A middle-aged male was brought to the emergency room by the police after he was found sitting on the sidewalk with a laceration on his four head. He states that he thinks his age is about 45, that he has been living in a shelter but he is unsure of today’s date and he knows that he is in the hospital but cannot give it its correct name. He cannot subtract serial sevens, or do more than simple calculations. He gives a history of having a drinking problem and says that he recently cut back because of no money. He says he had been in the hospital previously but does not remember the dates. He was told he had a liver problem but does not report the other illnesses. Over the past four days he reports seeing little animals that then disappear. On examination he is disheveled, unshaven, and tremulous. Temperature has 101, Pulse 120, blood pressure 140/90. There is a 3 cm recent cut on the left for head where he says he hit his head. He denies passing out and was just sitting on the sidewalk to rest. Neurologic exam and mental status discloses moderate confusion and agitation, hyperactive reflexes, unsteadiness when standing or attempting to walk, and no localized motor weakness with equal and reactive pupils. The liver is enlarged with no evidence of jaundice. EKG discloses sinus tachycardia. Because of the head trauma a CAT scan was performed which disclosed no fractures or hematoma.
