4/30/21: This patient comes in complaining of worsening low back pain.  She has a history of severe degenerative disease in his had surgery.  She was scheduled to see her neurosurgeon last year however it got canceled due to the COVID-19.  Patient states she saw her neurologist on Tuesday and was given injections which significantly helped.  She states that her pain has returned however.  She has had no trauma.  No footdrop.  No difficulty with her bowel or bladder.  Patient states she only uses Tylenol arthritis at home.  5/1/21:The patient is a 70-year-old female presenting to the emergency department for back pain.  She has a history of chronic back pain and states that has been worsening.  She was recently seen here for the same complaint.  She currently rates her pain 10/10 intensity.  She reports that she has chronic numbness and tingling of her bilateral arms/hands and legs/feet.  She states that this is also worsening.  She denies any changes in bowel or bladder function or perineal numbness.  She states that she has been using a walker at home and that she has tried to make an appointment with her neurosurgeon who previously operated on her but that she has been unable to get through to their office.  She reports that she only called 1 time on a Friday.  She is taking Tylenol at home for her pain and reports minimal relief.  She denies any fevers or associated concerns at this time.  5/2/21: This is actually her 3rd visit in less than a week with this complaint.  She was seen 2 other times at a outside facility.  She states that she had back surgery about 10 years ago at Beaumont.  She states she was supposed to see her neurosurgeon last year but this did not occur secondary to COVID-19.  Her primary care physician had referred her to a neurologist did some injections ahead some relief of her back pain for a week or 2 but this is since worsened.  She states that over last several days she has had increasing numbness and tingling in her feet as well as increasing weakness of her lower extremities as well as some now some new incontinence of urine when she stands up.  She today she also complains some chest pain she attributes more from just amount of pain he has from her back.  She rates her back pain as a 10/10 intensity.  She did have 1 episode of a week or 2 ago where she slipped down and fell on her knee but did not hit her back directly.  She did not hit her head.  She describes the chest discomfort in her upper abdomen lower chest area.  She is nauseated but not vomiting here.  She denies any exertional dyspnea or orthopnea prior to this.  She has had no recent fever chills.  5/11/21: The patient is an 70 y old female admitted on 5/4/2021.  The patient was originally seen by Neurology on 05/07/2021 when she presented with diffuse weakness.  She has a history of hyperlipidemia, hypertension and diabetes.  The patient at that time described the acute onset of weakness ascending from the feet, then involving the legs and arms also associated with sensory symptoms that started about 2 weeks prior to her presentation.  She also had persistent neck and back pain radiating to her arm and legs limiting her ability to walk.  On neurologic examination at that time the patient had absent deep tendon reflexes in the lower extremities and trace reflexes at the biceps.  She had significant weakness in the lower extremities and mild weakness in the upper extremities.  She also had a dysarthric speech.   Given the patient's CSF analysis showing protein elevation to 266 with no pleocytosis, wbc's were only for, there was support for a clinical diagnosis of acute inflammatory demyelinating poly radicular neuropathy or such variant.    The patient was started on plasmapheresis and has received her 2nd session of plasmapheresis on 05/09/2021.  She will have a total of 5 sections, one every other day.  The patient also has hyponatremia, this can be seen in about 5% of patients with Guillain-Barre syndrome, we also do see pseudohyponatremia but this is in patients that have received IVIG.