A patient 66yrs old male with a past medical history of alcohol abuse since age 25, homeless, with history of hypertension was brought by the paramedic, who report that he was walking home and got picked up from the ground. Pt unable to recall what happened. All he recalls is he fell and hit his shoulder, denies lost of consciousness but unable to recall incident. On arrival to the hospital the pt blood pressure was 206/120, CT to the head was done which revealed atrophy and small vessel ischemic changes and multiple lacunar infarcts. Ct of the cervical spine reveals no evidence of fracture. At time of examination the patient complained of pain in the shoulder. The patient was very slow to respond knows he is in the hospital and date but not able to recall.