2005-11-28 12:58 p.m.

The patient is a woman with history of Raynaud's and borderline hypertension who was admitted extremely hypertensive with a headache and was found on admission to have several CNS bleeds. She had an angiogran, which showed a beaded appearance of two of the arteries in her brain suggesting vasculitis and there was evidence of the posterior inferior cerebral artery (PICA) fusiform dilation consistant with a small aneurysm. She was see by Dr. Cokgor from neurology, Dr. Blumenfeld from neurosurgery, Dr.Stein for rheumatology, and she was seen by Dr. Stante for evalutation for anxiety and depression. The CT angiogram showed a beaded appearance in the A-three segment of the right anterior cerebral artery and mild narrowing at the right posterior cerebral arttery off the basilic arteriogram with an incindental finding of a 3.7 mm broadbased aneurysm arising adjacent to the left superior cerebellar artery with no evidence of spasm. Cardiac echocardiogram showed concentric left ventricular hypertrophy with normal systolic function. She had fairly extensive laboratory testing with tests at the time of discharge being largely back and showing no evidence of a coagulation abnormality still pending at the time of discharge is a factor 5 Leiden test also Lyme titer is still pending. There is no evidence of a lupus anticoagulant or antophospholipid antibody, protien S, protien C activity were within normal range and antithrombin III was normal, white count was normal throughout her hospitalization and sed rate was also normal. Electrolytes were normal. Urine drug screen when she was first admitted was positive for amphetamines,opiates, and benzodiazepines. TSH was normal. Liver functions were normal. Hepatitis B serology was negative. EKG showed some mild increase in lest ventricular size but no acute abnormalities. Sojgren's tests were negative. ANA still pending. Rheumatiod was negative. She was treated with high dose steroids 60mg initially and this has been weened down to 40 when she was discharged home. Her blood pressure was treated with amlodipine and she was running in the 140-150 range when she was discharged. She was very anxious and decided that she wanted to go home on the afternoon of discharge. Her husband came in and he was also very adamant that he wanted to take her home. I had extensive discussions with the patient, her mother and her husband as to the findings on all the tests, emphasizing the need for further follow up for some of the labs, which have not come back including some of the rheumatologic tests that are still outstanding and also emphasizing the need to slowly taper the prednisone rather than abruptly stopping it, also emphasizing the need too keep the blood pressure under excellent control by continuing to take the medication. She is being discharged home with her husband.

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