Age: 64.0
Sex: M
Vaccine: COVID19
Symptoms: Arteriogram carotid abnormal, Arteriosclerosis, Blood creatinine increased, Blood thyroid stimulating hormone, Brain stem infarction
Clinical narrative: Patient is a 66 y.o. male known history of stroke and intracranial microhemorrhages ,alcohol use disorder, CKD stage III, smoker, hypertension noncompliance to medication who presented from home on 9/26/2023 with confusion and found metabolic encephalopathy concern hypertensive encephalopathy versus from COVID and alcohol use disorder.  Neurology followed with completed work-up   Encephalopathy, concern for hypertensive encephalopathy, secondary to COVID and chronic EtOH abuse with prior history of stroke  Subcortical right lacunar infarct small Abnormal CTA neck with left ICA soft plaque/ulceration - Etiology: suspect hypertensive encephalopathy , COVID and chronic EtOH abuse .Per wife drink up to 5 packs/day - Presented with: confusion - Interventions: none - Current neurologic status: Improved confusion  - Labs/diagnostics:             CT: no acute changes             CTA: LEFT ICA plaque with ulceration             MRI/A: No acute infarct, mass effect or significant change compared to the prior MRI of 2021.  Moderate-to-severe atrophy and chronic small vessel ischemic changes of the pons and supratentorial white matter.  Chronic left pontine lacunar infarct.. - Dr -reviewed MRI and feels small lacunar subcortical infarct in the white matter on the right would not explain his symptoms and had a numerous vascular factors recommend remain on ASA Lipitor and BP control.              EKG:    NSR             ECHO:  per neurology ordered but unable to complete while here for 2 days and recommended outpatient             HgbA1c: 5.6             FLP: LDL 125 -Ammonia, B12 self-regulatory, TSH, HIV, RPR negative COVID-19 positive on admission B1 level pending.  - Antiplatelets/Anticoagulation: Aspirin - Statin: Lipitor 80 mg daily - BP goal: permissive HTN-completed?no stroke on MRI and required nicardipine drip started on home medication slowly for gradual normotension - DVT prophylaxis: Lovenox - Dietary modifications: none - Other Neurology recommendations: Neurology ordered lumbar puncture for CSF analysis but patient and wife both refused this at present we will monitor for recovery, continue empiric thiamine 500 mg 3 times daily for 2 days followed by 250 mg daily to 100 mg p.o. daily with prior EtOH use.  - Disposition: PT OT evaluation- 5 to 7 days of therapy but refuses for rehabilitation and wants to go home with home PT -Unable to complete echo in 2 days at hospital and need outpatient echo to be completed with PCP  COVID viral swab positive - Presented with: confusion - Symptom onset: none - Positive COVID-19: 9/26/23 at ED - Vaccination status: Vaccinated with Pfizer with last dose 2021. Had 2 vaccines. - CXR on admission showed no acute issues. - Oxygen status: room air  - Decadron: Does not qualify due to SpO2>94% on RA. - Remdesivir: Does not qualify due to SpO2>94% on RA. - DVT prophylaxis:Lovenox - Serial COVID labs ordered: No - Case Management/Social Services consulted: Yes  -Continue isolation for total of 10 days until 10/5   Smoker - Smokes 1/2 PPD since teenager, cessation encouraged.   CKD III - Creat 1.5 and appears to be at baseline.   AUD - Alcohol level negative on admit. He says he is not a daily drinker.   Hypertension, uncontrolled  Medication noncompliance - He is on 3 meds with CKD stage III.  -Started on all medication including amlodipine, Toprol-XL, losartan with IV as needed labetalol.