CHIEF COMPLAINT: L sided weakness

PRESENT ILLNESS: 77 year old right handed woman presenting with new onset left
sided weakness and ICH.  Today at 2 :30 she called her son and
stated that she was having difficulty lifting her left leg. The
son was alarmed and called 911 and she was brought to an OSH.
Was given an NIHSS of 2 for face and neglect.  She was
reportedly antigravity at that time.  She was given vitamin k
but no FFP as her INR was reportedly greater than 2 as she was
on coumadin.

MEDICAL HISTORY: -afib
-high cholesterol
-htn
-hypothyroid

MEDICATION ON ADMISSION: - Coumadin 5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime
- Premarin 0.625 mg Tab Oral
1 Tablet(s) Once Weekly
- Synthroid 100 mcg Tab Oral
1 Tablet(s) Once Daily
- Crestor 10 mg Tab Oral
2 Tablet(s) Once Daily, at bedtime
- Lopressor 50 mg Tab Oral
1 Tablet(s) Twice Daily
- Flonase 50 mcg/actuation Nasal Spray Nasal
1 Spray, Suspension(s) Once Daily
- aspirin 81 mg Tab Oral
1 Tablet(s) Once Daily
- One Daily Multivitamin Tab Oral
1 Tablet(s) Once Daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Physical Exam:
Vitals: T:98.2  P:95  R: 14  BP: 130/99  SaO2:100%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple,  No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, no masses or organomegaly noted.
Extremities:warm and well perfused
Skin: no rashes or lesions noted.
.
Neurologic:
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.   Language is fluent with intact repetition
and comprehension.  Normal prosody.  There were no paraphasic
errors.  Pt. was able to name both high and low frequency
objects.  Able to read without difficulty.  Speech was minimally
dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**1-30**] at 5
minutes last w semantic cues.  The pt. had good knowledge of
current events.  There was no evidence of apraxia.
.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  unclear if she has a field cut or
if she is just neglecting the left, but unable to to see the
left
visual field.
III, IV, VI: EOMI without nystagmus.  right gaze deviation
V: Facial sensation intact to light touch.
VII: left facial droop
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.
.
-Motor: Normal bulk, tone throughout.
  flaccid on the left.  will withdrawl a flicker movement in the
left IP to noxious.
.
-Sensory: will react to painful stimuli on the left but
otherwise
neglecting.  feels full on the right.
.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    3    2   2
R  2  2    2    2   1
Plantar response was flexor on right, extensor on the left
.
-Coordination:  No dysmetria on FNF on left.
.
-Gait: deferred

FAMILY HISTORY: no strokes

SOCIAL HISTORY: not smoker, etoh, illicit drug use.  retired teacher. lives
alone. has help from son.
Intracerebral hemorrhage,Flaccid hemiplegia and hemiparesis affecting nondominant side,Facial weakness,Atrial fibrillation,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Long-term (current) use of anticoagulants
Intracerebral hemorrhage,Flccd hmiplg nondmnt sde,Facial weakness,Atrial fibrillation,Pure hypercholesterolem,Depressive disorder NEC,Hypertension NOS,Hypothyroidism NOS,Long-term use anticoagul
Admission Date:  [**2105-2-10**]              Discharge Date:   [**2105-2-14**]

Date of Birth:  [**2027-11-5**]             Sex:   F

Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
L sided weakness

Major Surgical or Invasive Procedure:
Pt given 6 units of FFP and 1 unit of activated factor 9


History of Present Illness:
77 year old right handed woman presenting with new onset left
sided weakness and ICH.  Today at 2 :30 she called her son and
stated that she was having difficulty lifting her left leg. The
son was alarmed and called 911 and she was brought to an OSH.
Was given an NIHSS of 2 for face and neglect.  She was
reportedly antigravity at that time.  She was given vitamin k
but no FFP as her INR was reportedly greater than 2 as she was
on coumadin.

On neuro ROS, the pt denies headache, loss of vision, blurred
vision, diplopia, dysarthria, dysphagia, lightheadedness. Denies
difficulties producing or comprehending speech.  No bowel or
bladder incontinence or retention.

On general review of systems, she has nausea and vomiting. the
pt denies recent fever or chills.  No night sweats or recent
weight loss or gain. Denies cough, shortness of breath.  Denies
chest pain or tightness, palpitations.  No recent change in
bowel or bladder habits.  No dysuria.  Denies arthralgias or
myalgias.  Denies rash.


Past Medical History:
-afib
-high cholesterol
-htn
-hypothyroid


Social History:
not smoker, etoh, illicit drug use.  retired teacher. lives
alone. has help from son.

Family History:
no strokes


Physical Exam:
ADMISSION PHYSICAL EXAM:
Physical Exam:
Vitals: T:98.2  P:95  R: 14  BP: 130/99  SaO2:100%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple,  No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, no masses or organomegaly noted.
Extremities:warm and well perfused
Skin: no rashes or lesions noted.
.
Neurologic:
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.   Language is fluent with intact repetition
and comprehension.  Normal prosody.  There were no paraphasic
errors.  Pt. was able to name both high and low frequency
objects.  Able to read without difficulty.  Speech was minimally
dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**1-30**] at 5
minutes last w semantic cues.  The pt. had good knowledge of
current events.  There was no evidence of apraxia.
.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  unclear if she has a field cut or
if she is just neglecting the left, but unable to to see the
left
visual field.
III, IV, VI: EOMI without nystagmus.  right gaze deviation
V: Facial sensation intact to light touch.
VII: left facial droop
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.
.
-Motor: Normal bulk, tone throughout.
  flaccid on the left.  will withdrawl a flicker movement in the
left IP to noxious.
.
-Sensory: will react to painful stimuli on the left but
otherwise
neglecting.  feels full on the right.
.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    3    2   2
R  2  2    2    2   1
Plantar response was flexor on right, extensor on the left
.
-Coordination:  No dysmetria on FNF on left.
.
-Gait: deferred

DISCHARGE PHYSICAL EXAM:
Flattening of the left NL fold.  Full strength in right arm and
leg.  Dense hemiplegia in the left arm and leg.  Decreased light
touch on left arm and leg, extinction to DSS.

Pertinent Results:
ADMISSION LABS:

[**2105-2-10**] 06:02PM BLOOD WBC-7.8 RBC-4.98 Hgb-13.8 Hct-41.3 MCV-83
MCH-27.7 MCHC-33.4 RDW-12.9 Plt Ct-214
[**2105-2-10**] 06:02PM BLOOD Neuts-76.6* Lymphs-17.7* Monos-4.4
Eos-0.7 Baso-0.7
[**2105-2-10**] 06:02PM BLOOD PT-28.4* PTT-38.8* INR(PT)-2.7*
[**2105-2-10**] 08:15PM BLOOD PT-15.5* PTT-27.6 INR(PT)-1.5*
[**2105-2-11**] 12:00AM BLOOD PT-12.6* PTT-29.9 INR(PT)-1.2*
[**2105-2-11**] 03:40AM BLOOD PT-12.0 PTT-27.5 INR(PT)-1.1
[**2105-2-10**] 06:02PM BLOOD Glucose-122* UreaN-18 Creat-0.8 Na-142
K-3.7 Cl-107 HCO3-25 AnGap-14
[**2105-2-10**] 06:02PM BLOOD CK(CPK)-136
[**2105-2-11**] 03:40AM BLOOD ALT-21 AST-24 LD(LDH)-179 AlkPhos-71
TotBili-0.4
[**2105-2-10**] 06:02PM BLOOD CK-MB-3
[**2105-2-10**] 06:02PM BLOOD cTropnT-<0.01
[**2105-2-10**] 06:02PM BLOOD Calcium-9.3 Phos-2.3* Mg-2.2

DISCHARGE LABS:

[**2105-2-14**] 05:00AM BLOOD WBC-10.8 RBC-4.38 Hgb-12.2 Hct-35.8*
MCV-82 MCH-27.9 MCHC-34.2 RDW-12.8 Plt Ct-222
[**2105-2-14**] 05:00AM BLOOD Plt Ct-222
[**2105-2-14**] 05:00AM BLOOD Glucose-119* UreaN-15 Creat-0.5 Na-135
K-3.4 Cl-101 HCO3-25 AnGap-12
[**2105-2-14**] 05:00AM BLOOD Calcium-8.4 Phos-2.8 Mg-2.0

IMAGING:

NCHCT [**2105-2-10**]: IMPRESSION: Progression of right frontoparietal
intraparenchymal hemorrhage with extension into the ventricular
system as described above with minimal leftward shift of midline
structures.

NCHCT [**2105-2-11**]: IMPRESSION:
1. Significant short-interal enlargement of the right
parieto-occipital
parenchymal hemorrhage, with internal blood/fluid levels, likely
related to previous anticoagulation, with possible contribution
of CAA.
2. New intraventricular hemorrhagic extension without evidence
of
hydrocephalus.
3. Small amount of subarachnoid hemorrhage overlying the lobar
hematoma, also suggestive of underlying CAA.

CXR [**2105-2-11**]: IMPRESSION: No evidence of infection. Slightly
irregular contour of the right mediastinal border. CT of chest
is recommended .

CT Chest: [**2105-2-13**]: IMPRESSION:
No evidence of acute aortic syndrome or pulmonary embolus.

MRI brain: [**2105-2-12**]: IMPRESSION:
1. Unchanged intraparenchymal, subarachnoid, intraventricular
hemorrhage and mild mass effect.
2. No evidence of amyloid angiography, abnormal blood vessels,
or neoplasm
although these etiologies would be better evaluated after the
administration of contrast.


Brief Hospital Course:
[**Known firstname **] [**Known lastname 24049**] is a 77 year old right handed woman presenting with
new onset left sided weakness and ICH.  On exam she has neglect
of the left and is flacid on the left.   Her INR was 2.7 so she
was reversed with factor 9 in the ED.

# Neuro: we held her aspirin and coumadin given the hemorrhage,
with plan to restart the Aspirin only on [**2-17**] (7 days
after her ICH).  Her exam remained stable during this
hospitalization despite her CT scans showing some expansion of
her ICH from the OSH to her scan here.  However, on repeat
imaging her bleed stabilized by her first night here after she
had received FFP and factor 9.
.
# Cardiovascular: we maintained an SBP < 160 with PRN
hydralazine as needed, however, pt was able to maintain these
blood pressures without any intervention and did not require
hydralazine.  Digoxin was listed on her home medications on
transfer, however per discussion with her cardiologist this had
been stopped on [**1-15**], so was not continued.
.
# Endo: we continued pt's synthroid and put her on an ISS to
maintain euglycemia.  However, her glucose level here was very
steady and appropriate so we stopped it at discharge.  We
stopped her premarin to prevent any future clotting risk.
.
# Pulmonary: pt's CXR showed a possibly enlarged mediastinum so
we got a CT of her chest, which did not show any abnormalities,
and therefore was likely related to the positioning of her CXR.
.
# FEN: Pt was initially NPO, and on S&S exam she passed for
regular diet so we allowed her to eat with 1:1 supervision given
her inattention to her L side.
.
# CODE: full/ Contact - Pt's sons-[**Name (NI) **] [**Telephone/Fax (1) 94426**]/
[**Name2 (NI) **]-[**0-0-**]

PENDING RESULTS:

[**2105-2-11**] Finalized EEG Report
[**2105-2-12**] Finalized EEG Report

TRANSTIONAL CARE ISSUES:

Pt is to have her ASPIRIN RESTARTED on [**2-17**] (7 days
after her ICH), but we do not want her coumadin restarted.

MRI scheduled for pt in 8 weeks ([**2105-4-8**]) to better
determine source of the bleed.

Medications on Admission:
- Coumadin 5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime
- Premarin 0.625 mg Tab Oral
1 Tablet(s) Once Weekly
- Synthroid 100 mcg Tab Oral
1 Tablet(s) Once Daily
- Crestor 10 mg Tab Oral
2 Tablet(s) Once Daily, at bedtime
- Lopressor 50 mg Tab Oral
1 Tablet(s) Twice Daily
- Flonase 50 mcg/actuation Nasal Spray Nasal
1 Spray, Suspension(s) Once Daily
- aspirin 81 mg Tab Oral
1 Tablet(s) Once Daily
- One Daily Multivitamin Tab Oral
1 Tablet(s) Once Daily


Discharge Medications:
1. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO QHS (once a
day (at bedtime)).
3. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
4. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1)
Spray Nasal DAILY (Daily).
5. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
8. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
9. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain / temp >100.
10. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for HA.
11. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. heparin (porcine) 5,000 unit/mL Solution Sig: 5,000 units
Injection TID (3 times a day).
13. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Cape & Islands

Discharge Diagnosis:
Intraparenchymal Hemorrhage


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.

NEURO EXAM: Hemiplegic on the L side with L facial droop;
inattentive to the L-side.


Discharge Instructions:
Dear. Ms. [**Known lastname 24049**],

You were seen in the hospital for a bleed in your brain.  We
think that this was caused by fragile blood vessels as you aged
in combination with your coumadin and aspirin.  While here, we
reversed your coumadin, and monitored you closely.

We made the following changes to your medications:
1) We STOPPED your COUMADIN.
2) We STOPPED your ASPIRIN, but want you to RESTART it on the
[**4-18**]) We STOPPED your PREMARIN.
4) We STARTED you on DOCUSATE 100mg twice a day.
5) We STARTED you on SENNA 8.6mg twice a day as needed for
constipation.
6) We STARTED you on BISACODYL 10mg as needed for constipation.
7) We STARTED you on TYLENOL 325 to 650mg every 6 hours as
needed for pain or elevated temperature.
8) We STARTED you on TRAMADOL 50mg every 4 hours as needed for
headache pain.
9) We STARTED you on CITALOPRAM 20mg once a day.  Do not
abruptly stop this medication without first clearing it with
your daughter.
10) We STARTED you on SUBCUTANEOUS HEPARIN 5,000 units three
times a day to help prevent DVTs while you are in rehab.
11) We STARTED you on FAMOTIDINE 20mg twice a day.

Please continue to take your other medications as previously
prescribed.

If you experience any of the below listed Danger Signs, please
contact your doctor or go to the nearest Emergency Room.

It was a pleasure taking care of you on this hospitalization.

Followup Instructions:
Department: RADIOLOGY
When: WEDNESDAY [**2105-4-8**] at 2:20 PM
With: RADIOLOGY MRI [**Telephone/Fax (1) 327**]
Building: [**Hospital6 29**] [**Location (un) 861**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: NEUROLOGY
When: WEDNESDAY [**2105-4-8**] at 4:30 PM
With: [**First Name8 (NamePattern2) **] [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 3445**], MD [**Telephone/Fax (1) 2574**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Intracerebral hemorrhage,Flaccid hemiplegia and hemiparesis affecting nondominant side,Facial weakness,Atrial fibrillation,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Long-term (current) use of anticoagulants'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: L sided weakness

PRESENT ILLNESS: 77 year old right handed woman presenting with new onset left
sided weakness and ICH.  Today at 2 :30 she called her son and
stated that she was having difficulty lifting her left leg. The
son was alarmed and called 911 and she was brought to an OSH.
Was given an NIHSS of 2 for face and neglect.  She was
reportedly antigravity at that time.  She was given vitamin k
but no FFP as her INR was reportedly greater than 2 as she was
on coumadin.

MEDICAL HISTORY: -afib
-high cholesterol
-htn
-hypothyroid

MEDICATION ON ADMISSION: - Coumadin 5 mg Tab Oral
1 Tablet(s) Once Daily, at bedtime
- Premarin 0.625 mg Tab Oral
1 Tablet(s) Once Weekly
- Synthroid 100 mcg Tab Oral
1 Tablet(s) Once Daily
- Crestor 10 mg Tab Oral
2 Tablet(s) Once Daily, at bedtime
- Lopressor 50 mg Tab Oral
1 Tablet(s) Twice Daily
- Flonase 50 mcg/actuation Nasal Spray Nasal
1 Spray, Suspension(s) Once Daily
- aspirin 81 mg Tab Oral
1 Tablet(s) Once Daily
- One Daily Multivitamin Tab Oral
1 Tablet(s) Once Daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Physical Exam:
Vitals: T:98.2  P:95  R: 14  BP: 130/99  SaO2:100%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple,  No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, no masses or organomegaly noted.
Extremities:warm and well perfused
Skin: no rashes or lesions noted.
.
Neurologic:
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.   Language is fluent with intact repetition
and comprehension.  Normal prosody.  There were no paraphasic
errors.  Pt. was able to name both high and low frequency
objects.  Able to read without difficulty.  Speech was minimally
dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**1-30**] at 5
minutes last w semantic cues.  The pt. had good knowledge of
current events.  There was no evidence of apraxia.
.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  unclear if she has a field cut or
if she is just neglecting the left, but unable to to see the
left
visual field.
III, IV, VI: EOMI without nystagmus.  right gaze deviation
V: Facial sensation intact to light touch.
VII: left facial droop
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.
.
-Motor: Normal bulk, tone throughout.
  flaccid on the left.  will withdrawl a flicker movement in the
left IP to noxious.
.
-Sensory: will react to painful stimuli on the left but
otherwise
neglecting.  feels full on the right.
.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    3    2   2
R  2  2    2    2   1
Plantar response was flexor on right, extensor on the left
.
-Coordination:  No dysmetria on FNF on left.
.
-Gait: deferred

FAMILY HISTORY: no strokes

SOCIAL HISTORY: not smoker, etoh, illicit drug use.  retired teacher. lives
alone. has help from son. 

### Response:
{'Intracerebral hemorrhage,Flaccid hemiplegia and hemiparesis affecting nondominant side,Facial weakness,Atrial fibrillation,Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Long-term (current) use of anticoagulants'}
