Age: 69.0
Sex: M
Vaccine: COVID19-2, FLUA4
Symptoms: Syncope, Treatment noncompliance, Troponin normal, Tunnel vision, Urge incontinence
Clinical narrative: Discharge Provider: DO Primary Care Provider: MD Admission Date: 3/1/2023 Discharge Date: Mar 4, 2023  PRESENTING PROBLEM: Syncope and collapse [R55] Closed head injury, initial encounter [S09.90XA] Contusion of rib, unspecified laterality, initial encounter [S20.219A] Syncope, unspecified syncope type [R55] Urinary incontinence, unspecified type [R32] Acute midline low back pain without sciatica [M54.50] Incontinence of feces, unspecified fecal incontinence type [R15.9] Traumatic subdural hygroma [G96.08]   HOSPITAL COURSE: The patient is a 69 y.o. male with past medical history of BPH, non-insulin-dependent type 2 diabetes, depression, history of CVA, history of PE/DVT, history of renal cell carcinoma, and hypertension who presented with recent syncopal episodes x 2, low back pain from collapse, new urinary incontinence and worsening fecal incontinence.  Was recently vacationing and about 10 days prior to admission had a fall in the shower where he hit his head after a significant amount of alcohol.  His story did change slightly, initially reporting fecal incontinence after the fall but later stating fecal incontinence was the reason he went to the shower in the 1st place.  Since the fall he had severe headache.  Additionally he had orthostatic type symptoms afterward.  On the trip back he had orthostatic symptoms while reaching for his overhead bag, tunnel vision with vomiting and then urinary incontinence but did not pass out that time.  He had a telehealth visit with his primary care provider who was rightfully concerned for intracranial hemorrhage/NPH and/or cauda equina syndrome so he went to the emergency department on 3/1/23.  He was noted to be COVID-19 positive on admission with symptoms starting approximately 2/24/23.  Orthostatic vital signs were negative although he had received 1 L IV fluids prior to this.  Vital signs were stable, saturating well on room air.  Troponin negative.  EKG without ischemic changes, does demonstrate known 1st degree AV block.  UA without infection.  MRI lumbar spine completed urgently demonstrating no evidence of cauda equina but did show chronic L1 inferior endplate compression fracture with 50% anterior loss of vertebral body height, no bony retropulsion.  CT head without acute hemorrhage but did demonstrate high bifrontal subdural hygroma which could possibly be related to a prior subdural hematoma.  Neurology and neurosurgery consulted.  No intervention from Neurosurgery standpoint as there was no evidence of increased intracranial pressure.  Neurology recommending maximizing BPH treatment as incontinence episodes felt to be mixed stress/urge rather than neurological.  Echocardiogram completed demonstrating ejection fraction of 55% with no significant valvular disease.  UDS negative. Peth positive at 75 indicating moderate alcohol consumption but likely no more than 3-4 drinks per day.  TSH normal.  Telemetry while hospitalized did demonstrate bradycardia with heart rates in the low 40s while sleeping however they appropriately improved when awake with activity.  Telemetry reviewed showing first-degree AV block with PACs while HR was slow. He is on no AV nodal blocking medications.  A 2 week ZIO patch was placed on discharge with results to be sent to primary care provider.  Patient worked with PT and OT demonstrating independence.  Patient feeling back to baseline on day of discharge, denies needing any refills. PCP reported concern he may not be taking BPH medication as prescribed, discussed with patient and he admitted to intermittent noncompliance as he felt it made him need to urinate more frequently. He is also concerned about ED. Patient's daughter updated over the phone as was PCP on day of discharge.