and unable to speak for 90 seconds. We maintained her airway and she recovered.  She appeared postictal for 10-15 minutes before completing her physical exam that had 4/5 strength on the right and hemianesthesia on the right side of the body including the right forehead.