CHIEF COMPLAINT: transfer from OSH for L basal ganglia bleed

PRESENT ILLNESS: per admitting resident:

MEDICAL HISTORY: HTN (his wife was not sure when he last saw a PCP)

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam on admission:
T-97.7 BP-257/115--->140/86 HR-55-60
on vent 860/16/5   100%
Propofol turned off
Gen: intubated, ventilated, biting his ET tube
HEENT: NC/AT, moist oral mucosa
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Father - CAD
Mother - colorectal ca

SOCIAL HISTORY: Lives with his wife and son. According to his wife, he does
not smoke, drink alcohol or use recreational drugs. He works for
Standard Duplicity and records and ships machine parts. He is
non-compliant on meds, and has not seen a PCP in many years. His
wife has bipolar depression as she is currently off meds.
Wife - [**Name (NI) 717**] [**Last Name (NamePattern1) **]: [**Telephone/Fax (1) 83833**]
Son - [**Name (NI) **] [**Last Name (NamePattern1) **]: [**Telephone/Fax (1) 83834**]
Intracerebral hemorrhage,Malignant essential hypertension,Hemiplegia, unspecified, affecting nondominant side,Hypopotassemia,Examination of participant in clinical trial,Personal history of noncompliance with medical treatment, presenting hazards to health
Intracerebral hemorrhage,Malignant hypertension,Unsp hmiplga nondmnt sde,Hypopotassemia,Exam-clincal trial,Hx of past noncompliance
Admission Date:  [**2146-11-18**]              Discharge Date:   [**2146-11-25**]

Date of Birth:  [**2089-1-17**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
transfer from OSH for L basal ganglia bleed

Major Surgical or Invasive Procedure:
none

History of Present Illness:
per admitting resident:

57 yo LHM with a history of uncontrolled HTN, who went to
work around 7 am, at around 7 am, he called his wife to tell her
that he was having a stroke. According to both his wife and son,
he was perfectly well the evening prior and the morning of the
event.

He was then found by a co-worker outside of the bathroom
sometime
after 7 am, very confused and disorientated. EMS was [**Name (NI) 653**],
and he was taken to [**Hospital3 51769**]. He arrived at the OSH around
8:27
am, and he was found to have a right facial, right sided
weakness, but still oriented X3. His BP on arrival was 224/135.
He had a CT head scan which showed a left basal ganglia
hemorrhage (1.5X4.1 cm), his coags were normal. He started
vomiting, then became confused, barely rousable, no longer
opening his eyes consistently to command, thus he was intubated
and ventilated at 9:20 am (Lidocaine 100, Vecuronium one dose,
Etomidate 30, Succ 140, Fentanyl 100), and transferred to the
[**Hospital1 18**] ER.


Past Medical History:
HTN (his wife was not sure when he last saw a PCP)


Social History:
Lives with his wife and son. According to his wife, he does
not smoke, drink alcohol or use recreational drugs. He works for
Standard Duplicity and records and ships machine parts. He is
non-compliant on meds, and has not seen a PCP in many years. His
wife has bipolar depression as she is currently off meds.
Wife - [**Name (NI) 717**] [**Last Name (NamePattern1) **]: [**Telephone/Fax (1) 83833**]
Son - [**Name (NI) **] [**Last Name (NamePattern1) **]: [**Telephone/Fax (1) 83834**]


Family History:
Father - CAD
Mother - colorectal ca


Physical Exam:
Exam on admission:
T-97.7 BP-257/115--->140/86 HR-55-60
on vent 860/16/5   100%
Propofol turned off
Gen: intubated, ventilated, biting his ET tube
HEENT: NC/AT, moist oral mucosa
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: does not follow commands

Cranial Nerves:
Pupils equally round and reactive to light, 4 to 3 mm
bilaterally. Fundoscopy shows no papilledema bilaterally. Blinks
to threat bilaterally. Corneal reflexes are in tact bilaterally.
Dolls head response is normal. Nasal tickle is normal
bilaterally, but appears to have a right facial asymmetry
(intubated so difficult to make out properly). Gag is in tact.

Motor & sensory:
Moves his right side purposefully and spontaneously and appears
to be antigravity throughout. He has a left hemiparesis. Moves
his right side away from noxious stimulus, but not his left
side.

Reflexes are brisker on the right than on the left, with an
upgoing right toe.


Pertinent Results:
Labs on admission and dicharge:

[**2146-11-18**] 10:45AM BLOOD WBC-9.3 RBC-5.44 Hgb-16.4 Hct-46.6 MCV-86
MCH-30.2 MCHC-35.2* RDW-14.4 Plt Ct-183
[**2146-11-18**] 10:45AM BLOOD Neuts-91.6* Lymphs-6.0* Monos-1.8*
Eos-0.1 Baso-0.4

[**2146-11-21**] 02:14AM BLOOD WBC-5.1 RBC-4.62 Hgb-14.3 Hct-40.0 MCV-86
MCH-30.9 MCHC-35.8* RDW-14.2 Plt Ct-185

[**2146-11-18**] 10:45AM BLOOD PT-12.0 PTT-26.7 INR(PT)-1.0
[**2146-11-19**] 01:52AM BLOOD PT-12.5 PTT-29.9 INR(PT)-1.0
[**2146-11-21**] 02:14AM BLOOD PT-12.5 PTT-29.7 INR(PT)-1.1

[**2146-11-18**] 10:45AM BLOOD Glucose-127* UreaN-21* Creat-1.2 Na-140
K-4.0 Cl-102 HCO3-29 AnGap-13
[**2146-11-21**] 02:14AM BLOOD Glucose-92 UreaN-15 Creat-0.9 Na-137
K-3.1* Cl-104 HCO3-23 AnGap-13

[**2146-11-18**] 10:45AM BLOOD ALT-40 AST-34 CK(CPK)-174 AlkPhos-87
TotBili-1.1
[**2146-11-19**] 01:52AM BLOOD CK(CPK)-107
[**2146-11-21**] 02:14AM BLOOD ALT-19 AST-17 AlkPhos-74 TotBili-1.1

[**2146-11-18**] 10:45AM BLOOD cTropnT-<0.01
[**2146-11-18**] 08:23PM BLOOD CK-MB-5 cTropnT-<0.01
[**2146-11-19**] 01:52AM BLOOD CK-MB-5 cTropnT-<0.01

[**2146-11-18**] 10:45AM BLOOD Iron-116
[**2146-11-18**] 10:45AM BLOOD calTIBC-358 Ferritn-345 TRF-275
[**2146-11-19**] 01:52AM BLOOD Calcium-8.4 Phos-3.4 Mg-2.0 Iron-59
[**2146-11-19**] 01:52AM BLOOD calTIBC-287 Ferritn-300 TRF-221
[**2146-11-21**] 02:14AM BLOOD Calcium-8.5 Phos-2.5* Mg-1.9 Iron-93
[**2146-11-21**] 02:14AM BLOOD calTIBC-267 Ferritn-385 TRF-205

[**2146-11-18**] 10:45AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

[**2146-11-18**] 11:15AM URINE bnzodzp-POS barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG

Urine studies:
[**2146-11-18**] 11:15AM URINE Blood-MOD Nitrite-NEG Protein-75
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG
[**2146-11-19**] 01:53AM URINE Blood-NEG Nitrite-NEG Protein-25
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR
[**2146-11-20**] 02:09AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-80 Bilirub-NEG Urobiln-0.2 pH-5.0 Leuks-TR
[**2146-11-21**] 02:17AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-50 Bilirub-NEG Urobiln-1 pH-6.5 Leuks-NEG

Images:

CT head [**11-18**]

IMPRESSION: 34 x 16 mm hemorrhage within the area of the left
basal ganglia, relatively unchanged since prior exam at 8:26
a.m. on the same day, with mild mass effect and no shift of
normally midline structures.

CT head [**11-19**]

IMPRESSION Overall unchanged appearance of the brain with left
basal ganglia hemorrhage as seen on the previous CT of [**2146-11-18**].


CT head [**11-21**]

IMPRESSION:

No significant change in the left basal ganglion hemorrhage.


Brief Hospital Course:
57 yo man with uncontrolled HTN, who became suddenly confused
and disoriented on day of admission. He was taken to [**Hospital3 51769**]
where a he was noted to have a right facial droop and a right
hemiparesis. His BP was 224/135.  Head CT showed a hemorrhage
(1.5X4.1)cm in the left basal ganglia. He became progressively
confused, had emesis, was unable to follow commands and was
intubated for airway protection.  At time of transfer to [**Hospital1 18**],
his BP was 157/114, repeat CT head showed a stable hemorrhage
(1.6X3.4)cm.  His GCS was E1V0M5 and his ICH grade of 2. On
examination he had intact brainstem reflexes, actively movement
of LEFT side and RIGHT hemiparesis.  He was admitted to
NEURO-ICU for further monitoring and treatment.

NEURO.  Most likely etiology was felt to be a hypertensive
hemorrhage.  Patient was entered into a DFO (Deferoxamine) study
with appropriate consent.  He was treated per ICH guidelines and
was started on Nicardipine gtt with goal of SBP 120-140s.  He
received three days of Deferoxamine IV.  Fe studies, LFTs, CBC
and BMP were obtained as per protocol.  His Head CTs remained
stable throughout hospital stay.  By HD#3, his motor deficits
were largely resolved with mild D/WE/FE weakness on the RIGHT of
4+/5 intensity and IP/H 4+/5 weakness on the RIGHT as well.  He
had mild difficulty with coordination in RUE.  Nicardipine was
weaned by HD#4 and patient was transitioned to PO meds:
Amlodipine, Captopril.  There was difficulty controlling the
patient's blood pressure.  There internal medicine consult
service made a number of recommendations to  At time of
discharge his antihypertensive regimen included Amlodpine,
Clondine, Lisinopril and Metoprolol  and the BPs on day of
discharge ranged between 120-150 systolic and 70-90 diastolic.

PULM.  Patient was extubated by HD1 without complications.

CV.  Chronic hypertension.  The patient had a US which did not
show any signs of renal artery stenosis. A urine metanephenrine
study was sent as well but was pending on time of discharge.

RENAL.  Proteinuria noted.  Given history of HTN in his 20s he
underwent secondary hypertension evaluation including a TSH
which was normal and Renal US with dopplers which showed no
stenosis.


Discharge Medications:
1. Outpatient Physical Therapy
2. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
5. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
Disp:*120 Tablet(s)* Refills:*2*
6. Docusate Sodium 100 mg Capsule Sig: [**12-31**] Capsules PO once a
day: You can take Docusate more than once per day if he
continues to be constipated.
Disp:*60 Capsule(s)* Refills:*2*
7. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
capfull PO twice a day as needed for constipation: You can take
a little more or less to produce stools the consistency of
toothpaste.
Disp:*1 bottle* Refills:*2*
8. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 **]

Discharge Diagnosis:
Primary: Hypertensive left basal ganglia hemorrhage
Secondary: Hypertension


Discharge Condition:
Hemodynamically and medically stable.  Alert and oriented to
person, place, and time. Comprehension intact, following
commands.  Neurological exam remarkable for flattening of the
right nasolabial fold, right pronator drift, and decreased
coordination in the right hand.


Discharge Instructions:
You were admitted to [**Hospital1 18**] from another hospital after you
presented with a headache and right sided weakness.  You were
intubated for airway protection.  You were found to have a bleed
inside your head, that was most likely due to poorly controlled
hypertension.  You were treated with blood pressure medications
as well as deferoxamine (you were involved in a clinical trial
study).

Your weakness significantly improved.

The following medications were added to your regimen:
Amlodipine, HCTZ (hydrochlorothiazide), Metoprolol, Clonidine,
Lisinopril, Docusate, and Polyethylene Glycol (MiraLax).

Because of your body habitus and your neck size and history of
hypertension you may benefit from an evaluation for sleep apnea.

Should you develop a new headache, changes in vision, numbness,
tingling, shortness of breath, chest pain, weakness or any other
symptom concerning to you please call your doctor or go to the
emergency room.

Followup Instructions:
Please follow up with the following appointments:

NEUROLOGY:
Provider [**Name9 (PRE) 4267**] [**Last Name (NamePattern4) 4268**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 657**]
Date/Time:[**2146-12-13**] 3:30
On the [**Location (un) **] of the [**Hospital Ward Name 23**] Clinical Center, [**Hospital1 771**], [**Location 83835**]

PRIMARY CARE:
Your son is finding a PCP for you in your [**Location 27224**] and will make
a follow up appointment. You are planning to see Dr. [**Last Name (STitle) **]
[**Name (STitle) **] at [**Hospital3 **] in [**Location (un) 7661**], MA.


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Intracerebral hemorrhage,Malignant essential hypertension,Hemiplegia, unspecified, affecting nondominant side,Hypopotassemia,Examination of participant in clinical trial,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: transfer from OSH for L basal ganglia bleed

PRESENT ILLNESS: per admitting resident:

MEDICAL HISTORY: HTN (his wife was not sure when he last saw a PCP)

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam on admission:
T-97.7 BP-257/115--->140/86 HR-55-60
on vent 860/16/5   100%
Propofol turned off
Gen: intubated, ventilated, biting his ET tube
HEENT: NC/AT, moist oral mucosa
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Father - CAD
Mother - colorectal ca

SOCIAL HISTORY: Lives with his wife and son. According to his wife, he does
not smoke, drink alcohol or use recreational drugs. He works for
Standard Duplicity and records and ships machine parts. He is
non-compliant on meds, and has not seen a PCP in many years. His
wife has bipolar depression as she is currently off meds.
Wife - [**Name (NI) 717**] [**Last Name (NamePattern1) **]: [**Telephone/Fax (1) 83833**]
Son - [**Name (NI) **] [**Last Name (NamePattern1) **]: [**Telephone/Fax (1) 83834**] 

### Response:
{'Intracerebral hemorrhage,Malignant essential hypertension,Hemiplegia, unspecified, affecting nondominant side,Hypopotassemia,Examination of participant in clinical trial,Personal history of noncompliance with medical treatment, presenting hazards to health'}
