Age: 45.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase increased, Amphetamines negative, Angina pectoris, Angiogram cerebral normal, Arachnoid cyst
Clinical narrative: Patient reports onset of symptoms after first vaccine 07SEP.  Kept a log of symptoms in his phone. Notes that he was forced to receive vaccine. Recorded sx to include: "ear ringing, hearing loss, dizziness, mood fatigue, fatigue, sometimes sounds funny". 18Sep recorded "heart flutters while running, off balance, front of brain fuzzy, memory loss." 05OCT received second vaccination, recorded "Ringing in ear again, headache, front of brain feels numb, hard to focus, wife dropped off at hospital, heart flutters 1-2 min, show speaking, lost some feeling on left side of body, tremble shaking."   Patient was evaluated at that time w/ CBC, CMP, CK, TSH, troponin, phos,  mag, UA, UDS.  CT head, CTA head,  CTA neck performed w/o any abnormalities. All labs were WNL besides mildly elevated liver enzymes.  EKG w/o any remarkable findings. Patient instructed to f/u with his PA.  Had an appt with his PA this AM - afterwards noted "0915 numbness on L side of face, dull pain L chest, shot down arm (lasted 1 minute), subsided on its own. While in the waiting room had heartaches." Presented a second time to the ED.  Upon further clarification - pt describes chest pain sx as a dull feeling in his L chest w/o associated nausea, diaphoresis, SOB or difficulty breathing. Lasted less that 1 min, not exertional. Describes numbness as "like goosebumps or when your foot goes numb."   Currently has a headache, now 4-5/10 located at the center of his forehead. Has not taken any pain medications for this.  No fevers/chills, nausea/vomiting, no weight loss or BM changes, no SOB, no abdominal pain. Feels like he's had "slight inflammation" - has seasonal allergies. Felt lightheaded a few times while standing up quickly from a squat or sitting, no syncope/presyncope, no rashes/sores, no weakness.  Neuro exam: CN2-12 intact. Does note decreased sensation (50%) in L side of face in opthalmic, maxillary, and mandibular distributions of trigeminal nerve. Motor fxn of trigeminal nerve is symmetric.  Strength symmetric in face and bilateral upper and lower extremities. Sensation decreased in LUE and LLE (50%) compared to right. Normal gait. No cerebellar signs.   Patient is a 45 y/o M w/ left-sided weakness and numbness after COVID vaccine 2 days ago, endorsing similar sx after first dose in early September.  Presented initally 05OCT, CT head, CTA head, CTA neck nml. Symptoms concerning for stroke vs. TIA vs. brain lesion. ABCD2 score of 3 (elevated BP, long duration of numbness), low risk of stroke. NIHSS of 1. Patient has had many brief, transient symptoms since receiving first dose of Pfizer vaccine.  Symptoms appear to vary in terms of character, temporality, and severity. CT head, CTA head, CTA neck, MRI head were performed, no e/o vascular injury, infarction, or stenosis. No brain lesions or inflammatory changes. Patient w/ unremarkable labs and otherwise healthy. Does have unilateral decrease in sensation in left face, arm, and leg on exam which are not readily explained given imaging and otherwise unremarkable exam. Chest pain not consistent with angina, normal EKG and troponins negative. With very low likelihood of ischemic event, patient can discharge home w/ f/u with his PA (has an appt this Tuesday).  Neurology consult was placed to further evaluate decreased sensation in left face and left arm/leg.