Age: 61.0
Sex: F
Vaccine: COVID19
Symptoms: Facial paralysis, Implantable cardiac monitor insertion, Intensive care, Laboratory test, Magnetic resonance imaging
Clinical narrative: ADVERSE EVENT: PRT MCA Embolic Stroke (on 11/17/2021) RT small SAH (upon hospital discharge on 11/22/2021). TREATMENT: Received IV blood thinners and underwent thrombectomy. CT showed a small bleed. Monitored off antiplatelets and anticoagulants. CT was repeated. Underwent placement of loop recorder to monitor for any irregular rhythm of the heart. OUTCOME: After this stroke, I am experiencing memory loss and confusion. Still difficult to keep my balance.  A detailed description of this life-threatening AE can be found on the "Continuation Page". A week prior to the AE I felt some palpitations...like tachycardia but didn't pay much attention to it. On 11/17/2021 (WEDNESDAY) Around 7:30 pm just before a board meeting at our community, my wife who was standing in front of me noticed how I abruptly lost my balance, leaning towards my left side. (This is seeing on the surveillance video camera of the clubhouse where the meeting was going to take place).  She described me having slurred speech, left facial droop, left hand weakness and pale appearance.  She sat me on a chair, took off my mask and immediately proceeded to have someone call 911. In the meantime, she continued to attend me, holding my head, asking me questions, and even tapping some cold water in my forehead and back of the neck. Close to 10 or 15 minutes, the paramedics (EMS) arrived.  After a quick evaluation, they transported me as "stroke alert" (ASPHASIA) to the Hospital (Emergency Room). (Close to 20 minutes distance).  A CTA head and neck was done which indeed showed a 5 mm clot in my brain.  Alteplase was administered at 8:25 pm after consulting with us (me and my wife) the risks and benefits.  We also consented to a mechanical thrombectomy. After this procedure I was then admitted to the ICU for a period of three days, where medical staff and personnel continued to run all kinds of tests including speech and memory therapy.  Following days on the ICU unit included MRI, repeat CT brain which showed a small amount of subarachnoid hemorrhage.  On Friday (11/29/2021) I was transferred to MICU to continue treatment as follows: On 11/19/2021 (FRIDAY) Underwent Transesophageal echo and an insertion of an implantable loop recorder was performed. (Which I will need to keep for approximately 3 years). Transferred to MICU. 11/20/2021 (SATURDAY) Still under observation. 11/21/2021 (SUNDAY) Still under observation. 11/22/2021 (MONDAY) Repeat CT brain.  Small hemorrhage still present. 6 sessions of physical therapy and 6 visits from a registered nurse ordered upon hospital discharge. 12/06/2021 FOLLOW UP APPOINTMENT WITH NEUROSURGEON. Neurologically intact.  MRI and non-contrast CT demonstrated a small amount of right sylvian petechial hemorrhage and right sylvian fissure subarachnoid hemorrhage asymptomatic. Cardiac Echo demonstrated no evidence of a right-to-left shunt and a normal ejection fraction. Loop recorder implanted-far no arrhythmias. Source of right middle cerebral artery thrombus is cryptogenic, although most likely cardiac, as the patient reported palpitations a few weeks earlier. PLAN: Continue Aspirin 81mg.  Non-contrast CT of the brain in 1 month.  Follow-up in neuro interventional clinic in 1 month.