Age: 28.0
Sex: F
Vaccine: RSV, RSV
Symptoms: Electrolyte imbalance, Exposure during pregnancy, Eyelid function disorder, Facial asymmetry, Facial pain
Clinical narrative: 12/19/23 2343 -  The patient complains of left sided facial weakness.  She was trying to drink out of a straw and had difficulty.  She also has some neck and facial pain.  She does not have any weakness in her arms or legs.  She feels like the closure of her left eye is somewhat delayed.  She has no history of similar symptoms.  She did have a failed root canal on that side in September.  She has no chest pain or shortness of breath.  No arm pain. 12/20/23 1348 - Neurology consult - She states prior to delivery yesterday morning she felt a little tingling sensation of the left side of her lip and noticed that her lip looked a little asymmetrical.  She was also having a little bit of left-sided neck pain and a mild headache.  The neck pain and headache have since resolved since delivery.  She states last night she noticed she was having trouble holding the straw in her mouth. From my review her MRI looks okay, no obvious intracranial abnormalities or areas of restricted diffusion. 12/21/23 0906 - Dr - For Bell's patient was seen and evaluated by Neuro.  Home on steroids and Valtex. 12/28/23 2009 - Dr -  Patient called physician call line. She is currently completing tx for left-sided Bell's Palsy which has improved, however this evening she developed new onset right sided facial drooping. She also now has no ability to taste. She denies other weakness, difficulty talking or other signs of stroke. Discussed with her that while this does sound like possible Bell's pelsy on the right side, I would recommend that she proceed to the emergency department for evaluation and confirmation. She will go in tonight. 12/2923 0936 - Hospitalist Dr- Bilateral Bell's palsy in the third trimester/early puerperium.  Most likely idiopathic.  Recent RSV vaccine.  Differential diagnosis includes GBS, Lyme or other atypical infection, other autoimmune disease.  She has no previous history of autoimmune disease, no other significant exposures. 1/2/24 1359 - Dr - Assessment & Plan   GBS (Guillain Barre syndrome)   Bell's palsy   NSVD (normal spontaneous vaginal delivery)   Facial droop   Abnormal brain MRI     Plan:  Plasma exchange number 2 out of 5 today Replacing with 5% albumin, additional IV calcium with treatment Slightly acidotic today but volume, electrolytes and renal function otherwise stable   Her tunneled catheter will need to be removed once her treatment course is complete Will monitor calcium, renal function, volume and blood counts closely with pheresis treatment  D/C 1/3/24 1528 - Patient is a 28 y.o. female with a history of recent spontaneous vaginal delivery and diagnosis of Bell's palsy who presented to hospital initially complaining of right facial weakness.  Please see the admitting history and physical for further details.  She was found to have Guillain-Barré and was admitted to the hospital for further evaluation and treatment.  Following the delivery of her child she had left-sided facial weakness.  She was evaluated by neurology and diagnosed with Bell's palsy.  She was treated appropriately and discharged home however she came back into the emergency room with right-sided facial weakness and had a lumbar puncture performed consistent with Guillain-Barré syndrome.  A tunneled catheter was placed and she was started on plasmapheresis.  She had a few episodes of tachycardia not consistent with SVT was seen by cardiology who recommended no further workup at this time.  Neurology and nephrology assisted with management and arrange for her to complete her pheresis in the outpatient setting.  Arrangements are being made for her to have her tunneled dialysis catheter removed following her last pheresis session.  She should follow-up with neurology in 4 to 6 weeks and follow-up with her primary care physician in 2 to 3 weeks.