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Write-up: 54-year-old female with past medical history of hypothyroidism, vitamin D deficiency presenting to the emergency room with bilateral paresthesias of foot and hand. Patient had received her first more Darner vaccine 3 weeks prior to presentation. Patient was also noted to have left facial droop and loss of sensation on the anterior tongue. Patient does report a prior history of cold sores on her mouth. She was seen by neurologist outpatient where she underwent nerve conduction studies which showed delayed and prolonged F waves consistent with a diagnosis of Guillain Barre room. Patient underwent a lumbar puncture which revealed markedly elevated protein with very few WBCs consistent with albumin cytologic dissociation. Patient was started on IVIG for 5 days per neurology''s recommendations. Patient reported improvement in her paresthesias prior to discharge. Patient was also diagnosed with having Bell''s palsy and started on valacyclovir and prednisone per infectious disease consultation recommendations. Patient underwent an MRI brain which revealed prior trauma/cortical contusion, and mild multiple nonspecific periventricular deep white matter foci of abnormal signal intensity, and no MR evidence of acute infarct. Also underwent an MRI cervical spine which revealed multilevel cervical enthesopathy with moderate to severe right C4-C5, left C5-C6 and left C6-7 foraminal stenoses. MRI lumbar spine also reviewed revealed moderate bilateral facet arthropathy at L4-L5 and L5-S1. Thoracic spine MRI was unremarkable. Patient''s paresthesias improved. Per neurology''s recommendations, patient was discharged home to follow-up with neurology in 2 weeks outpatient. Patient was also instructed to follow-up with her primary care doctor in 2 to 3 days for hospital discharge follow-up.
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