The patient is a 79-year-old gentleman who presented ER stating that he missed a step at home and fell. He complains of having headac, left arm pain, back pain and left leg pain. He denies any loss of consciousness.. His medical history is significant for hypertension. On presentation his BP is 170/96 with pulse is 68, respirations of 20, temp of 100.9 and is oxygenating well on room air. Initial exam showed multiple abrasions on his shoulders, his back and his legs with ecchymoses. There were no fractures, no gross deformities. However the initial physical therapy evaluation done the day after presentation they found the patient to have significant weakness in his left upper extremity 3+ over 4, in his left lower extremity 3 over 3