8/37

(continuation of evaluation of Dr. Sagman, Sunday, 8/22/93)

Father says he is sli(ghtly) confused or "slower" this P.M. than he was this morning.

Exam:
1.  diffident, hesitant speech - facial abrasions - tongue unbitten
2.  Fundus - negative

3.  active tremor

4.  significant H(?and) - K(nee) tremulousness

5.  BP 160/80 supine

           130/80 standing

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Imp(ression):  1.  Drug - induced orthostatic 
                                 hypotension
                      2.  Convulsive syncope
                      3.  Benign Familial Essential
                      4.  Modified (benzodiazepine)
                                   withdrawal state

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Rec(ommendation):   1.  EEG
                                 2.  Supplementary diazepam now
                                                 (for protection)
                                 3.  Psych consult
                                 4.  MRI head if subsequent
                                       exams suggest
                                       cognitive decline.

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