78 year old female with PMHx HTN, dCHF, Diabetes, CKD, Atrial
   fibrillation on coumadin, ischemic stroke, admitted after
   presenting to cardiology clinic today with confusion and
   Somnolence. Of note, she was recently discharged at the
   beginning of [**2876-4-14**] after presyncope/falls. At that time,
   lasix was stopped and atenolol was switched to metoprolol as
   there was concern that blunting of tachycardia could be
   contributing to falls. She was discharged to rehab (previously
   living at home).
   
   Per report from the ER, patient has had confusion at home x 3
   weeks, though no family accompanies her to corroborate this
   story, and patient denies this. The patient is not sure why she
   is in the hospital. She saw her cardiologist today, who
   referred her to the ER after she appeared to be dehydrated,
   somnolent, and confused.
   
   The patient denies headache, blurry Vision,
   numbness, tingling or weakness. No CP. +SOB, worsening DOE. 
   No nausea, vomiting.
   
   Physical Exam:
   GENERAL: Intubated, NAD
   HEENT: Normocephalic, atraumatic. No scleral icterus. MMM, OP
   clear.
   CARDIAC: irregularly irregular. Normal S1, S2. No murmurs, rubs
   or [**Last Name (un) 597**].
   LUNGS: CTAB
   ABDOMEN: Soft, NT, ND. +BS
   EXTREMITIES: 1+ edema
   
   NEUROLOGIC:
   Mental status: Intubated, off sedation, minimal arousal to
   voice/stimulation. Not following commands.
   Cranial nerves: Pupils sluggishly reactive, both post-surgical,
   R 4->3, L 3.5->3. Gaze midline and conjugate, face appears
   symmetric.
   Motor: Withdraws LUE and LLE weakly, no response RUE, triple
   flexion RLE.
   Sensory: withdraws to noxious stimulation weakly as above, L>R
   Coordination: unable to assess
   Gait: unable to assess