Age: 43.0
Sex: F
Vaccine: COVID19
Symptoms: Activated partial thromboplastin time normal, Anticoagulant therapy, Blood chloride increased, Blood creatine phosphokinase MB, Blood creatine phosphokinase normal
Clinical narrative: 43-year-old female with history of anxiety and depression presents to the emergency room with complaints of numbness sensation to the left side of her face and left-sided body pain since Monday evening after she received her first dose of the visor Covid vaccine.  She states around 6:30 PM Monday evening 2 days ago on 15 November she received her first dose of the visor Covid 19 vaccine.  She states approximately 30 minutes later she noted she had some pain to her arm and to her left leg.  She then states that she started feeling like her left side of her face was "droopy".  She states she just did not feel right.  By about 2 hours after the shot she noted that it felt like her left side of her face was numb.  She states ultimately she went to bed and the next day yesterday she thought she was a little better but describe that she just kind of felt sore all over.  However she persist to feel this numbness sensation to the left side of her face from her eyelid on down the cheek and jaw.  She states although it felt like it was heavy and "droopy" when she looked in the mirror she did not notice any facial droop.  She states right now it just continues to feel heavy feeling to her.  She states yesterday she felt occasional tremulous.  She reports she does feel little bit of a numbing sensation to her left upper extremity including her hand.  She does not feel any numbness or tingling to her l legs.  She states yesterday morning she did have a little bit of blurry vision but has had no vision changes since then.  No diplopia.  She does report that she feels a little weak on the left side of her body.  She denies headache.  She denies fever or chills.  She denies chest pain, shortness of breath, palpitations, syncope or near syncope feeling.  Yesterday she was nauseated but does not have that today.  She denies dizziness, lightheadedness, syncope or near syncope feeling.  No speech impairment.  No history of blood clotting disorder.  No history of CVA.  She is not on any birth control or hormonal replacement.  No exposure to person with Covid-19 positive.  Reviewed the MRI of the brain with and without contrast which as read by radiologist shows findings are suspicious for possible right transverse sigmoid sinus thrombosis.  No evidence of infarct or other acute intracranial abnormality. Reviewed the MR venous brain without contrast which as read by radiologist shows partial thrombosis right transverse and sigmoid sinus suspected.  Remainder of the venous sinuses are widely patent.  Recontacted Dr. and reviewed with her the results of the MRI of the brain and MRV of the brain.  She recommends admission, anticoagulation with heparin followed by Coumadin.  She has recommended coagulopathy work-up in addition which she has ordered additional laboratory testing.  Heparin will be started after the additional laboratory testing blood is collected.  Reviewed all testing results with the patient and her husband and the limitations of the testing that has been performed today.  Discussed with her the recommendation by neurologist Dr.  The heparin anticoagulation was started.  -Patient be admitted under observation status as neurology would like to have the patient monitor overnight for the cerebral venous sinus thrombosis  -Patient be placed on Lovenox and Coumadin and will monitor PT/INR  -Neurological checks will be also done every 4 hours  -Continue with telemetry monitoring  -If patient exhibits any change in her clinical status or neurological symptoms patient will need to have a stroke work-up done starting off with a CT scan of the brain  -Echocardiogram ordered  -Labs for tomorrow morning ordered and Dr ordered anticoagulation labs  -Dr  was consulted by emergency room physician