71- year-old male with history of TAVR, cardiomyopathy, pacemaker, cirrhosis, DM, HTN and chronic vertigo presented with syncope accompanied by vertigo. The patient reported a fall several days earlier, striking head.
Day of presentation:
1838: CT head negative, CT Abd/Pelvic Cirrhosis with splenomegaly.
2048: Observation order placed
2130: H&P assessment: Syncope, intense vertigo, frequent falls. Plan telemetry, carotid ultrasound, TTE, orthostatic vital signs
0915: Neurology consult: Noted disorientation. Repeat CT brain, CT Cervical spine, EEG.
1029: CT Brain – chronic small vessel ischemia, CT Cervical Spine – No acute abnormalities
1052: Carotid US – No significant stenoses
1200: PT Evaluation – Recommend SNF placement
1448: Inpatient order placed
1505: Hospitalist note: Still dizzy. Cardiac ECHO and EEG pending.
1700: Cardiology consult: Plan interrogate pacemaker, review ECHO.
1720: Orthostatic vital signs normal
0642: EEG normal
1011: Neurology note: Remains ataxic, rehab when stable.
1652: Cardiology note: Pacer function normal. ECHO normal.
1947: Discharge to SNF
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