CHIEF COMPLAINT: Agitation/ speech disturbance

PRESENT ILLNESS: Patient is a 55 y/o female with a PMHx of DM complicated by
neuropathy, HTN, hypercholesterolemia, hepatitis C and h/o
polysubstance use who presents with concerns for a stroke.
Patient was at her usual baseline yesterday evening and went to
bed at her usual time of ~11pm.  At 05:30 her son also spoke to
her describing her as having normal speech.  However at ~7am she
was then noted to be aphasic and moaning in bed found by her
son.
EMS was contact[**Name (NI) **] and she was brought to [**Hospital1 18**]. Of note, she
likely vomited en route.  Here she was noted to follow simple
comands but was combative prompting sedation and intubation.

MEDICAL HISTORY: CAD and question of history of old inferior MI based upon EKG,
partially reversible defect on
MIBI [**6-16**]
Chronic dizziness and gait disorder
Hearing loss L ear x past year
Diabetes mellitus - on Lamictal for neuropathy
HTN
Cataract [**Doctor First Name **]
Hepatitis C
Hyperlipidemia
GERD
Atypical migraines - on Topamax

MEDICATION ON ADMISSION: -Humalog 75-25 17U q am and 20U q pm
-Lamictal 200mg [**Hospital1 **]
-Lisinopril 5mg daily
-Metformin 500mg [**Hospital1 **]
-Omepraxole 20mg daily
-Simvastatin 80mg daily
-Sumatriptan 50mg daily
-Tramadol 50mg q 8hrs prn headaches
-ASA 81mg daily
-IB 800mg prn
-Aleve
-Nicotine patch

ALLERGIES: Penicillins / Ambien / Metronidazole

PHYSICAL EXAM: PE on admition
HEENT:  NCAT, mucous membranes moist and pink, sclera
non-icteric, OP clear
- Neck:  Supple, no thyromegaly, no lymphadenopathy, no bruits
- Lungs:  Clear bilaterally, good aeration, no wheezing/crackles
- Cardiac:  Normal S1 and S2, no murmur
- Abdomen:  S/NT/obese, normoactive BS
- Extremities:  warm, no C/C/E

FAMILY HISTORY: Alcoholism, diabetes

SOCIAL HISTORY: -Tobacco: recently quit smoking; smoked since age 12, one ppd
-ETOH: hx of alcohol abuse
-IVDA: hx of heroin and cocaine abuse
Altered mental status,Aphasia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified viral hepatitis C without hepatic coma,Polyneuropathy in diabetes,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified essential hypertension,Long-term (current) use of insulin,M?ni?re's disease, unspecified,Tobacco use disorder
Altered mental status,Aphasia,DMII neuro nt st uncntrl,Hpt C w/o hepat coma NOS,Neuropathy in diabetes,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Esophageal reflux,Hypertension NOS,Long-term use of insulin,Meniere's disease NOS,Tobacco use disorder
Admission Date:  [**2146-10-30**]              Discharge Date:   [**2146-11-1**]

Date of Birth:  [**2091-6-5**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins / Ambien / Metronidazole

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Agitation/ speech disturbance

Major Surgical or Invasive Procedure:
Intubation/ extubation

History of Present Illness:
Patient is a 55 y/o female with a PMHx of DM complicated by
neuropathy, HTN, hypercholesterolemia, hepatitis C and h/o
polysubstance use who presents with concerns for a stroke.
Patient was at her usual baseline yesterday evening and went to
bed at her usual time of ~11pm.  At 05:30 her son also spoke to
her describing her as having normal speech.  However at ~7am she
was then noted to be aphasic and moaning in bed found by her
son.
EMS was contact[**Name (NI) **] and she was brought to [**Hospital1 18**]. Of note, she
likely vomited en route.  Here she was noted to follow simple
comands but was combative prompting sedation and intubation.


Past Medical History:
CAD and question of history of old inferior MI based upon EKG,
partially reversible defect on
MIBI [**6-16**]
Chronic dizziness and gait disorder
Hearing loss L ear x past year
Diabetes mellitus - on Lamictal for neuropathy
HTN
Cataract [**Doctor First Name **]
Hepatitis C
Hyperlipidemia
GERD
Atypical migraines - on Topamax

Social History:
-Tobacco: recently quit smoking; smoked since age 12, one ppd
-ETOH: hx of alcohol abuse
-IVDA: hx of heroin and cocaine abuse


Family History:
Alcoholism, diabetes

Physical Exam:
PE on admition
HEENT:  NCAT, mucous membranes moist and pink, sclera
non-icteric, OP clear
- Neck:  Supple, no thyromegaly, no lymphadenopathy, no bruits
- Lungs:  Clear bilaterally, good aeration, no wheezing/crackles
- Cardiac:  Normal S1 and S2, no murmur
- Abdomen:  S/NT/obese, normoactive BS
- Extremities:  warm, no C/C/E

Neurologic Examination:
- MS:  Unintelligible / dysarthric speech, per report able to
say
"no" but did not witness

- Cranial Nerves:
I:  not tested
II:  Blinks to visual threat, pupils 3->1.5mm bilaterally
III, IV, VI:  eyes midline, no nystagmus, doesn't follow
commands
for VFFTC testing, turns whole head in direction of sounds /
questions
V:  unable to assess
VII:  Facial movements grossly symmetric, unable to assess for
subtle facial droop
VIII:  unable to assess
IX, X:  gag intact
[**Doctor First Name 81**]:  unable to assess
XII:  unable to assess

- Motor:  Normal bulk and tone, restrained, full grasp with both
hands, attempts to pull out ETT symmetrically, withdrawals legs
from restraints with good strenght

- Coordination:  unable to assess

- Reflexes:   No clonus, toes downgoing bilatrally
         [**Hospital1 **]   Tri   [**Last Name (un) 1035**]  Pat   Ach
        C5-6 C7-8   C5-6   L3-4  S1-2
Right	 2     2     2      1      1
Left	 2     2     2      1      1


Pertinent Results:
[**2146-10-30**] 10:57PM   ALT(SGPT)-64* AST(SGOT)-55* LD(LDH)-200 ALK
PHOS-100 AMYLASE-136* TOT BILI-0.2
[**2146-10-30**] 10:57PM   CK-MB-5 cTropnT-<0.01
[**2146-10-30**] 10:57PM   %HbA1c-5.7 eAG-117
[**2146-10-30**] 10:57PM   TRIGLYCER-166* HDL CHOL-43 CHOL/HDL-2.9
LDL(CALC)-49
[**2146-10-30**] 08:59PM   LACTATE-1.5 NA+-140 K+-3.7 CL--106

ct head:
IMPRESSION:
1. No evidence of hemorrhage or loss of [**Doctor Last Name 352**]-white matter
differentiation or
mass effect on CT head without contrast.
2. CT perfusion demonstrates no evidence of asymmetric perfusion
to indicate
acute ischemia or infarct.
3. CT angiography of the neck demonstrates 50% narrowing of the
right and 25
to 50% narrowing on the left near the carotid bifurcation.
4. CT angiography of the head demonstrates no vascular
occlusion, stenosis or
aneurysm greater than 3 mm in size. Vascular calcifications are
seen at
cavernous carotids bilaterally.
5. Retained secretions in the nasopharynx likely due to
intubation.

MRI head: Wet read. No acute process

Brief Hospital Course:
Mrs [**Known lastname 6330**] was admitted as a code stroke. She was seen in the ED
and was noted to be agitated and had a speech disturbance that
was not described in detail. A complete neurologic examination
was not completed in ED. The patient was intubated in the ED and
had a STAT CT head done. This was negative. She then proceeded
to get an MRI of the brain done. This was also negative. She was
extubated the next day without problems. She was awake
interactive, oriented and had not known what had occurred the
day before. She denies any fever/chills/headache. She states she
has never had a seizure and takes Lamictal for her peripheral
neuropathy secondary to DM II.

Medications on Admission:
-Humalog 75-25 17U q am and 20U q pm
-Lamictal 200mg [**Hospital1 **]
-Lisinopril 5mg daily
-Metformin 500mg [**Hospital1 **]
-Omepraxole 20mg daily
-Simvastatin 80mg daily
-Sumatriptan 50mg daily
-Tramadol 50mg q 8hrs prn headaches
-ASA 81mg daily
-IB 800mg prn
-Aleve
-Nicotine patch


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary
- Acute/transient altered Mental status (etiology unknown)

Secondary
-DM, insulin dependent - followed at [**Last Name (un) **] in the past but has
not been see recently
-HTN
-Hypercholesterolemia - last lipids checked in [**2141**]
-Hep C - per notes in remission
-Diabetic neuropathy
-Atypical Meniere's disease x 5 years - characterized by
imbalance and lightheadedness


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted for workup of your speech disorder and altered
mental status. You were intubated in the ER for tests to rule
out stroke. You had a CT of your head and an MRI of your brain
which did not show any evidence of stroke. You were extubated
the next day. You had an EEG which did not show any seizure
activity. We are not sure what had caused this but it could have
been a seizure.

Followup Instructions:
Please follow up with your primary care physician in the next
2-3 weeks. Call [**Telephone/Fax (1) 250**] for an appointment.

Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 275**] [**Last Name (NamePattern1) **], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2146-12-21**] 3:50
Provider: [**Name10 (NameIs) 1382**] [**Name11 (NameIs) 1383**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2147-1-9**] 11:30


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{"Altered mental status,Aphasia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified viral hepatitis C without hepatic coma,Polyneuropathy in diabetes,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified essential hypertension,Long-term (current) use of insulin,M?ni?re's disease, unspecified,Tobacco use disorder"}


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: Agitation/ speech disturbance

PRESENT ILLNESS: Patient is a 55 y/o female with a PMHx of DM complicated by
neuropathy, HTN, hypercholesterolemia, hepatitis C and h/o
polysubstance use who presents with concerns for a stroke.
Patient was at her usual baseline yesterday evening and went to
bed at her usual time of ~11pm.  At 05:30 her son also spoke to
her describing her as having normal speech.  However at ~7am she
was then noted to be aphasic and moaning in bed found by her
son.
EMS was contact[**Name (NI) **] and she was brought to [**Hospital1 18**]. Of note, she
likely vomited en route.  Here she was noted to follow simple
comands but was combative prompting sedation and intubation.

MEDICAL HISTORY: CAD and question of history of old inferior MI based upon EKG,
partially reversible defect on
MIBI [**6-16**]
Chronic dizziness and gait disorder
Hearing loss L ear x past year
Diabetes mellitus - on Lamictal for neuropathy
HTN
Cataract [**Doctor First Name **]
Hepatitis C
Hyperlipidemia
GERD
Atypical migraines - on Topamax

MEDICATION ON ADMISSION: -Humalog 75-25 17U q am and 20U q pm
-Lamictal 200mg [**Hospital1 **]
-Lisinopril 5mg daily
-Metformin 500mg [**Hospital1 **]
-Omepraxole 20mg daily
-Simvastatin 80mg daily
-Sumatriptan 50mg daily
-Tramadol 50mg q 8hrs prn headaches
-ASA 81mg daily
-IB 800mg prn
-Aleve
-Nicotine patch

ALLERGIES: Penicillins / Ambien / Metronidazole

PHYSICAL EXAM: PE on admition
HEENT:  NCAT, mucous membranes moist and pink, sclera
non-icteric, OP clear
- Neck:  Supple, no thyromegaly, no lymphadenopathy, no bruits
- Lungs:  Clear bilaterally, good aeration, no wheezing/crackles
- Cardiac:  Normal S1 and S2, no murmur
- Abdomen:  S/NT/obese, normoactive BS
- Extremities:  warm, no C/C/E

FAMILY HISTORY: Alcoholism, diabetes

SOCIAL HISTORY: -Tobacco: recently quit smoking; smoked since age 12, one ppd
-ETOH: hx of alcohol abuse
-IVDA: hx of heroin and cocaine abuse 

### Response:
{"Altered mental status,Aphasia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Unspecified viral hepatitis C without hepatic coma,Polyneuropathy in diabetes,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Esophageal reflux,Unspecified essential hypertension,Long-term (current) use of insulin,M?ni?re's disease, unspecified,Tobacco use disorder"}
