CHIEF COMPLAINT: found down

PRESENT ILLNESS: 71 yo woman with a h/o HTN, who was transferred from OSH to
[**Hospital1 18**] after being found unresponsive.  Her husband relates the
story.  She was sleeping soundly at 7am on Saturday [**2188-6-28**] when
the husband left to run some errands.  He returned home and
found her lying on her left side beside her bed at 2:30pm.  No
emesis, stool incontinence or tongue biting, but she was
drooling and
incontinent from urine.  She was unresponsive, an abrasion was
on her left cheek.  At OSH she was occasionally responding to
commands, given narcan without response.  CT scan at OSH showed
hypodensity of the cerebral [**Male First Name (un) 4746**] and vague hypodensities in the
anterior aspects of the thalami.  No hemorrhage.  (all per
report, no scans to assess for myself).  Upon admission to the
ED she was completely obtunded, given narcan with minimal
reponse.  Admitted to the ICU.

MEDICAL HISTORY: 1.  HTN
2.  low back pain - per husband, has had MRI in the past that
only showed osteoporosis/arthritis, takes darvocet and relafen,
scoliosis
3.  s/p CCY 25 [**Month/Day/Year 1686**] ago
4.  s/p rupture of the esophagus after dilation therapy for
stricture in [**2177**], resulting in 35 day hospitalization course
5.  ovarian cyst removal
6.  Hysterectomy at age 28, cervical cancer
7.  h/o ulcers several years ago, this is why she is not takin
aspirin

MEDICATION ON ADMISSION: 1.  relafen 500mg qD (NSAID)
2.  Amitriptyline 25mg qD
3.  Prinovil 5mg qD
4.  HCTZ 25mg qD
5.  Evista 60 mg
6.  darvocet 100/650, takes 4-6 tabs qD, for low back pain

ALLERGIES: Codeine / Vitamin K / Tagamet

PHYSICAL EXAM: Upon transfer to the floor:
MENTAL STATUS:  hypersolmnolent, not following commands or
answering questions, not opening eyes to voice or pain.
CN:  eyes midline but unable to assess doll's head with c-collar
in place, pupils equal 2mm->1.5mm bilaterally, consenual to
light, no RAPD, wrinkles forehead symmetrically with pain, +
corneal reflex bilaterally, + gag with suction
MOTOR:  unable to assess at this time.
DTR: 1 throughout, no clonus, no snout, upgoing toe on right,
downgoing toe on left
[**Last Name (un) **]: purposefully responds to painful stimuli (reaches for her
sternum with rub, purposeful movements in all 4 limbs to pain.
[**Last Name (un) 7058**] & GAIT:  unable to assess

FAMILY HISTORY: Dad passed away at age 76 of heart disease, infection. Mom
passed away at age 54 of a tumor or brain.  No h/o stroke in the
family.

SOCIAL HISTORY: no tob/etoh/drugs, lives with husband of 51 [**Name2 (NI) 1686**], walks unaided,
home maker her whole life.  2 healthy daughters and 4 healthy
grandsons.
Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Lumbosacral spondylosis without myelopathy,Personal history of malignant neoplasm of other parts of uterus,Facial weakness,Memory loss
Crbl art ocl NOS w infrc,Food/vomit pneumonitis,Iron defic anemia NOS,Hypertension NOS,Lumbosacral spondylosis,Hx-uterus malignancy NEC,Facial weakness,Memory loss
Admission Date:  [**2188-6-28**]              Discharge Date:   [**2188-7-9**]

Date of Birth:  [**2116-11-6**]             Sex:   F

Service: NMED

Allergies:
Codeine / Vitamin K / Tagamet

Attending:[**First Name3 (LF) 6075**]
Chief Complaint:
found down

Major Surgical or Invasive Procedure:
MRI/A brain


History of Present Illness:
71 yo woman with a h/o HTN, who was transferred from OSH to
[**Hospital1 18**] after being found unresponsive.  Her husband relates the
story.  She was sleeping soundly at 7am on Saturday [**2188-6-28**] when
the husband left to run some errands.  He returned home and
found her lying on her left side beside her bed at 2:30pm.  No
emesis, stool incontinence or tongue biting, but she was
drooling and
incontinent from urine.  She was unresponsive, an abrasion was
on her left cheek.  At OSH she was occasionally responding to
commands, given narcan without response.  CT scan at OSH showed
hypodensity of the cerebral [**Male First Name (un) 4746**] and vague hypodensities in the
anterior aspects of the thalami.  No hemorrhage.  (all per
report, no scans to assess for myself).  Upon admission to the
ED she was completely obtunded, given narcan with minimal
reponse.  Admitted to the ICU.

In the ICU, she was given ASA PR, extubated on [**6-29**], found to
have a LLL infiltrate on CXR with febrile to 102, started on
levofloxacin [**2188-6-30**].

Per the husband, she is active at baseline walking unaided.  No
recent illnesses, no complaints such as recent HA, tinnitus,
diplopia, fevers/chills, CP, SOB, abd pain, diarrhea,
constipation, BRBPR.  She has low back pain x "many years" and
takes darvocet prn.


Past Medical History:
1.  HTN
2.  low back pain - per husband, has had MRI in the past that
only showed osteoporosis/arthritis, takes darvocet and relafen,
scoliosis
3.  s/p CCY 25 [**Month/Day/Year 1686**] ago
4.  s/p rupture of the esophagus after dilation therapy for
stricture in [**2177**], resulting in 35 day hospitalization course
5.  ovarian cyst removal
6.  Hysterectomy at age 28, cervical cancer
7.  h/o ulcers several years ago, this is why she is not takin
aspirin

Social History:
no tob/etoh/drugs, lives with husband of 51 [**Name2 (NI) 1686**], walks unaided,
home maker her whole life.  2 healthy daughters and 4 healthy
grandsons.


Family History:
Dad passed away at age 76 of heart disease, infection. Mom
passed away at age 54 of a tumor or brain.  No h/o stroke in the
family.


Physical Exam:
Upon transfer to the floor:
MENTAL STATUS:  hypersolmnolent, not following commands or
answering questions, not opening eyes to voice or pain.
CN:  eyes midline but unable to assess doll's head with c-collar
in place, pupils equal 2mm->1.5mm bilaterally, consenual to
light, no RAPD, wrinkles forehead symmetrically with pain, +
corneal reflex bilaterally, + gag with suction
MOTOR:  unable to assess at this time.
DTR: 1 throughout, no clonus, no snout, upgoing toe on right,
downgoing toe on left
[**Last Name (un) **]: purposefully responds to painful stimuli (reaches for her
sternum with rub, purposeful movements in all 4 limbs to pain.
[**Last Name (un) 7058**] & GAIT:  unable to assess

Upon discharge to rehab:
MS:  poor memory, not remembering husbands name or why she's
here.  hypersolmnolent but less so that originally.  following
commands.
CN:  left face droop
Motor: no clear weakness, lifts all extrem to gravity, ambulates
with PT


Pertinent Results:
[**2188-6-28**] MRI/A:  Bilateral thalamic lesions, most likely acute,
posterior paramedian thalamic artery distribution infarctions.
Diffuse imaging could not be performed on this instrument.

[**2188-6-30**] carotid US:  Absence of significant plaque and carotid
artery stenosis. Antegrade flow in the bilateral vertebral
arteries.

[**2188-6-30**] CXR:  possibly LLL infiltrate.

[**2188-6-30**] TTE:  No atrial septal defect is seen by 2D or color
Doppler. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is
normal. Overall left ventricular systolic function is normal
(LVEF 70%). Right
ventricular chamber size and free wall motion are normal. The
aortic valve
leaflets (3) are mildly thickened but not stenotic. No aortic
regurgitation is
seen. The mitral valve leaflets are mildly thickened. There is
no mitral valve
prolapse. There is borderline pulmonary artery systolic
hypertension. There is
no pericardial effusion.

[**2188-7-4**] NGT placement:  Successful placement of an 8 french
[**Doctor First Name 1557**] feeding tube with distal tip in the proximal
jejunum.[**2188-6-28**] 8:10 pm BLOOD CULTURE     Site: ARM

                            **FINAL REPORT [**2188-7-4**]**

   AEROBIC BOTTLE (Final [**2188-7-2**]):
      REPORTED BY PHONE TO [**Doctor First Name **],[**Doctor Last Name **]  -FA5- @ 20:50
[**2188-6-30**].
      STAPHYLOCOCCUS, COAGULASE NEGATIVE.    OF TWO COLONIAL
MORPHOLOGIES.
         ISOLATED FROM ONE SET ONLY SENSITIVITIES PERFORMED ON
REQUEST..

   ANAEROBIC BOTTLE (Final [**2188-7-4**]):    NO GROWTH.

Blood cx from [**6-29**] (2/2 bottles) and [**6-30**] (4/4 bottles):  NO
GROWTH

[**2188-6-28**] 08:10PM   GLUCOSE-133* UREA N-15 CREAT-0.7 SODIUM-143
POTASSIUM-4.3 CHLORIDE-107 TOTAL CO2-24 ANION GAP-16
[**2188-6-28**] 08:10PM   AST(SGOT)-23 CK(CPK)-97 ALK PHOS-64
[**2188-6-28**] 08:10PM   cTropnT-<0.01
[**2188-6-28**] 08:10PM   CK-MB-NotDone
[**2188-6-28**] 08:10PM   CALCIUM-9.5 PHOSPHATE-3.7 MAGNESIUM-1.7
[**2188-6-28**] 08:10PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2188-6-28**] 08:10PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.007
[**2188-6-28**] 08:10PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2188-6-28**] 08:10PM URINE  RBC-0-2 WBC-0 BACTERIA-NONE YEAST-NONE
EPI-0
HCT [**7-8**]:  36
Chol 200, LDL 79, HDL  92, TG 145

Brief Hospital Course:
1. cerebral infarction of the bilateral thalami - she was
started on a statin, modafinil to decrease solmnolence, and
aggrenox for antiplatelet therapy.  Carotid US and TTE were
unrevealing re: a source of embolus. Antihypertensives were
initially held.  Later, SBP rose to the 180's so ramipril was
started.  This drug has been shown to be beneficial in stroke
patients.  Her glucose was well controlled.  She worked well
with pt/ot.

2. Left Lower Lobe pneumonia, febrile to 102 - she completed a 7
day course of levofloxacin and was afebrile for the remainder of
the course.

3. Bacteremia - she grew one out of two positive blood cultures
on [**2188-6-28**], GPC prs and clusters.  Started on vancomycin until
specificities returned.  Found to be coag neg staph aureus,
likely a contaminant.  Subsequent blood cultures (6 bottles)
were all no growth.

4. normocytic anemia:  iron studies consistent with iron
deficiency anemia, all stools were guaiac negative.  She was
transfused a total of 2 u pRBCs ([**7-2**] - hct bumped from 26->31,
and [**7-4**] for Hct 27->35).  She should recieve an outpatient
colonoscopy at some point.

FEN: She eventually passed a video swallow soft foods, thickened
liquids, however her dobhoff tube should remain in place for
additional nutritional needs.
PPx:  sc heparin for dvt proph, PPI given h/o ulcers on Aspirin
FULL CODE


Medications on Admission:
1.  relafen 500mg qD (NSAID)
2.  Amitriptyline 25mg qD
3.  Prinovil 5mg qD
4.  HCTZ 25mg qD
5.  Evista 60 mg
6.  darvocet 100/650, takes 4-6 tabs qD, for low back pain


Discharge Medications:
1. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
5000 units Injection TID (3 times a day): for DVT prophylaxis.
2. Acetaminophen 650 mg Suppository Sig: One (1) Suppository
Rectal Q4-6H (every 4 to 6 hours) as needed: may give PO in
custard.
3. Modafinil 100 mg Tablet Sig: One (1) Tablet PO qAM () as
needed for bilateral thalamic infarcts.
4. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO QD (once a day).
5. Ramipril 1.25 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day): hold for SBP<130, HR<55.
6. Dipyridamole-Aspirin 200-25 mg Capsule, Multiphasic Release
Sig: One (1) Cap PO BID (2 times a day).
7. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO QD
(once a day).


Discharge Disposition:
Extended Care

Facility:
St. [**Hospital 11042**] Hospital Rehab

Discharge Diagnosis:
Bilateral thalamic strokes of unclear etiology.
Left lower lobe pneumonia s/p 7 days of levofloxacin
Bacteremia, likely contaminant
Iron deficiency anemia


Discharge Condition:
improved - able to swallow (see swallow eval) but getting
supplemental tube feeds, ambulates with PT.

Discharge Instructions:
Please take all medications.
Please return to the ED if you experience weakness, numbness, or
other concerning symptoms.

Followup Instructions:
Please call the stroke clinic when you leave rehab for a
followup appointment.  [**Telephone/Fax (1) 1694**].

Please call your PCP for [**Name Initial (PRE) **] followup appointment after you leave
rehab.  [**Telephone/Fax (1) 39293**].

You should have an outpatient colonoscopy at some point to
evaluate for colon cancer given your iron deficiency anemia.
{'Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Lumbosacral spondylosis without myelopathy,Personal history of malignant neoplasm of other parts of uterus,Facial weakness,Memory loss'}


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: found down

PRESENT ILLNESS: 71 yo woman with a h/o HTN, who was transferred from OSH to
[**Hospital1 18**] after being found unresponsive.  Her husband relates the
story.  She was sleeping soundly at 7am on Saturday [**2188-6-28**] when
the husband left to run some errands.  He returned home and
found her lying on her left side beside her bed at 2:30pm.  No
emesis, stool incontinence or tongue biting, but she was
drooling and
incontinent from urine.  She was unresponsive, an abrasion was
on her left cheek.  At OSH she was occasionally responding to
commands, given narcan without response.  CT scan at OSH showed
hypodensity of the cerebral [**Male First Name (un) 4746**] and vague hypodensities in the
anterior aspects of the thalami.  No hemorrhage.  (all per
report, no scans to assess for myself).  Upon admission to the
ED she was completely obtunded, given narcan with minimal
reponse.  Admitted to the ICU.

MEDICAL HISTORY: 1.  HTN
2.  low back pain - per husband, has had MRI in the past that
only showed osteoporosis/arthritis, takes darvocet and relafen,
scoliosis
3.  s/p CCY 25 [**Month/Day/Year 1686**] ago
4.  s/p rupture of the esophagus after dilation therapy for
stricture in [**2177**], resulting in 35 day hospitalization course
5.  ovarian cyst removal
6.  Hysterectomy at age 28, cervical cancer
7.  h/o ulcers several years ago, this is why she is not takin
aspirin

MEDICATION ON ADMISSION: 1.  relafen 500mg qD (NSAID)
2.  Amitriptyline 25mg qD
3.  Prinovil 5mg qD
4.  HCTZ 25mg qD
5.  Evista 60 mg
6.  darvocet 100/650, takes 4-6 tabs qD, for low back pain

ALLERGIES: Codeine / Vitamin K / Tagamet

PHYSICAL EXAM: Upon transfer to the floor:
MENTAL STATUS:  hypersolmnolent, not following commands or
answering questions, not opening eyes to voice or pain.
CN:  eyes midline but unable to assess doll's head with c-collar
in place, pupils equal 2mm->1.5mm bilaterally, consenual to
light, no RAPD, wrinkles forehead symmetrically with pain, +
corneal reflex bilaterally, + gag with suction
MOTOR:  unable to assess at this time.
DTR: 1 throughout, no clonus, no snout, upgoing toe on right,
downgoing toe on left
[**Last Name (un) **]: purposefully responds to painful stimuli (reaches for her
sternum with rub, purposeful movements in all 4 limbs to pain.
[**Last Name (un) 7058**] & GAIT:  unable to assess

FAMILY HISTORY: Dad passed away at age 76 of heart disease, infection. Mom
passed away at age 54 of a tumor or brain.  No h/o stroke in the
family.

SOCIAL HISTORY: no tob/etoh/drugs, lives with husband of 51 [**Name2 (NI) 1686**], walks unaided,
home maker her whole life.  2 healthy daughters and 4 healthy
grandsons. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Iron deficiency anemia, unspecified,Unspecified essential hypertension,Lumbosacral spondylosis without myelopathy,Personal history of malignant neoplasm of other parts of uterus,Facial weakness,Memory loss'}
