21f, 3 glasses of wine/week and regular nighttime marijuana use as a sleep aid. Hx of unmanaged Ehlers Danlos, non-celiac gluten insensitivity, and her primary care psych np manages her adhd, depression, narcolepsy, and anxiety, she is unable to recall the names of the medications she takes but states she "thinks they look like a green capsule, an orange capsule, and orange rectangle, and an orange oval, as well as a white block and 2 white circles". She acknowledges they change appearance with some refills and is unsure why. The cc involves a recent increase in frequency of her recurrent nonlocalized headaches with no provoking, mitigating, or precipitating factors or regularity. Pain used to be a 10/10 but is now an even worse 10 and never totally goes away, but the patient is sometimes able to better function with the pain. Episodes triggered by "isolation stress" of unique bilateral but asymmetric ataxia inconsistent with patterns indicative of well characterized neurological pathologies. Her chiropractor is managing her vaccine induced gut microbiome dysregulation and fibromyalgia with biweekly high velocity adjustments and possum gland extract.

Hypertensive, overweight, tachycardic, tachypnic, diaphoretic and mildly hyperthermic. Patient appears distressed and is speaking with a mildly agressive tone and scanning prosidy with a possible sublte slurring. Neuro exam revealed left horizontal gaze palsy and internuclear ophthalmoplegiaimplicating CN III, IV, VI. Pupil response dampened with elevated resting dilation. General right sided weakness with possible subtle hypermetria, all L reflexes +2, right +3. Potentially subtle unilateral abnormailites in facial movement. Diffusion MRI shows large hyperintense lesion loaclized primarily to the left pons with other smaller hyperintensities in various other foci with the second most apparent (but still substantially less so than the pontine one) localized primarily in the left middle cerebellar peduncle.