Discharge Summary by (Privacy) MD at 2/4/2022 11:20 AM Hospital Medicine Discharge Summary   Date of Admission: 2/2/2022 Date of Discharge: 2/4/2022 Code Status: Full Code Advanced Healthcare Directive / (Privacy) available: NO. LCP referral sent: NO.   Reason for Hospital Admission:  Stroke   Diagnoses: (Principal) HEMIPLEGIA & HEMIPARESIS, LEFT NONDOMINANT SIDE, LATE EFFECT OF STROKE HYPOTHYROIDISM HX OF BREAST CANCER Hospital Course and Significant Findings: 81 Y Female with hx of hypothyroid, breast ca post mastectomy w/ LUE lymphedema admitted 2/2 with acute LUE weakness due to acute ischemic CVA.  CTH neg acute .  CTA no LVO or hemodynamically sig stenosis.  Given TNK, and admitted to ICU for close observation.  F/u CT showed a small R parietal lobe infarct, and concern for petechial hemorrhages vs artifact in b/l frontal parietal convexity.     LUE weakness resolved.  Neuro recommended MRI scan - showed a tiny foci of acute ischemia in the right posterior frontal cortex.  No petechial hemorrhages noted.    Per Neuro recs, dc'd home on aspirin plus high dose statin and 30 day monitor ordered.    Plan      CVA: post TNK, improved- no sig residual deficit. Plan asa plus statin . Pt is normotensive without meds.  LDL is 160 - starting high dose statin.      Hypothyroid: continue thyroid replacement      Remote Hx of Breast Ca post mastectomy / xrt/ chemo   Complications: none   Operative Procedures:  None   Non-operative Procedures: Mri/ ct scans    Consults:  NEUROLOGY - INITIAL INPATIENT CONSULTATION. NEUROLOGY - ONGOING INPATIENT CONSULTATION. PHYSICAL MEDICINE - INITIAL INPATIENT CONSULTATION. PHYSICAL MEDICINE - ONGOING INPATIENT CONSULTATION.   Smoker: No.   Condition on Discharge: Stable   Events / Subjective: feels fine and wants to go home    Physical Exam:  BP 121/78  | Pulse 73  | Temp 98.4 °F (36.9 °C)  | Resp 16  | Wt 62.1 kg (136 lb 14.5 oz)  | SpO2 98%  | Breastfeeding No  | BMI 22.78 kg/m²    Vitals last 24hrs BP  Min: 100/65  Max: 153/95 Temp  Avg: 97.2 °F (36.2 °C)  Min: 96.6 °F (35.9 °C)  Max: 97.7 °F (36.5 °C) Pulse  Avg: 72.8  Min: 64  Max: 92 Resp  Avg: 15.1  Min: 11  Max: 23 SpO2  Avg: 96.5 %  Min: 94 %  Max: 99 % Weight : 62.1 kg (136 lb 14.5 oz)   Exam: neuro face symmetric, speech is fluid, eomi, upper ext intact prox and distal equal and symmetric . No sensory issues.  LE also fully strong intact strength and sensory Normal steady gait.    Labs reviewed:  Chem/ cbc stable LDL 169.     Discharge Disposition: Home  Right posterior frontal tiny foci of acute ischemia.   Narrative: MRI BRAIN WITHOUT CONTRAST   ** HISTORY **: Stroke, follow up small punctate hyperdensities in frontal parietal convexity on head CT   ** TECHNIQUE **: 1.5T MR images of the brain acquired without intravenous contrast.   COMPARISON: CT 2/3/2022   ** FINDINGS **: BRAIN PARENCHYMA: A few tiny foci of T2 hyperintensity and reduced diffusion in the right posterior frontal cortex with involvement of the precentral gyrus are consistent with acute ischemia.   Additional mild foci of T2 hyperintensity scattered in the bilateral cerebral white matter are nonspecific but compatible with chronic small vessel ischemic changes. No evidence of acute hemorrhage. No significant mass effect or herniation.   VENTRICLES: Ventricles are midline. No acute hydrocephalus.   FLOW VOIDS: Grossly patent.   BONES: No suspicious osseous abnormality.   OTHER/EXTRACRANIAL STRUCTURES: Unremarkable.  =======================================================================================================================================