Complete Blood Count, complete metabolic panel, Vitamin B12, methylmalonic acid, and ferritin were all within normal limits. Epstein Barr Viral panel was negative for an acute or chronic viral infection Tryptase levels were within normal limits.
Echocardiogram: Normal Left Ventricular Ejection Fraction, normal left and right atrium size. Normal aortic valve and normal mitral valve.
Exercise stress test: resting ECG demonstrated normal sinus rhythm and did not show ST segment changes consistent with myocardial ischemia.
MRI of the brain with and without contrast was consistent with a Chiari malformation. There was cerebellar tonsillar ectopia through the foramen magnum of approximately 12mm. The Craniocervical junction was otherwise unremarkable.
At three months, the patient was also evaluated by cardiology. A workup included an unremarkable EKG and echocardiogram.
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