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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


Day 1:

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


Day 2:

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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