Age: 60.0
Sex: F
Vaccine: COVID19
Symptoms: Aphasia, CSF immunoglobulin increased, CSF oligoclonal band, Cognitive disorder, Condition aggravated
Clinical narrative: Acute demyelination disease - Around mid April, noted a gradual onset of brain fog but got to the point that she was able to do her typical tasks at work. At first she thought is was from stress from the taxes. But this was progressive over 2-3 days and that she started to feel like she was on a boat and rocking but was walking fine. She does think she was having trouble with words or cognition at that time and thinks she was having mild issues starting at the beginning of April. . She was also having trouble with scalp tingling as well tingling of her feet. The MRI showed likely acute demyelination and so she was admitted and she received an LP that showed this was likely a Sjogrens flare rather than a new onset of MS. Not sure that the entire report is back as several markers are nor reported on, including ones related to sjogrens. But she did have oligoclonal bands and elevate IgG levels both of which can point to MS but also Acute disseminated encephalomyelitis which can happen with vaccines. There is one case report thus far with the COVID vaccine which she had in January and February. She was treated with 5 days of iv steroid infusion. She is not sure it helped except that the tingling resolved. She still feels that she is rocking and with brain fog. She followed up with Dr, Neuro a few days ago. He was concerned about acute prednisone withdrawal so he put her on a taper that just started yesterday. He thinks it is not MS but likely Sjogrens. She has a Rheum follow up in 3 weeks but was unable to find any one who could see her sooner. She also has an appointment but not until September.  This was too long to wait, so  she went to her PCP who helped her get to the Sjogrens center. They got her right in and she was assessed by the head of the department. He ordered repeat imaging of the head. Based upon the results, she was called by Neurology who admitted her directly for plasmapheresis therapy. Was told it is not Sjorgens but they are not sure what it it. She has another spinal tap and another MRI. They also wanted a biopsy but she refused. They ruled out lymphoma as much as they could without the biopsy. So they started plasmapheresis (PLEX) and she did just complete the 5th one and now the team is meeting to determine the next step. She also got high dose solumedrol when she was in patient. Notes that she is feeling better since then. She has been out of the hospital for about a week. Since the 5th PLEX treatment, she does not feel as wobbly and she is able to do more around the house. She no longer feels like she is rocking internally but still needs to steady herself. But cannot move quick or she would fall. She also notes that she has no stamina. But notes that multi-step tasks are very hard to complete. For example, she has made jam for as long as she can remember. She was not able to do and her husband had to finish it. Does not feel able to drive and feels that she is not cognitively capable of working as a nurse right now. She is currently on short term disability. She is supposed to hear back from the team as to what her next steps will be once they meet again as her last scheduled treatment today. Is still seeing acupuncture and it is helping.   After the 5 PLEX treatments, the patient continues to note slowed cognition with persistent trouble with memory.  There is no further treatment other to see what time does.