CHIEF COMPLAINT: Left intracranial hemorrhage

PRESENT ILLNESS: Patient is unable to give history. History taken from friend and
nursing/ED notes. Patient is a 61 year old man, unknown
handedness, who was transferred to [**Hospital1 18**] ED on [**2195-1-11**] from
[**Location (un) 47**] ED for evaluation and management of left intracranial
hemorrhage after being found confused and aphasic earlier today.

MEDICAL HISTORY: None known. As [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Scientist, he practices faith
based healing.

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc: 99.4 BP: 116/94 HR: 70 RR: 17 O2Sat.: 98%/2L
Gen: WD/WN, comfortable, NAD.
HEENT: NC/AT. Anicteric. MMM.
Neck: Supple. No masses or LAD. No JVD. No thyromegaly. No
carotid bruits.
Lungs: CTA bilaterally. No R/R/W.
Cardiac: RRR. S1/S2. No M/R/G.
Abd: Soft, NT, ND, +NABS. No rebound or guarding. No HSM.
Extrem: Warm and well-perfused. No C/C/E.
Neuro: Alert and awake. Oriented to self.  Speech fluent, pt
loquacious with non-sensical steady stream of words.  Naming
intact to high frequency objects but not to low frequency ones.
Speech with many phonemic and semantic paraphasic errors.
Repetition intact.  Following midline commands, but not lateral
commands.

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Married. Lives with wife. Wife is in [**State **] on a business
trip but is on her way back to [**Location (un) 86**] area. Unknown habits
history.
Intracerebral hemorrhage,Chronic kidney disease, unspecified,Unspecified essential hypertension
Intracerebral hemorrhage,Chronic kidney dis NOS,Hypertension NOS
Admission Date:  [**2195-1-11**]              Discharge Date:   [**2195-1-16**]

Date of Birth:  [**2133-12-30**]             Sex:   M

Service: [**Year (4 digits) **]

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8747**]
Chief Complaint:
Left intracranial hemorrhage

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Patient is unable to give history. History taken from friend and
nursing/ED notes. Patient is a 61 year old man, unknown
handedness, who was transferred to [**Hospital1 18**] ED on [**2195-1-11**] from
[**Location (un) 47**] ED for evaluation and management of left intracranial
hemorrhage after being found confused and aphasic earlier today.

Patient was last seen well around 11am today. He leads a
[**Doctor First Name **] Scientist service and was able to complete service
without any difficulties. Afterwards, he went to clean out an
office nearby. Friends were to meet him there to help. His
friends arrived around 11:30 am. They found him down on the
ground. He was confused, speaking gibberish, and had right
facial droop and weakness of his right side. They opted to take
him to [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Scientist nursing center, where he was
observed until just before 2pm, at which time an ambulance was
called.

He arrived at [**Location (un) 47**] [**Hospital1 1281**] at around 2:15 pm. Initial vitals
with BP 118/94, HR 77, RR 18, O2 98%/Ra. He did have BP spike up
to 165/103 and was given 10 mg IV Labetalol. Head CT there
reportedly showed a 3.5 x 2.6 left basal ganglia hemorrhage as
well as a smaller focus of hemorrhage on the right. He was
loaded with Dilantin there.

His wife was spoken to via telephone and reportedly said she
wanted option of surgical intervention if necessary. He was
therefore transferred to our facility.

Past Medical History:
None known. As [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Scientist, he practices faith
based healing.


Social History:
Married. Lives with wife. Wife is in [**State **] on a business
trip but is on her way back to [**Location (un) 86**] area. Unknown habits
history.


Family History:
Unknown.


Physical Exam:
Tc: 99.4 BP: 116/94 HR: 70 RR: 17 O2Sat.: 98%/2L
Gen: WD/WN, comfortable, NAD.
HEENT: NC/AT. Anicteric. MMM.
Neck: Supple. No masses or LAD. No JVD. No thyromegaly. No
carotid bruits.
Lungs: CTA bilaterally. No R/R/W.
Cardiac: RRR. S1/S2. No M/R/G.
Abd: Soft, NT, ND, +NABS. No rebound or guarding. No HSM.
Extrem: Warm and well-perfused. No C/C/E.
Neuro: Alert and awake. Oriented to self.  Speech fluent, pt
loquacious with non-sensical steady stream of words.  Naming
intact to high frequency objects but not to low frequency ones.
Speech with many phonemic and semantic paraphasic errors.
Repetition intact.  Following midline commands, but not lateral
commands.

Pertinent Results:
CT head [**1-11**]: There is a large area of high attenuation within
the region of the left lentiform nucleus. There is low
attenuation of the periventricular white matter consistent with
chronic microvascular infarction. There is no shift of normally
midline structures or hydrocephalus. The [**Doctor Last Name 352**]-white matter
differentiation remains intact. There is slight asymmetry of the
sulci, with slightly more effacement of the left cerebral sulci.
The osseous structures are normal. There is a polyp versus
mucosal retention cyst in the left maxillary sinus.

CT head [**1-12**]: IMPRESSION: No significant interval change in the
appearance of the intraparenchymal hematoma in the left basal
ganglia.
[**2195-1-11**] 04:10PM BLOOD WBC-16.6* RBC-4.58* Hgb-15.1 Hct-40.5
MCV-88 MCH-32.9* MCHC-37.2* RDW-13.3 Plt Ct-206
[**2195-1-13**] 05:35AM BLOOD WBC-8.6 RBC-4.51* Hgb-14.7 Hct-41.0
MCV-91 MCH-32.6* MCHC-35.8* RDW-13.2 Plt Ct-192
[**2195-1-11**] 04:10PM BLOOD Neuts-90.2* Bands-0 Lymphs-7.3* Monos-2.1
Eos-0 Baso-0.3
[**2195-1-11**] 04:10PM BLOOD PT-13.0 PTT-27.5 INR(PT)-1.1
[**2195-1-11**] 04:10PM BLOOD Plt Smr-NORMAL Plt Ct-206
[**2195-1-11**] 04:10PM BLOOD Glucose-112* UreaN-21* Creat-1.6* Na-142
K-4.1 Cl-107 HCO3-24 AnGap-15
[**2195-1-13**] 05:35AM BLOOD Glucose-96 UreaN-14 Creat-1.5* Na-143
K-3.7 Cl-109* HCO3-24 AnGap-14
[**2195-1-14**] 08:30AM BLOOD Glucose-87 UreaN-12 Creat-1.5* Na-142
K-4.2 Cl-106 HCO3-25 AnGap-15
[**2195-1-15**] 11:25AM BLOOD ALT-39 AST-43* AlkPhos-84
[**2195-1-11**] 04:10PM BLOOD CK(CPK)-108
[**2195-1-11**] 04:10PM BLOOD CK-MB-3 cTropnT-0.01
[**2195-1-14**] 08:30AM BLOOD Calcium-9.3 Phos-2.6* Mg-1.9
[**2195-1-15**] 11:25AM BLOOD Albumin-4.1 Cholest-PND

Brief Hospital Course:
Patient is a 61 year old man with no known PMH who presented
with garbled speech, R hemiparesis and R facial droop, found to
have a L basal ganglia bleed.

1. Neuro: CT scan was done showing low attenuation of the
periventricular white matter consistent with chronic
microvascular infarction as well as a L BG bleed.  CT was
repeated the next day and showed no progression of the bleed.
The etiology of the bleed was presumed to be [**3-19**] a combination
of HTN and hypercholesterolemia, although these are difficult to
be certain of given lack of previous medical contact.  The
patient was found to have Wernicke's aphasia.  His language
improved dramatically over the course of a few days.  At the
time of discharge he was able to express himself fully, although
still making some paraphasic errors.  His repetition and
comprehension are fully intact.  He continues to have a mild R
facial droop.  His R hemiparesis improved significantly with R
deltoid and IP muscles improving to [**5-20**].  He was able to walk
without assistance, albeit somewhat unsteady.  His cerebellar
exam is unremarkable.

2. HTN - The patient was found to be hypertensive during his
stay with SBP in the 150's, and was started on metoprolol which
was titrated up to 25mg PO BID with improved BP control.

3.  Hypercholesterolemia - a lipid panel was sent showing total
cholesterol of 219 and LDL of 158.  He was started on lipitor at
10mg daily.

4.  Renal Insufficiency - a slightly elevated Cr of 1.5 was
found which remained stable during his admission.  A renal U/S
was ordered showing some assymetry with the L kidney being
smaller.  He was not started on an ACE-I because of unknown
previous Cr values, but he will be scheduled to follow up with
the [**Month/Day (1) **] clinic to discuss possible imaging for
renovascular disease or possibly initiating ACE-Inhibitor
therapy.

5.  FEN - blood sugars were normal throughout admission

6.  Dispo - pt refused to go to a rehab facility, wanted to go
home.  At the time of discharge, pt was given a walker to aid
with mobility.  He will be scheduled for a follow-up head MRI in
6 weeks, follow-up with a [**Month/Day (1) 3390**], [**Name10 (NameIs) **], and referred to the
[**Name10 (NameIs) **] clinic.

Medications on Admission:
none

Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Toprol XL 50 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Stroke, hemorrhagic
Hypertension
Chronic Renal Insufficiency


Discharge Condition:
stable


Discharge Instructions:
Please take your medications as prescribed.  Follow-up with your
neurologist and primary care physician as scheduled.  In
addition follow up in the [**Name10 (NameIs) **] (kidney) clinic as
scheduled.  Call the radiology department within the next week
to schedule an outpatient MRI in [**6-20**] weeks.  Discuss with your
doctor [**First Name (Titles) 3380**] [**Last Name (Titles) **] after that.
Call your doctor or report to the nearest hospital if you
develop any worsening in your speech or if you develop any
weakness, numbness or other concerning symptoms.

Followup Instructions:
Call Dr.[**Name (NI) 12755**] ([**Name (NI) **]) office at ([**Telephone/Fax (1) 7394**] to
schedule a follow-up appointment.

Call the Radiology department at [**Telephone/Fax (1) 327**] to schedule a
follow-up MRI in [**6-20**] weeks.

Provider [**Name Initial (PRE) **] [**Name Initial (NameIs) 3390**]: [**Name10 (NameIs) 23675**] [**Name11 (NameIs) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2195-2-6**] 1:30

Provider [**Name Initial (PRE) **] [**Name Initial (NameIs) 10701**]: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 7198**], M.D.
Date/Time:[**2195-2-25**] 1:00.  You need to call the clinic prior to
appointment to update your registration information.



Completed by:[**2195-1-25**]
{'Intracerebral hemorrhage,Chronic kidney disease, unspecified,Unspecified essential hypertension'}


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 intracranial hemorrhage

PRESENT ILLNESS: Patient is unable to give history. History taken from friend and
nursing/ED notes. Patient is a 61 year old man, unknown
handedness, who was transferred to [**Hospital1 18**] ED on [**2195-1-11**] from
[**Location (un) 47**] ED for evaluation and management of left intracranial
hemorrhage after being found confused and aphasic earlier today.

MEDICAL HISTORY: None known. As [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] Scientist, he practices faith
based healing.

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Tc: 99.4 BP: 116/94 HR: 70 RR: 17 O2Sat.: 98%/2L
Gen: WD/WN, comfortable, NAD.
HEENT: NC/AT. Anicteric. MMM.
Neck: Supple. No masses or LAD. No JVD. No thyromegaly. No
carotid bruits.
Lungs: CTA bilaterally. No R/R/W.
Cardiac: RRR. S1/S2. No M/R/G.
Abd: Soft, NT, ND, +NABS. No rebound or guarding. No HSM.
Extrem: Warm and well-perfused. No C/C/E.
Neuro: Alert and awake. Oriented to self.  Speech fluent, pt
loquacious with non-sensical steady stream of words.  Naming
intact to high frequency objects but not to low frequency ones.
Speech with many phonemic and semantic paraphasic errors.
Repetition intact.  Following midline commands, but not lateral
commands.

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: Married. Lives with wife. Wife is in [**State **] on a business
trip but is on her way back to [**Location (un) 86**] area. Unknown habits
history. 

### Response:
{'Intracerebral hemorrhage,Chronic kidney disease, unspecified,Unspecified essential hypertension'}
