Age: 72.0
Sex: F
Vaccine: COVID19, COVID19, COVID19, COVID19
Symptoms: Activated partial thromboplastin time normal, Alanine aminotransferase normal, Angiogram cerebral, Anion gap, Anticoagulant therapy
Clinical narrative: ED note by Dr. on 8/24/22: "Chief Complaint Patient presents with ? Eye Problem     HISTORY OF PRESENT ILLNESS   Patient is a 72 y.o.female who presents to the Emergency Department with left lateral vision loss.  Patient was vaccinated for COVID-19 on 08/06/2022.  Shortly after that she developed left lateral peripheral vision loss in her eye.  She states she attributes this to getting her COVID vaccination.  She said that she has no pain associated with his vision loss.  She follow-up with an ophthalmologist who said there were no retinal issues and thought maybe on examination that she had a stroke.  She follow-up with her family doctor who ordered an outpatient MRI she presents here to the emergency department after results for called stating that she needed to come to the hospital.  She denies any focal neurological deficits otherwise such as weakness in her upper lower extremities, dysarthria aphasia or any other associated symptoms." "CLINICAL IMPRESSION   1. Acute cerebrovascular accident   DISPOSITION/PLAN   Admitted   Condition at Disposition: Fair"  H&P by Dr. on 8/24/22:  Date of Admission:  8/24/2022 Date of Birth:    PCP: MD Chief Complaint:  Left eye peripheral visual loss     HPI: Patient is a 72 y.o., female with medical history significant for diabetes and hypertension who presents after being referred for suspected acute CVA.  Patient noticed left peripheral visual loss with no associated pain, for which she is on ophthalmologist.  Retinal examination was okay so stroke was suspected and MRI of head requested by her primary care physician.  MRI results showed acute to subacute right occipital lobe infarct.  Patient was then referred to go to the ED. Upon evaluation, alert and oriented, no significant complete intervene on left peripheral vision loss.  NIH stroke scale of 1. She was given aspirin, CT angiogram of head and neck requested and now being admitted for further neurological evaluation.   There are no active hospital problems to display for this patient." "Assessment/Plan:    # acute to subacute occipital lobe infarct Patient has already received aspirin 324 mg once.  Will continue with Aspirin 81 mg once a day.  Increase home dose of Crestor Echocardiogram NIH stroke scale of 1 Speech and swallow/physical therapy CT angiogram of neck and head Formal neurology evaluation Blood pressure currently acceptable, will resume home dose of ACE inhibitor after 48 hours/permissive hypertension.   # history of diabetes mellitus Patient takes metformin at home.  Hold metformin for now Hemoglobin A1c Sliding scale with coverage/frequent fingerstick check   # history of hypertension Resume home dose of lisinopril, after 48 hours.  Patient has been having symptoms more than 1 week, subacute in nature   # difficulty of hearing Advised to bring her home hearing aid   Capacity: Yes DVT prophylaxis.  Low risk for DVT, encourage ambulation. Code status. Full code."  Consult not by Dr. on 8/25/22: Pstient, 72 y.o. female Date of Admission:  8/24/2022 Date of Birth:    PCP: MD   Information obtained from: patient and history reviewed via medical record Chief Complaint: left VFC     HPI Patient is a 72 y.o., female who presents to eye clinic with Left VFC and OP MR brain revealed a subacute R PCA infarct. Neurology consulted for stroke. Patient states that around 10 days ago she started noticing decrease vision and thought it was due to the covid booster shot. She denies any difficulty with speech, language, comprehension, or sensory/motor deficits. She denies having heart flutters or chest pain or palpitations. I went over her stroke with her and husband and discussed additional work up needed. She will need to be discharge on a heart monitor and if Afib is found will be started on Eliquis. Patient was agreeable." "ASSESSMENT & PLAN Active Hospital Problems   Diagnosis ? Acute CVA (cerebrovascular accident)   R PCA infarct  Etiology: concern for occult Afib/PAfib vs cryptogenic  - no tPA given due to out of time window - Patient was not taking ASA - CTSP demonstrate a distal R PCA  - MRI as above   Recommendation - TTE w/shunt to rule out cardiac source of embolism - Cardiac workup: EKG, serial troponins, telemetry  - ASA 81 mg   - High dose statin - Evaluation with PT/OT/SS - event monitor on discharge               If Afib is found, will need asa switch to Eliquis/Xarelto "