Age: 24.0
Sex: F
Vaccine: FLU3
Symptoms: Red blood cell sedimentation rate increased, Reflex test normal, Vitamin B12 normal
Clinical narrative: HISTORY OF PRESENT ILLNESS Patient is a 24 y.o. female with a past medical history significant for B12 deficiency and complex partial epilepsy who presents with bilateral lower extremity numbness and weakness that has been progressively worsening.   Per report, around 10/25/2024 patient noted some numbness of the left foot however now this has been progressing to both feet and has been starting to ascend up her legs with associated weakness.  Patient did undergo MRI spine thoracic with and without contrast on 10/31 which was without any abnormalities.  ESR elevated at 31 on 10/31/2024.  Because of her symptoms she was referred to neurology.  Neurology had been interacting with patient via records and nursing staff and it was ultimately recommended today by neurology that patient should present to emergency room to be seen for possible admission for suspected Guillain-Barré syndrome.   Upon presentation to the emergency room neurology did evaluate the patient.  Neurological evaluation was significant for weakness of lower extremities bilaterally especially with hip/knee/ankle flexion/extension. Reflexes intact.  It was recommended by neurology that patient be admitted for progressive bilateral lower extremity weakness with concerns for GBS.  Patient subsequently admitted to Hospital.   Upon speaking with the patient she states that she currently has numbness from her knees down.  This has been getting progressively worse with ascending numbness and weakness.  She denies any significant history.  She did receive her flu shot over 1 month ago.  No other GI illnesses etc.  She does live in another state and what does work for company.     General:  Alert and oriented no acute distress.  Nontoxic-appearing. Skin: No rashes or lesions. HEENT:  Moist mucous membranes.  No scleral icterus.  No JVD. Lungs:  Clear to auscultation Heart:  Regular rate and rhythm.  No murmurs. Abdomen:  Soft nontender.  Nondistended. Extremities:  No edema.  Pulses intact bilaterally. Neuro: Numbness to bilateral lower extremities from knees down Psych:  Does not appear anxious or depressed   HOSPITAL COURSE: The patient was admitted on 11/6 with subacute rapid onset of  bilateral lower extremity numbness and weakness. Neurology team was consulted. There was initial concern for Guillain-Barré syndrome, however, clinical course would be atypical and lumbar puncture was unremarkable. MRI w and w/o contrast of brain, cervical and lumbar spine were obtained. Spinal imaging unremarkable. Brain notable for several nonspecific punctate foci of abnormal T2 prolongation noted in bilateral frontal subcortical white matter. These are most commonly related to to microvascular ischemic events but differential considerations are broad. No contrast enhancement concerning for demyelinating lesions MRI of thoracic spine obtained at outside hospital and reportedly normal. Electrolytes, HIV, B12 level, lyme serology, TSH were normal. The differential for her current presentation remains broad and includes AIDP, functional disorder, unknown myopathy, vs other by neurology evaluation. Neurology recommended further evaluation outpatient and no longer requires inpatient level cares. Patient was medically stable for discharge and discharged home on 11/7/24.   Recommendations: - follow up outpatient for continued work up of lower extremity weakness and neuropathy - EMG/NCS ordered for assessment of sensory-motor neuropathy, follow up results with neurology - follow up with PCP in 1-2 weeks  - outpatient physical therapy referral placed