CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 76 year old woman with
a history of hypercholesterolemia, hypertension and
supraventricular arrhythmia in the past who presents after
being found down.  Her story begins earlier on the day of
admission when she was doing well at her baseline, living at
home with her husband.  [**Name (NI) **] saw her well at about 10:30 a.m.
and then subsequently found her on the floor at 12:00 p.m.,
not moving her left side.  She was brought to the E.R. and
the stroke Fellow was called shortly thereafter.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Supraventricular tachycardia intermittently.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: No history of stroke, hypertension or CAD.
She has a brother who died of cancer and a father who died at
age [**Age over 90 **] after an accidental fire.

SOCIAL HISTORY: She is married with children and lives at
home independently.  She has worked as a secretary for her
husband who is a lawyer.  She smoked, but quit smoking in the
[**2122**].  She does not drink.
Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation,Hemiplegia, unspecified, affecting unspecified side,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Neurologic neglect syndrome
Crbl art ocl NOS w infrc,Atrial fibrillation,Unsp hemiplga unspf side,Hypertension NOS,Hypothyroidism NOS,Pure hypercholesterolem,Neurologic neglect syndr
Admission Date:  [**2165-11-6**]       Discharge Date:  [**2165-11-14**]

Date of Birth:   [**2089-9-10**]       Sex:  F

Service:  NEUROLOGY

NOTE:  The following history and physical is as noted by Dr.
[**First Name8 (NamePattern2) 60451**] [**Last Name (NamePattern1) 1001**].

DIAGNOSIS:  Right MCA stroke.

HISTORY OF PRESENT ILLNESS:  This is a 76 year old woman with
a history of hypercholesterolemia, hypertension and
supraventricular arrhythmia in the past who presents after
being found down.  Her story begins earlier on the day of
admission when she was doing well at her baseline, living at
home with her husband.  [**Name (NI) **] saw her well at about 10:30 a.m.
and then subsequently found her on the floor at 12:00 p.m.,
not moving her left side.  She was brought to the E.R. and
the stroke Fellow was called shortly thereafter.

PAST MEDICAL HISTORY:  Hypertension.  Hypercholesterolemia.
Supraventricular tachycardia intermittently.

MEDICATIONS:  Aspirin 325 mg p.o. q.day, atenolol q.day.

SOCIAL HISTORY:  She is married with children and lives at
home independently.  She has worked as a secretary for her
husband who is a lawyer.  She smoked, but quit smoking in the
[**2122**].  She does not drink.

FAMILY HISTORY:  No history of stroke, hypertension or CAD.
She has a brother who died of cancer and a father who died at
age [**Age over 90 **] after an accidental fire.

PHYSICAL EXAMINATION:  Blood pressure 184/64, heart rate 52,
SpO2 98% on 2 liters, afebrile.  Exam revealed slight
drowsiness with dysarthria.  Language was intact.  There was
left sided neglect and _______________ There was no
anisocoria and pupils were equal and reactive to light.  Eyes
were deviated to the right, but crossed midline on doll's
eye.  No response to threat on the left.  There was left
facial droop.  Left arm was flaccid as well as left leg which
was markedly weak.  There was decreased sensation on the left
with extinction.  The left toes were upgoing and right toes
were downgoing.  There was no bruit on exam.  Cardiovascular:
she had a slow rate and regular rhythm.  There were no
murmurs, gallops or rubs.  Overall the NIHSS score was 17.

LABORATORY DATA:  White count 10, hematocrit 35.7, platelets
232.  PTT 24, PT 12.  Sodium 136, potassium 4.3, chloride 99,
bicarb 26, BUN 23, creatinine 0.8, glucose 115.
Transthoracic echocardiogram in [**2165-7-4**] revealed no wall
motion abnormalities with EF of 70% to 80%.  No source of
emboli identified.

HOSPITAL COURSE:  The patient presented with what appeared to
be an acute stroke.  CT scan revealed a right hyperdense MCA
sign without early evidence of ischemic changes.  MR imaging
at that time revealed diffusion slowing within the posterior
limb of the right internal capsule as well as the right
caudate nucleus.  There was a portion of the right cerebral
hemisphere that was spared.  MR angiography revealed high
grade stenosis or occlusion of the right internal carotid
artery.  Given these findings patient was enrolled into the
DEFUSE study.  She tolerated intravenous tPA with a total of
54 mg IV given initially as a 6 mg bolus.  She did not show
any evidence of clinical improvement, however, and subsequent
MR imaging revealed no recanalization of the occluded right
MCA.  There was evidence by T2 star weighted sequences
consistent with right striatal capsular basal ganglia and
________________ hemorrhage which occupies virtually the
entire area of the diffusion slowing as previously noted.
There was also hemorrhage into the right ventricle with
involvement of the third ventricle.

The patient remained stable during this time and subsequent
CT scan did not reveal any enlargement of the hemorrhage.
She remained hemodynamically stable and, therefore, was
transferred to the neurology service for further management.
While in-house her heart rate was intermittently irregular
and had been documented on several occasions by 12 lead ECG
to be in atrial fibrillation with a rapid ventricular
response.  Carotid Dopplers were also done for further
evaluation which revealed no evidence of intrinsic carotid
disease.  Given the atrial fibrillation, ________________
with patient's cardiologist, Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **], we began a
regimen of oral diltiazem for rate control with a small dose
of metoprolol to help both with rate control and to protect
the heart.  At the time of this dictation patient is
tolerating 30 mg of diltiazem t.i.d. and 12.5 mg of
metoprolol b.i.d. with adequate rate control and perfusion
pressures with a systolic blood pressure in the 130s.

Given the atrial fibrillation, the treatment of choice to
prevent further cerebrovascular ischemic events is warfarin.
However, given the hemorrhage, after further discussion with
the stroke service, decision was made to not anticoagulate
until two weeks out from her initial bleed.  Therefore, the
plan is to start warfarin daily on [**2165-11-22**], with an
INR goal of between 2 and 3.  At this time we would also
consider the addition of aspirin for further protection
against both cardiovascular and cerebrovascular disease.  At
the time of this dictation patient is clinically stable with
adequate rate control and neurologically stable.  She is
awake, alert and interactive, but remains hemiplegic on the
left with some left sided neglect.  She has more control of
her left leg than left arm.

CONDITION ON DISCHARGE:  Improved.

DISCHARGE STATUS:  Discharged to [**Hospital3 **]
where the emphasis will be on improving gait stability and
left sided strength.  Teaching compensatory mechanisms for
her left sided neglect will also be an emphasis.

DISCHARGE DIAGNOSES:
1.  Right MCA ischemic infarction with left hemiparesis.
2.  Paroxysmal atrial fibrillation.
3.  Hypertension.
4.  Hypothyroidism.
5.  Hypercholesterolemia.

DISCHARGE MEDICATIONS:
1.  Diltiazem 30 mg p.o. t.i.d.  This can be titrated as
needed for rate control.
2.  Lopressor 12.5 mg p.o. b.i.d.
3.  Lipitor 10 mg p.o. q.day.
4.  Levothyroxine 88 mcg p.o. q.day.
5.  Prevacid 30 mg p.o. q.day.
6.  Colace 100 mg p.o. b.i.d.
7.  Dulcolax 10 mg p.o./p.r. b.i.d. p.r.n.
8.  Fioricet one to two tablets p.o. q.six hours p.r.n.
headache.

Start warfarin q.day on [**2165-11-22**], with a goal INR
between 2 and 3.  Consider aspirin at this time as well.

FOLLOWUP:  The patient is to follow up with her primary
physician, [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) 324**] [**Last Name (NamePattern1) 311**]; her cardiologist, Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) **]; Dr. [**First Name (STitle) **] [**Name (STitle) **] in one month's time in stroke
neurology, please call [**Telephone/Fax (1) 657**].






                            [**Doctor Last Name **] [**Name8 (MD) 8346**], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern4) 43065**]
MEDQUIST36

D:  [**2165-11-13**]  16:04
T:  [**2165-11-13**]  17:45
JOB#:  [**Job Number 108690**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation,Hemiplegia, unspecified, affecting unspecified side,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Neurologic neglect syndrome'}


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: 

PRESENT ILLNESS: This is a 76 year old woman with
a history of hypercholesterolemia, hypertension and
supraventricular arrhythmia in the past who presents after
being found down.  Her story begins earlier on the day of
admission when she was doing well at her baseline, living at
home with her husband.  [**Name (NI) **] saw her well at about 10:30 a.m.
and then subsequently found her on the floor at 12:00 p.m.,
not moving her left side.  She was brought to the E.R. and
the stroke Fellow was called shortly thereafter.

MEDICAL HISTORY: Hypertension.  Hypercholesterolemia.
Supraventricular tachycardia intermittently.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: No history of stroke, hypertension or CAD.
She has a brother who died of cancer and a father who died at
age [**Age over 90 **] after an accidental fire.

SOCIAL HISTORY: She is married with children and lives at
home independently.  She has worked as a secretary for her
husband who is a lawyer.  She smoked, but quit smoking in the
[**2122**].  She does not drink. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation,Hemiplegia, unspecified, affecting unspecified side,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Pure hypercholesterolemia,Neurologic neglect syndrome'}
