Age: 56.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19-2
Symptoms: Acute disseminated encephalomyelitis, Alanine aminotransferase normal, Albumin globulin ratio, Anion gap, Anti-aquaporin-4 antibody
Clinical narrative: Initial History: 11/19/2022 Patient is a 57 y.o. year old that the Neuro-Hospitalist service was asked by the attending provider to see for initial assessment of progressing quadriparesis, abnormal brain and cervical spine imaging.  Patient is a healthy 57-year-old who received her 4th COVID vaccination on Wed. October 26th.  Thirteen days later on November 8 she developed a funny sensation in her face that was hard to describe.  On October 10th she developed numbness in the face and hands and did go to an urgent care having negative workup.  Her symptoms continue to progress with weakness of the lower extremities greater than upper extremities, slurred speech, double vision.  She was able to follow up with her primary care provider earlier this week who had recommended MRI of the brain and cervical spine which patient reported to the outside hospital yesterday.  She reports to the hospital she has significant difficulty getting around, thus ended up going into the emergency room where she was found to have significant urinary retention and profound weakness of the lower extremities greater than upper extremities.  Since she had imaging already scheduled, they completed the brain MRI with and without contrast and C-spine MRI with and without contrast as ordered.  Studies revealed what appeared to be acute inflammation symmetrically in the lower brainstem and patchy in the upper cervical cord.  She was given a 1000 mg of IV Solu-Medrol and transferred for additional neurologic evaluation and treatment.  Since being admitted last night, she feels about the same today.  Still reporting his double vision which is mostly a side-by-side, slurred speech, weakness in arm and legs.  Interval History: 11/20/2022.  Following up for suspected acute disseminated encephalomyelitis following COVID-19 vaccination on 10/26/2022.  Patient is a 57-year-old transferred from outside facility on 11/18/2022 after she presented there for outpatient diagnostic imaging to include a brain MRI and C-spine MRI.  These studies revealed concern for acute disseminated encephalomyelitis patient was given a 1000 mg of IV Solu-Medrol and transferred to facility for additional evaluation and treatment.  She received her 2nd dose of IV Solu-Medrol yesterday 11/19/2022.  She denies any side effects from steroid therapy.  She denies any significant neuropathic pain or spasticity at this time.  She continues with an indwelling Foley catheter she presented also with he had neurogenic bladder and urinary retention.  She slept fairly well.  She is still unable to get up and ambulate without assistance.  Her legs are too weak.  She feels as if her diplopia and dysarthria may be improving.  She is comfortable with the diagnostic and treatment plan as outlined in reviewed once again with her today.  She will undergo a lumbar puncture tomorrow.  She will also undergo an MRI of the thoracic and lumbar spine to serve as a baseline and.  She will continue a daily IV Solu-Medrol x5 total days with her last day to be completed 11/22/2022.  11/21 - Still at facility Day 4 of 5 IV Solumedrol.  LP completed.  11/22 - Still at facility.  Day 5 of 5 IV solumedrol.   MRI T-spine and L-spine completed.  Considering Plasma Exchange