CHIEF COMPLAINT: The patient was admitted to undergo coiling
of her left anterior communicating artery aneurysm.

PRESENT ILLNESS: The patient is a 73 year old
woman with a history of CAD, PVD, right internal carotid
artery stenosis status post stenting, lung nodule and left
ACOM aneurysm, who was admitted for coiling.  The left ACOM
aneurysm is 4 x 5 mm in diameter and asymptomatic.  However,
patient requires an open resection of her lung nodule as
previous attempts at more noninvasive diagnostic procedures
have not yielded a definitive diagnosis.  Her cardiothoracic
surgeons require that the left ACOM aneurysm be coiled prior
to taking her to surgery.  She underwent cerebral angiogram
and an attempted coiling procedure of [**2155-1-28**].
However, the coiling was not successful as the base of the
aneurysm was large and did not allow for sufficient
aneurysmal luminal closure.  Post procedure patient had high
blood pressure and required unit level care with IV agents to
maintain her pressure below a systolic of 200.

MEDICAL HISTORY: CAD.  Right ICA disease status post
stenting.  Lung mass.  Hypothyroidism.  History of breast
cancer.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin and codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: Diabetes, hypertension, heart disease.

SOCIAL HISTORY: The patient lives with her daughter.  She
does not smoke.
Cerebral aneurysm, nonruptured,Pneumonitis due to inhalation of food or vomitus,Iatrogenic cerebrovascular infarction or hemorrhage,Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of breast,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified
Nonrupt cerebral aneurym,Food/vomit pneumonitis,Iatrogen CV infarc/hmrhg,Subendo infarct, initial,Hematoma complic proc,Other lung disease NEC,Hx of breast malignancy,Hypothyroidism NOS,Periph vascular dis NOS
Admission Date:  [**2155-1-28**]       Discharge Date:  [**2155-2-8**]

Date of Birth:   [**2081-9-9**]       Sex:  F

Service:  NEUROLOGY

CHIEF COMPLAINT:  The patient was admitted to undergo coiling
of her left anterior communicating artery aneurysm.

HISTORY OF PRESENT ILLNESS:  The patient is a 73 year old
woman with a history of CAD, PVD, right internal carotid
artery stenosis status post stenting, lung nodule and left
ACOM aneurysm, who was admitted for coiling.  The left ACOM
aneurysm is 4 x 5 mm in diameter and asymptomatic.  However,
patient requires an open resection of her lung nodule as
previous attempts at more noninvasive diagnostic procedures
have not yielded a definitive diagnosis.  Her cardiothoracic
surgeons require that the left ACOM aneurysm be coiled prior
to taking her to surgery.  She underwent cerebral angiogram
and an attempted coiling procedure of [**2155-1-28**].
However, the coiling was not successful as the base of the
aneurysm was large and did not allow for sufficient
aneurysmal luminal closure.  Post procedure patient had high
blood pressure and required unit level care with IV agents to
maintain her pressure below a systolic of 200.

PAST MEDICAL HISTORY:  CAD.  Right ICA disease status post
stenting.  Lung mass.  Hypothyroidism.  History of breast
cancer.

MEDICATIONS:  Levoxyl 150 mcg p.o. q.day, Celexa 10 mg p.o.
q.day, folic acid 1 mg p.o. q.day, tamoxifen 10 mg p.o.
b.i.d., mesalamine DR 800 p.o. t.i.d., Neurontin 300 p.o.
t.i.d., Celebrex 100 p.o. b.i.d., sublingual nitroglycerin
0.3 mg p.r.n. chest pain, isosorbide dinitrate 10 p.o.
t.i.d., aspirin 325 mg p.o. q.day, Lopressor 50 mg p.o.
b.i.d., losartan potassium 50 mg p.o. q.d., Fosamax 70 mg
p.o. q.week, Percocet p.r.n.

ALLERGIES:  Penicillin and codeine.

SOCIAL HISTORY:  The patient lives with her daughter.  She
does not smoke.

FAMILY HISTORY:  Diabetes, hypertension, heart disease.

PHYSICAL EXAMINATION:  Temperature 97.2, blood pressure
200/85, heart rate 80, oxygen saturation 98% in room air.  In
general, obese woman in no acute distress.  Cardiovascular
regular rhythm, normal rate.  Pulmonary clear to auscultation
bilaterally.  Abdomen positive bowel sounds, soft,
nondistended, nontender.  Neurologic awake, alert and
interactive.  Language and comprehension were intact.
Cranial nerves pupils equal and reactive to light.
Extraocular motions were full.  Visual fields were full.
Facial movement and palatal elevation were normal.  Tongue
protruded midline.  Facial sensation was intact to touch,
temperature and pin prick.  Motor normal bulk, tone and power
throughout except for the iliopsoas which could not be tested
adequately as there were two sheaths in place post procedure.
There were positive pulses in the femoral arteries as well as
more distally bilaterally.  Sensation was intact to touch,
temperature and pin prick.  Reflexes were symmetric and toes
were downgoing.

HOSPITAL COURSE:  The patient was admitted to the intensive
care unit where IV agents were used to lower her blood
pressure to more normal range.  Her oral agents were
restarted.  However, the next morning patient was found to be
weak on the left side, particularly in her face, arm and leg.
She transiently improved.  However, subsequently redeveloped
the same symptoms and, therefore, she underwent a stat head
CT which revealed a right ACA distribution ischemic infarct
which was small and in the right frontal lobe perisagittally.
Over the next several hospitalization days patient improved
strength-wise.  Her facial, leg and arm weakness improved
back to normal strength, however, she had a difficult time
initiating movement on that side.  This may be secondary to
the small stroke in the premotor cortex.

She improved steadily throughout her course and was weaned
off IV antihypertensive agents and transferred to the floor.
Her course there was complicated by chest pain and cardiac
enzymes consistent with a non-ST segment elevation MI with
troponins which steadily climbed to greater than 50 troponin
I.  CKs remained unchanged at less than 100 without an
elevated MB fraction.  EKG showed some nonspecific T wave
changes, but there was no ST segment elevation.  Cardiology
was consulted at that time and they recommended conservative
management with heparin IV.  However, her IV access became
problem[**Name (NI) 115**] and, therefore, surgery was consulted to place a
central venous line.  This procedure was complicated by post
procedure ecchymosis and hematoma in the left chest and neck
owing to failed attempt at left IJ and subclavian venous
cannulations.  Her hematocrit dropped from 35 to 28.  She
received 2 units of blood and her hematocrit went up
appropriately and was most recently 33.

Except for an episode of substernal chest pain in the setting
of a low hematocrit, patient has been chest pain free.  She
underwent cardiac echo which did not show any evidence of
abnormal wall motion.  Her ejection fraction was within the
normal range.  Cardiology, therefore, recommended
discontinuation of heparin and continued conservative
management.  They expect the troponin elevation to last
several weeks.

The patient had an episode of left ptosis which was evaluated
with MR imaging of the head and neck.  This did not reveal
any acute infarction.  However, there was diffusion and T2
abnormalities in the ACA distribution as described by the CT
scan previously.  There was also a smaller area of
abnormality both on T2 and diffusion in the right ACA
territory which was further rostral in the brain.  There was
also evidence of previous small vessel disease.

The patient continued to do well clinically and, therefore,
she would be appropriate for physical therapy and
rehabilitation.  At the time of this dictation she is chest
pain free and doing well.  She should follow up with
cardiology, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**], in two to three weeks' time.

CONDITION ON DISCHARGE:  Clinically stable.

DISCHARGE STATUS:  Discharged to [**Hospital 246**] rehabilitation
facility.

DISCHARGE DIAGNOSES:
1.  Left ACOM aneurysm.
2.  Right ACA ischemic infarction.
3.  Non-ST segment elevation myocardial infarction with
troponin greater than 50.
4.  Post central line ecchymosis and hematoma.

SECONDARY DIAGNOSES:
1.  Lung nodule.
2.  CAD.
3.  Hypothyroidism.
4.  Breast cancer.
5.  Hypertension.

DISCHARGE MEDICATIONS:
1.  Levoxyl 150 mcg p.o. q.day.
2.  Celexa 10 mg p.o. q.day.
3.  Folic acid 1 mg p.o. q.day.
4.  Tamoxifen 10 mg p.o. b.i.d.
5.  Mesalamine DR 800 mg p.o. t.i.d.
6.  Neurontin 300 mg p.o. t.i.d.
7.  Celebrex 100 mg p.o. b.i.d.
8.  Sublingual nitroglycerin 0.4 mg p.r.n. chest pain.
9.  Percocet one tablet p.o. q.four to six hours p.r.n.
10. Colace 100 mg p.o. b.i.d.
11. Isosorbide dinitrate 10 mg p.o. t.i.d.
12. Lopressor 50 mg p.o. b.i.d.
13. Losartan 50 mg p.o. q.day.
14. Fosamax 70 mg p.o. q.week.
15. Aspirin 325 mg p.o. q.day.
16. Plavix 75 mg p.o. q.day.
17. Cream for psoriasis to include hydrocortisone cream
b.i.d., triamcinolone cream b.i.d.

NOTE:  The patient was restarted on her Plavix regimen which
had been stopped prior to her angiogram.

FOLLOWUP:  The patient is to follow up with Dr. [**Last Name (STitle) **].
She will also follow up with cardiology, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 73**],
at [**Telephone/Fax (1) 902**], in two to three weeks' time.  The exact date
will be placed on the page one.






                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 43**], M.D.  [**MD Number(1) 2107**]

Dictated By:[**Dictator Info **]
MEDQUIST36

D:  [**2155-2-7**]  02:17
T:  [**2155-2-7**]  15:16
JOB#:  [**Job Number 101644**]
{'Cerebral aneurysm, nonruptured,Pneumonitis due to inhalation of food or vomitus,Iatrogenic cerebrovascular infarction or hemorrhage,Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of breast,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified'}


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: The patient was admitted to undergo coiling
of her left anterior communicating artery aneurysm.

PRESENT ILLNESS: The patient is a 73 year old
woman with a history of CAD, PVD, right internal carotid
artery stenosis status post stenting, lung nodule and left
ACOM aneurysm, who was admitted for coiling.  The left ACOM
aneurysm is 4 x 5 mm in diameter and asymptomatic.  However,
patient requires an open resection of her lung nodule as
previous attempts at more noninvasive diagnostic procedures
have not yielded a definitive diagnosis.  Her cardiothoracic
surgeons require that the left ACOM aneurysm be coiled prior
to taking her to surgery.  She underwent cerebral angiogram
and an attempted coiling procedure of [**2155-1-28**].
However, the coiling was not successful as the base of the
aneurysm was large and did not allow for sufficient
aneurysmal luminal closure.  Post procedure patient had high
blood pressure and required unit level care with IV agents to
maintain her pressure below a systolic of 200.

MEDICAL HISTORY: CAD.  Right ICA disease status post
stenting.  Lung mass.  Hypothyroidism.  History of breast
cancer.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin and codeine.

PHYSICAL EXAM: 

FAMILY HISTORY: Diabetes, hypertension, heart disease.

SOCIAL HISTORY: The patient lives with her daughter.  She
does not smoke. 

### Response:
{'Cerebral aneurysm, nonruptured,Pneumonitis due to inhalation of food or vomitus,Iatrogenic cerebrovascular infarction or hemorrhage,Subendocardial infarction, initial episode of care,Hematoma complicating a procedure,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of breast,Unspecified acquired hypothyroidism,Peripheral vascular disease, unspecified'}
