CHIEF COMPLAINT: Left hemiparesis, left neglect.

PRESENT ILLNESS: 87yo woman with HTN, Hyperlipidemia, CAD, recent
ERCP with biliary stent placement aditted to the medicine servie
[**5-9**] with UTI who now presents with acute onset left hemiparesis
and left sided neglect. She was last seen well at ~11:17pm [**5-10**]
when medicine nightfloat coverage was called to evaluate the pt
for slumping against a wall in the bathroom. Medicine
nightfloat's exam at that time found the pt was fluent, using
both hands to roll toilet paper ([**Name8 (MD) **] RN), able to ambulate back
to bed. Brief neurologic exam at that time was absent for any
facial palsy. At 3am the RN noted left sided weakness and called
medicine resident to re-evalute. Code Stroke was called.
Neurology Resident examination at this time revealed NIHSS of 13
for left arm > leg hemiparesis, profound left sided
neglect/inattention, facial droop, slight dysarthria. Pt was
brought for STAT head CT/CTA/CT perfusion revealing proximal R
ICA occlusion just prior to bifurcation with prolonged MTT on
perfusion images in R MCA territory. Neurosurgery was contact[**Name (NI) **]
for possible IA intervention given that the pt was at ~5hrs
since
time last seen normal. Unfortunately given the location of the
ICA thrombus the risk of distal embolization causing total MCA
occlusion with mechanical and IA TPA clot disruption was high.
Per discussion with Dr. [**First Name (STitle) **] (neurosurgery) and Dr. [**First Name (STitle) **]
(stroke neurology), medical therapy was deemed most beneficial.

MEDICAL HISTORY: Coronary Artery Disease s/p stent placement; MI in [**1-/2140**]
S/p appendectomy
S/p cataract surgery
Transient isolated third nerve palsy- ([**2140**]) thought [**2-10**]
diabetes, resolved fully by the time the pt was seen by Dr.
[**Last Name (STitle) 4253**] at [**Hospital1 18**] neurology.
Diabetes
Lumbar spinal stenosis
CAD- s/p stents, MI [**1-/2140**]
Hypertension
Hypercholesterolemia
s/p ventral hernia repair
s/p ERCP with biliary stent placement, new afib documented with
this admission, coumadin held s/p procedure.

MEDICATION ON ADMISSION: Clopidogrel 75mg daily
Lisinopril 40mg daily
Aspirin 81mg daily
Bactrim DS [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:  T 98, BP 140/70, P  71, R 12, Sat 99% 2LNC
Gen- well appearing, older woman, R gaze preference
HEENT- NCAT, aniceric, OP clear
Neck- no carotid bruits bilat
CV- RRR, no MRG
PULM- CTA B
ABD- soft, nt, nd, bs +
Extrem- no CCE

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives at home alone, daughter lives nearby, quit smoking 65
years back prior to which she was not a heavy smoker, no
alcohol.
Urinary tract infection, site not specified,Cerebral artery occlusion, unspecified with cerebral infarction,Hemiplegia, unspecified, affecting unspecified side,Neurologic neglect syndrome,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Spinal stenosis, lumbar region, without neurogenic claudication,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status
Urin tract infection NOS,Crbl art ocl NOS w infrc,Unsp hemiplga unspf side,Neurologic neglect syndr,Atrial fibrillation,Crnry athrscl natve vssl,DMII wo cmp nt st uncntr,Hypertension NOS,Pure hypercholesterolem,Spin sten,lumbr wo claud,Old myocardial infarct,Status-post ptca
Admission Date:  [**2142-5-9**]              [**Month/Day/Year **] Date:   [**2142-5-15**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Left hemiparesis, left neglect.

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
87yo woman with HTN, Hyperlipidemia, CAD, recent
ERCP with biliary stent placement aditted to the medicine servie
[**5-9**] with UTI who now presents with acute onset left hemiparesis
and left sided neglect. She was last seen well at ~11:17pm [**5-10**]
when medicine nightfloat coverage was called to evaluate the pt
for slumping against a wall in the bathroom. Medicine
nightfloat's exam at that time found the pt was fluent, using
both hands to roll toilet paper ([**Name8 (MD) **] RN), able to ambulate back
to bed. Brief neurologic exam at that time was absent for any
facial palsy. At 3am the RN noted left sided weakness and called
medicine resident to re-evalute. Code Stroke was called.
Neurology Resident examination at this time revealed NIHSS of 13
for left arm > leg hemiparesis, profound left sided
neglect/inattention, facial droop, slight dysarthria. Pt was
brought for STAT head CT/CTA/CT perfusion revealing proximal R
ICA occlusion just prior to bifurcation with prolonged MTT on
perfusion images in R MCA territory. Neurosurgery was contact[**Name (NI) **]
for possible IA intervention given that the pt was at ~5hrs
since
time last seen normal. Unfortunately given the location of the
ICA thrombus the risk of distal embolization causing total MCA
occlusion with mechanical and IA TPA clot disruption was high.
Per discussion with Dr. [**First Name (STitle) **] (neurosurgery) and Dr. [**First Name (STitle) **]
(stroke neurology), medical therapy was deemed most beneficial.

At present, the patient denies any headache, she is unaware of
her left sided deficit. She denies weakness, numbness, tingling.
She denies any pain, f,c, CP, SOB, nausea.


Past Medical History:
Coronary Artery Disease s/p stent placement; MI in [**1-/2140**]
S/p appendectomy
S/p cataract surgery
Transient isolated third nerve palsy- ([**2140**]) thought [**2-10**]
diabetes, resolved fully by the time the pt was seen by Dr.
[**Last Name (STitle) 4253**] at [**Hospital1 18**] neurology.
Diabetes
Lumbar spinal stenosis
CAD- s/p stents, MI [**1-/2140**]
Hypertension
Hypercholesterolemia
s/p ventral hernia repair
s/p ERCP with biliary stent placement, new afib documented with
this admission, coumadin held s/p procedure.

Social History:
Lives at home alone, daughter lives nearby, quit smoking 65
years back prior to which she was not a heavy smoker, no
alcohol.

Family History:
Non contributory

Physical Exam:
Vitals:  T 98, BP 140/70, P  71, R 12, Sat 99% 2LNC
Gen- well appearing, older woman, R gaze preference
HEENT- NCAT, aniceric, OP clear
Neck- no carotid bruits bilat
CV- RRR, no MRG
PULM- CTA B
ABD- soft, nt, nd, bs +
Extrem- no CCE

NEUROLOGIC EXAM:
MS- alert and oriented to month, pt's age. Follows midline and
appendicular commands (severely neglecting left hemibody). Her
speech is mildly dysarthric, fluent. Naming intact. She neglects
the left side of the cookie theft picture.

CN-  PERRL 4-->3mm bilaterally, conjugate right gaze preference,
but EOM's are full without nystagmus. left UMN facial paresis,

Motor- left arm is [**1-13**], left leg is [**2-13**], right arm is
antigravity
x 10 seconds, right leg is antigravity x 10 seconds. No
adventitious movements.

Sensory- neglects left side. Intact on R.

Coordination- unable to test on left, itact FNF on right.

Reflexes- brisk on left, 2+ on right.

Left toe is upgoing, right toe is downgoing.


Pertinent Results:
Admission labs:

145  108  16  AGap=15
---+---+----<167
4.0  26  0.8

CK: 124  MB: 4  Trop-T: <0.01

Ca: 9.1 Mg: 2.1 P: 3.9
ALT: 19 AP: 101 Tbili: 0.7 Alb:
AST: 17

WBC 6.7, Hb 12.6, Hct 36.3, Plt 185

[**2142-5-13**] Radiology HIP UNILAT MIN 2 VIEWS LEFT
Degenerative changes, no #

[**2142-5-12**] Radiology CHEST (PORTABLE AP)   [**Last Name (LF) 162**],[**First Name3 (LF) **] APPROVED
Stable cardiomegaly and elevation of the left hemidiaphragm.
Calcification projecting over the heart. Localization of this
finding may be obtained with a lateral view

[**2142-5-12**] Radiology CT HEAD W/O CONTRAST
Evolving right MCA infarct, without significant mass effect at
this time. No hemorrhage

[**2142-5-11**] Cardiology ECHO [**2142-5-11**] [**Last Name (LF) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 975**]
The left atrium is mildly dilated. There is moderate symmetric
left ventricular hypertrophy. The left ventricular cavity size
is normal. Left ventricular systolic function is hyperdynamic
(EF 70-80%). Tissue Doppler imaging suggests an increased left
ventricular filling pressure (PCWP>18mmHg). Transmitral Doppler
and tissue velocity imaging are consistent with Grade II
(moderate) LV diastolic dysfunction. Right ventricular chamber
size and free wall motion are normal. The ascending aorta is
mildly dilated. The aortic valve leaflets (3) are mildly
thickened but aortic stenosis is not present. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. There is no mitral valve prolapse. There is severe
mitral annular calcification. Mild (1+) mitral regurgitation is
seen. [Due to acoustic shadowing, the severity of mitral
regurgitation may be significantly UNDERestimated.] The
tricuspid valve leaflets are mildly thickened. The supporting
structures of the tricuspid valve are thickened/fibrotic. There
is moderate pulmonary artery systolic hypertension. There is no
pericardial effusion.
*** Compared with the findings of the prior study (images
reviewed) of [**2142-4-24**], the findings are similoar

[**2142-5-11**] Radiology CTA HEAD W&W/O C & RECONS
1. Large area of right MCA territory ischemia, without definite
evidence of acute infarction on the included images. However,
small areas of acute infarction or infarction in areas in
territories outside the included images cannot be assessed on
the present study. MR of the head can be considered, for better
evaluation.
2. Large intraluminal filling defect, in the right distal common
carotid, common carotid bifurcation, and proximal cervical
internal carotid artery, as well as a tiny filling defect in the
cavernous right internal carotid artery, related to thrombosis.
3. Patent mid and distal cervical, intracranial internal
carotid, anterior and middle cerebral arteries.
4. Mild stenosis, without flow-limiting stenosis or
hemodynamically significant in the left common carotid, as well
as at the cavernous internal carotid arteries

[**2142-5-9**] Cardiology ECG [**2142-5-11**] [**Last Name (LF) 162**],[**First Name3 (LF) **]
Sinus bradycardia. Peaked P waves with rightward P wave axis
consistent with right atrial enlargement. There is slight ST
segment depression and T wave inversion in leads I and aVL, more
prominent as compared with prior tracing of [**2142-4-22**]. The rate
has slowed. Non-conducted atrial ectopy is no longer recorded.
A-V conduction delay persists. No diagnostic interim change.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
50 228 76 456/438 74 -7 119

[**2142-5-9**] Radiology CT HEAD W/O CONTRAST   [**Last Name (LF) 21753**],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
APPROVED
1. No acute intracranial process.
2. Likely chronic lacunar infarct in the left thalamus. Please
note that MRI with diffusion-weighted imaging is more sensitive
for detection of acute brain ischemia

Brief Hospital Course:
NEURO 87yo woman with HTN, Hyperlipidemia, CAD, recent ERCP with
biliary stent placement aditted to the medicine service [**5-9**]
with UTI who developed acute onset left hemiparesis and left
sided neglect. Her neurologic exam is notable for left
hemiparesis, profound left sided neglect and anosognosia. NCHCT
negative, but CTA/perfusion with large R ICA thrombus and
prolonged MTT in R MCA territory.  Mechanism was probably
cardioembolic as she has atrial fibrillation and was not on
heparin or coumadin and INR was sub therapeutic. She was not
considered for IV tPA as she was out of three hour window.
Interventionlist Dr [**First Name (STitle) **] was contact[**Name (NI) **] for potential IA
intervention but she was not considered for IA intervention as
right common carotid was completely occluded and there was
significant concern that introduction of a catheter may cause
dislodgement of the clot with distal embolization. Admitted to
the NeuroICU for with a large close observation of her
neurological status.

* She neurologically completed her R MCA stroke, her hemiparesis
became a diffuse grade 4 whereas at first it was strongly
dependent on the level of neglect. She continued to have a
fluctuating mental status but often was alert. She had
extinction to double sided stimulation, and a persistent
neglect, motor impersistence and inattention. Her speech was
hypophonic.

* She was started on Heparin and transitioned to warfarin given
the cardioembolic nature of the stroke (atrial fibrillation).
Heparin gtt was at 600 units per hour at the time of [**Name (NI) **]
and PTT goal should be 50-70 until INR is therapeutic (2 to 3).
She will follow-up with Dr. [**First Name8 (NamePattern2) 2530**] [**Name (STitle) **] in Neurology after
[**Name (STitle) **].

CARDIO Her bloodpressures were stable without further
interventions or changes in her bloodpressure medications. She
had intermittent Afib but did not go into RVR. Her ECHO and EKG
were stable, see "results". She should continue aspirin 81mg
daily given CAD.

ABD She was able to eat thickened liquids and pureed solids, and
was allowed to advance her diet. There were no signficant GI
issues. She was placed on a bowel regimen.

ID No issues. Afebrile throughout.

Medications on Admission:
Clopidogrel 75mg daily
Lisinopril 40mg daily
Aspirin 81mg daily
Bactrim DS [**Hospital1 **]


[**Hospital1 **] Medications:
1. Heparin (Porcine) in NS  Intravenous
2. Warfarin 5 mg Tablet Sig: One (1) Tablet PO QPM (once a day
(in the evening)).
3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
5. Aspirin 81mg po daily.


[**Hospital1 **] Disposition:
Extended Care

Facility:
[**Hospital3 7**]

[**Hospital3 **] Diagnosis:
Large R MCA territory stroke

[**Hospital3 **] Condition:
Fair. Neurologic examination notable for mild left hemiparesis
and left hemineglect.

[**Hospital3 **] Instructions:
You have been admitted with a large R sided stroke, with
neurological deficits on the L side of your body. The cause for
this is most likely your irrgeular heart which may have produced
a clot, and for this reason you will need to take Coumadin.

Please take all your medications excactly as directed and please
attend all your follow-up appointments.

Please report to the nearest ER or call 911 or your PCP
immediately when you experience recurrence of weakness,
numbness, tingling, problems with speech, language, walking,
thinking, headache, or difficulties arousing, or any other signs
or symptoms of concern.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1008**], M.D. Phone:[**Telephone/Fax (1) 285**]
Date/Time:[**2142-6-5**] 3:20

Please follow-up with your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **]
from Rehab.

Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2142-6-18**] 2:30


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{'Urinary tract infection, site not specified,Cerebral artery occlusion, unspecified with cerebral infarction,Hemiplegia, unspecified, affecting unspecified side,Neurologic neglect syndrome,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Spinal stenosis, lumbar region, without neurogenic claudication,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}


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: Left hemiparesis, left neglect.

PRESENT ILLNESS: 87yo woman with HTN, Hyperlipidemia, CAD, recent
ERCP with biliary stent placement aditted to the medicine servie
[**5-9**] with UTI who now presents with acute onset left hemiparesis
and left sided neglect. She was last seen well at ~11:17pm [**5-10**]
when medicine nightfloat coverage was called to evaluate the pt
for slumping against a wall in the bathroom. Medicine
nightfloat's exam at that time found the pt was fluent, using
both hands to roll toilet paper ([**Name8 (MD) **] RN), able to ambulate back
to bed. Brief neurologic exam at that time was absent for any
facial palsy. At 3am the RN noted left sided weakness and called
medicine resident to re-evalute. Code Stroke was called.
Neurology Resident examination at this time revealed NIHSS of 13
for left arm > leg hemiparesis, profound left sided
neglect/inattention, facial droop, slight dysarthria. Pt was
brought for STAT head CT/CTA/CT perfusion revealing proximal R
ICA occlusion just prior to bifurcation with prolonged MTT on
perfusion images in R MCA territory. Neurosurgery was contact[**Name (NI) **]
for possible IA intervention given that the pt was at ~5hrs
since
time last seen normal. Unfortunately given the location of the
ICA thrombus the risk of distal embolization causing total MCA
occlusion with mechanical and IA TPA clot disruption was high.
Per discussion with Dr. [**First Name (STitle) **] (neurosurgery) and Dr. [**First Name (STitle) **]
(stroke neurology), medical therapy was deemed most beneficial.

MEDICAL HISTORY: Coronary Artery Disease s/p stent placement; MI in [**1-/2140**]
S/p appendectomy
S/p cataract surgery
Transient isolated third nerve palsy- ([**2140**]) thought [**2-10**]
diabetes, resolved fully by the time the pt was seen by Dr.
[**Last Name (STitle) 4253**] at [**Hospital1 18**] neurology.
Diabetes
Lumbar spinal stenosis
CAD- s/p stents, MI [**1-/2140**]
Hypertension
Hypercholesterolemia
s/p ventral hernia repair
s/p ERCP with biliary stent placement, new afib documented with
this admission, coumadin held s/p procedure.

MEDICATION ON ADMISSION: Clopidogrel 75mg daily
Lisinopril 40mg daily
Aspirin 81mg daily
Bactrim DS [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals:  T 98, BP 140/70, P  71, R 12, Sat 99% 2LNC
Gen- well appearing, older woman, R gaze preference
HEENT- NCAT, aniceric, OP clear
Neck- no carotid bruits bilat
CV- RRR, no MRG
PULM- CTA B
ABD- soft, nt, nd, bs +
Extrem- no CCE

FAMILY HISTORY: Non contributory

SOCIAL HISTORY: Lives at home alone, daughter lives nearby, quit smoking 65
years back prior to which she was not a heavy smoker, no
alcohol. 

### Response:
{'Urinary tract infection, site not specified,Cerebral artery occlusion, unspecified with cerebral infarction,Hemiplegia, unspecified, affecting unspecified side,Neurologic neglect syndrome,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Pure hypercholesterolemia,Spinal stenosis, lumbar region, without neurogenic claudication,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status'}
