Age: 47.0
Sex: F
Vaccine: COVID19
Symptoms: Electrocardiogram ambulatory normal, Eye movement disorder, Fatigue, Gait disturbance, Gene mutation identification test positive
Clinical narrative: 12/24/2020  PT is a 47 y.o. female who arrived by Car presented to the emergency department for Stroke symptoms.  Patient awoke at 6:15 this morning, some difficulty seeing out of the right eye and also was stumbling towards the left and to table.  Concerned about things not being right so brought to the emergency department.  Patient feels her speaking and swallowing are okay.  She did drink a bit of coffee earlier.  She denies headache or significant vision problems presently.  Continues to not feel normal on her left side.  No history of stroke and parents or siblings.  She does give personal history of an occipital migraine many years ago at which time she did not have a headache but had some vision troubles.  Patient's speech seems a bit slurred to me.  Absence of ocular movements towards left noted as well as upward movements.  Tongue is midline.  Patient is unable to shrug the left shoulder or lift the left arm off the bed.  Grip strength is 4 out of 5 on the left.  Left leg strength is 3 out of 5.  Extremity strength on right arm and leg is 5 out of 5.  Pt transferred to another facility.   PT is a 47 y.o. female with benign past medical history apart from tobacco use presents as a transfer to our facility from ER for further evaluation and treatment sudden onset bilateral blurred vision, difficulty with visual tracking as well as slurred speech, perioral paresthesias, with left hemiparesis. Patient was last known well last evening. She awoke today at approximately 6:15 AM with above described focal neurologic deficits. She does have a history of migraines (specifically citing an ocular migraine roughly 12 years ago which resulted in similar strokelike symptoms) but denied aura, headaches in the last 24 hours. No other physical complaints noted including chest pain, shortness of breath, GI upset, irritative urinary symptoms; no fevers, body aches or chills; no recent illnesses. She does work in the lab at Hospital and admits to possible Covid encounters but denies Covid symptoms. She was in fact vaccinated yesterday 12/23/2020. Pt has had extensive rehab and therapies.   PT is a 47-year-old female with a history of PFO, CVA and tobacco abuse. On 12/24/2020 she awoke with vision changes and some issues with walking and depth perception. She was diagnosed with acute ischemic stroke. MRI showed a basal ganglia stroke, CT of the head and neck arteries were without significant carotid disease. She had an extended Holter monitor that did not suggest significant arrhythmias. Her hypercoagulable work-up was positive for MTHFR mutation. She is on single antiplatelet therapy with aspirin and high intensity statin. She presented to Hospital on 4/15/2021 with planned PFO closure procedure. 6/29/21   HPI patient is seen today to discuss going back to work.  She feels like she is ready to go back to work and did have a work well functional capacity evaluation on 6/15/21.  This did demonstrate that she is able to work at medium physical demand level VIII hours a day for 5 days a week.  She continues to follow with neuro-ophthalmology for her left eye.  She is currently wearing a frosted lens on the left and states that she was told that her eye is a 20% chance of improving on its own or 80% chance of having to proceed with surgery.  She feels like her gait and balance are much improved.  She has been doing household chores, shopping, gardening, even mowing the yard and has tolerated this well.  Sometimes she gets more tired but does feel like her excessive fatigue is not quite as bad since she has been more active.  She continues to sleep well at night.  She does occasionally have to take a nap in the afternoon.  She does have chronic neck and back pain which she uses tramadol occasionally for.  She has been having more achiness in her hips, legs as well as arms but is wondering if this is due to lack of activity and she also blames weight gain since her stroke.  She has not had any swelling in her lower extremities.  She does have some varicose veins of lower extremities and has support hose but has not been wearing them. Plan: She will continue with her current medications.  She states that her neurologist to decrease her Lipitor to 40 milligrams daily.  She does not feel like this has necessarily caused increased myalgias or arthralgias.  She does have varicosities of the lower extremities and encouraged her to use her support hose especially when she returns to work.  She does feel like she is ready and capable to return to work and will gradually ease back into this.  I think it is best to start with 4 hours a day 3 times a week the first week then increase to 4 times a week (or 16 hours a week) for 1?2 weeks and if tolerated increase this to 32 hours a week.  Once she is able to tolerate 32 hours a week for 4 weeks then would try to resume her normal 40 hours a week.  She is going to give us a phone report in 2 weeks however she is to call or return sooner if she cannot tolerate this.