Age: 71.0
Sex: F
Vaccine: COVID19
Symptoms: Aphasia, Arteriogram carotid abnormal, Asthenia, Blood creatinine normal, Blood culture negative
Clinical narrative: Follow-up and final report: Patient was admitted to the hospital on the morning of 11/20/2022. That morning, patient's spouse noticed a change in her neurological status and weakness. Spouse called EMS. In the ED she was noted to have right facial droop, right-sided weakness. Aphasia. Imaging revealed an acute CVA. Patient was initially diagnosed with acute ischemic stroke and sepsis. Sepsis criteria for tachycardia, tachypnea, and elevated WBC count. CT negative for hemorrhage. CTA revealed L ICA occlusion with partial thrombosis of terminal segment and occlusion of L M3. TNK not administered, patient out of the treatment window. Thrombectomy not performed, imaging negative for large vessel occlusion. HEAD CT: No intracranial hemorrhage, mass, or definite CT evidence of recent ischemia. Head CTA: the left internal carotid artery is occluded proximally through most of its intracranial course with partial thrombosis of the terminal segment, there is occlusion of a distal M2 branch of the left middle cerebral artery. NECK CTA: 1) The left internal carotid artery is occluded shortly after its origin. This is suspected to be atherosclerotic in origin. 2) Minor right carotid artery atherosclerosis without significant narrowing. 3) Patent vertebral arteries. Neurology consulted in the ED and evaluated patient. Imaging revealed left internal carotid artery is occluded proximally through most of its intracranial course with partial thrombosis of the terminal segment. There is occlusion of a distal M2 branch of the left middle cerebral artery. The left internal carotid artery is occluded shortly after its origin. This is suspected to be atherosclerotic in origin. Minor right carotid artery atherosclerosis without significant narrowing. Patent vertebral arteries. Patient was not a candidate for TNK or thrombectomy. There was concern for sepsis with tachycardia, tachypnea, and elevated WBC. Patient with known history of recurrent UTIs, ESBL in the past. ID consulted with concern for sepsis, unclear etiology and patient with complicated history. As of 11/29/22, WBS had come down since initial levels seen at admission. Infectious disease recommended continuing meropenem for total of 7 days, then restarting patient's prior to admission suppressive therapy with ciprofloxacin 500 mg p.o daily. Patient completed a course of meropenem. Additional treatment provided included Aspirin 325 mg daily per neurology and Simvastatin 20 mg daily. On 11/22/2022, electrolyte abnormalities were noted. Nasogastric Tube was placed on 11/23/22 for tube feedings. PICC line placed per IR on 11/24/2022. Patient had minimal improvement--unable to communicate with severe aphasia and significant right-sided hemiparesis. Patient had difficulty swallowing. Patient was also noted to have Metabolic acidosis (she is chronically below normal but not to the degree while in this admission). Hypomagnesemia, Hypokalemia, and Hypophosphatemia. NG tube was removed. Patient was discharged to hospice care on 12/1/2022. All medications were discontinued--only blood glucose meter was discharged with patient to their hospice facility. On January 5, 2023, research team received a notification regarding patient. Patient's date of death was 12/5/22. Cause of death: Cerebrovascular disease ? Stroke. Patient received the Janssen Ad26.CoV2.S Vaccine on 10/17/2022. Per, this event is unrelated to the Janssen Ad26.CoV2.S vaccination that was administered 10/17/2022.