Age: 43.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Aphasia, Blood pressure abnormal, COVID-19, Cerebrovascular accident, Dysarthria
Clinical narrative: Hospitalized;  COVID-19 positive (9.2.21);  fully vaccinated Admission Date: 9/3/2021 Discharge Date: 09/04/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Stroke-like symptom [R29.90] Cerebrovascular accident (CVA), unspecified mechanism  COVID-19    HOSPITAL COURSE:  SUBJECTIVE: Patient is a 43 y.o. female who presents today with her husband at bedside. After she developed symptoms of acute aphasia, left sided weakness, left sided numbness and a headache at a ball game 9/2/2021 @ 1430, she remembers it being the bottom of the third, she felt whole body tingling sensation, had a brief "black out" for seconds and felt hot, ushers took her to the medical bay at the park, she then was sent to hospital due to concern for stroke. She was given tPA at 1600 9/2/2021. She recalls the providers talking to her about tPA and the risks and they had to call her husband because she was unable to answer their questions.    Then she was in the  ED, and they told her they were going to get an MRI and stroke evaluation, though there were no beds available in the ICU  and she would need to be watched in the ED. Patient states she did not feel like she was being observed in the ED, so she left AMA with her husband to drive 3 hours from hospital to another facility for management and workup for possible stroke.  43 y.o. female presenting from Hospital after patient left AMA status post tPA.  Reportedly patient was at baseball game.  She was in the lower section, sitting in the sun and went to walk up the steps.  She said there were a lot of them.  During the ascension she started feeling warm and needed to sit down.  She felt tingling on both sides of her body.  She said paramedics took her BP and all she recalls was being told it was low in the 80's and that they couldn't measure the other number.  She also recalls having difficulty getting words out.  She was taken to the hospital where it was suggested that she may have a facial droop.  She was given a mirror and recalls telling them that it looked like her face.  She was given tPA at 4:00 p.m with resolution of symptoms approximately 5:30 p.m on 09/02/2021.  Onset of symptoms was roughly 2-3 pm.  Patient was unhappy with the care received via an emergency room and decided to seek care elsewhere.  Now at this hospital, patient reports she is back to normal.  MRI brain was negative for acute abnormality.  It was not obtained with contrast but there is no evidence of chronic lesions with demyelinating appearance.  Etiology considered likely pre-syncopal d/t hypotensive event.  Echo without clear abnormality but suggesting atypical septal motion in one sequence.  I discussed with cardio who suggested this would not be expected to elicit a syncopal event and did not require follow-up.  Patient with sinus arrythmia while tele and will obtain ziopatch at discharge.  Patient should modify stroke risk factors for primary prevention, including glycemic control through diet and exercise as A1c 6.0.  Recommend marijuana cessation.  Otherwise patient should f/u with PCP post-hospitalization and for resolution of UTI treated with Azithromycin.  Otherwise EEG pending read at discharge.  Patient discharged home.