Physician's Assistant

Refined ultra rapid review Mon 09 February 2026 10:35

Last Modified: 8 weeks ago

MRN:

Content:

Medical ST5 Miller Review

Reason:
Patient requesting discharge against medical advice following admission for falls and seizure activity.

History:
Patient fell at home and had a further fall in hospital. Confirmed seizure in emergency department. 
History of alcohol use - drinks daily.

Examination:
Appears slightly fidgety, possibly related to anxiety about wanting to go home and potential alcohol withdrawal. Certainly not withdrawing significantly currently, CIWA 0

Impression:
Likely seizure secondary to possible stroke. Patient has capacity and understanding of risks including potential for further disabling or fatal stroke. Understands need for urgent MRI scan to establish diagnosis. Patient aware of risks of sudden alcohol cessation including seizures and potential fatality.

Plan:
1. Patient choosing to self-discharge against medical advice despite understanding risks
2. Patient states will return for MRI scan as outpatient
3. Advised regarding gradual alcohol reduction rather than sudden cessation
4. Patient has capacity to make informed decision regarding discharge

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Summary:

Investigations:

Refined ultra rapid review Mon 09 February 2026 10:35

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