CHIEF COMPLAINT: CVA with R hemiparesis and R facial, slurred speech x 11hours

PRESENT ILLNESS: 57yo RFHM with h/o NIDDM, no CAD/HTN/HL/MI who presents from
[**Hospital3 2568**] for CVA at L basal ganglia on MRI.  Story starts
several days ago.  Pt had been in [**Male First Name (un) 1056**] for a week, fine,
no illness.  Returned 3 d PTA and was well.  Then 2 d PTA she
was
looking tired, with less expression, rather quiet.  1d PTA
family
went to McDonald's and on the drive home for one hour she was
really quiet, no focal movments, or eye deviation, just not very
talkative, around 3 pm on [**1-26**].  Then at home she was doing
laundry, cooking, seeming normal.  Aroudn 5pm she suddenly c/o
feeling very dizzy but only for about 30 seconds and she was
hold
her cooking spoon with both hands in front of her for a few
seconds without moving, again very quiet.  Then she came back to
normal, finished cooking, serving and eating and went to bed at
usual time an hour later.
 She slept separately fr husband [**3-1**] not feeling well, and the
next morning she got up to go the bathroom and fell, and told
her
husband she fell (around 8AM on DOA).  They went to eat
breakfast
and huband noted slurred nonsensical, jibberish and she was
producing less speech.  At that time she was noted to have a L
facial droop but no other weakness.  Husband checked [**Name2 (NI) 31567**] at 42
and gave wife coffee, toast, chocolate, which she ate without
drooling or difficultiy.  They called a relative who said she
should go to the [**Name (NI) **].

MEDICAL HISTORY: NIDDM, unclear how good her control was.  GERD, knee
surgery.  See above

MEDICATION ON ADMISSION: Glyburide 20 [**Hospital1 **], Omeprazole 20 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:    T:   97 BP:    120/80  P:   67  RR:  18   O2 sat:  97  NC

FAMILY HISTORY: DM

SOCIAL HISTORY: Tob: [**1-30**] cig qd for [**11-8**] yers, quit years ago
           EtOH:    no                IVDA: no
Cerebral embolism with cerebral infarction,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux
Crbl emblsm w infrct,Urin tract infection NOS,DMII wo cmp nt st uncntr,Esophageal reflux
Admission Date:  [**2108-1-27**]              Discharge Date:   [**2108-2-1**]

Date of Birth:  [**2050-5-19**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5868**]
Chief Complaint:
CVA with R hemiparesis and R facial, slurred speech x 11hours


Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
57yo RFHM with h/o NIDDM, no CAD/HTN/HL/MI who presents from
[**Hospital3 2568**] for CVA at L basal ganglia on MRI.  Story starts
several days ago.  Pt had been in [**Male First Name (un) 1056**] for a week, fine,
no illness.  Returned 3 d PTA and was well.  Then 2 d PTA she
was
looking tired, with less expression, rather quiet.  1d PTA
family
went to McDonald's and on the drive home for one hour she was
really quiet, no focal movments, or eye deviation, just not very
talkative, around 3 pm on [**1-26**].  Then at home she was doing
laundry, cooking, seeming normal.  Aroudn 5pm she suddenly c/o
feeling very dizzy but only for about 30 seconds and she was
hold
her cooking spoon with both hands in front of her for a few
seconds without moving, again very quiet.  Then she came back to
normal, finished cooking, serving and eating and went to bed at
usual time an hour later.
 She slept separately fr husband [**3-1**] not feeling well, and the
next morning she got up to go the bathroom and fell, and told
her
husband she fell (around 8AM on DOA).  They went to eat
breakfast
and huband noted slurred nonsensical, jibberish and she was
producing less speech.  At that time she was noted to have a L
facial droop but no other weakness.  Husband checked [**Name2 (NI) 31567**] at 42
and gave wife coffee, toast, chocolate, which she ate without
drooling or difficultiy.  They called a relative who said she
should go to the [**Name (NI) **].

They went to [**Hospital3 2568**] where pt had [**Hospital3 31567**] 336, got 6 U insulin,
head CT with R frontal 1cm hypodensity, Large L internal capsule
and head of caudate hypodensity, no shift or bleed (my read on
the disk).  The MRI had L basal ganglia, mostly IC, DWI bright,
ADC dark abnl and several smaller L MCA hyperintensities on DWI,
likely embolic infarcts.  The FLAIR was highly abnl with
multiple
subcortical grey matter bilateral hemispheric, frontal and
parietal round 4-7mm or so hyperintensities, maybe with some
string of pearl appearance on the R, but also in other areas, to
our eyes.  Family denies any h/o HTN/CAD/MI/HL.


Past Medical History:
NIDDM, unclear how good her control was.  GERD, knee
surgery.  See above


Social History:
Tob: [**1-30**] cig qd for [**11-8**] yers, quit years ago
           EtOH:    no                IVDA: no


Family History:
DM

Physical Exam:
VS:    T:   97 BP:    120/80  P:   67  RR:  18   O2 sat:  97  NC

General: WNWD, NAD
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no LAD, no carotid bruits
CV: RRR  s1s2     no m/r/g
Resp: CTAB   no r/w/r
Abd: +BS    Soft/NT/ND    no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

MS: Pt is arrousable with loud speech, falls asleep often, even
while examining fundi.  With help of translator she was able to
tell us her name, that she is in hospital, her soninlaw's name,
and says 2 or 3 words together at most.  Her speech is about 50%
understandable to the translator.  She sounds slurred.  She
willl
not repeat.  At her best she scribbled her name, but it was
illegible.  She did name my hand and fingers in English.  She
remains awake for a few seconds then drifts to sleep.
CN: I - not tested, II,III - PERRL, optic discs sharp; III,IV,VI
- EOMI, no ptosis, no nystagmus;  V-  VII -  R facial
weakness/asymmetry, r droop/drool; VIII - hears voice; IX,X -
gag
strong, palate elevates symmetrically; [**Doctor First Name 81**] ; XII - tongue midline
Motor: nl bulk and tone, no tremor, rigidity.  Noncoop with
drift.  Moves around in bed and lifts all extremities
antigravity
but moves R side less.
DTRs: [**Name2 (NI) **] (C56) BR (C6) Tri (C7) Pa (L34) Ac (S12)  Plantar
        L 2 2 2 2 1   down
        R 2 2 2 post sx   1   down
Sensory: LT, and pinch make her w/d x 4 ext
Coord: reaches for my arm and pen with either hand at times
Gait: unable


Pertinent Results:
Labs: [**2108-1-27**]
7:30p

Trop-*T*: <0.01

Comments: Ctropnt > 0.10 Ng/Ml Suggests Acute Mi

137
103
13
125 AGap=14

3.8
24
0.7

Comments: Note Updated Reference Range As Of [**2107-7-29**]

CK: 48  MB: Notdone
Ca: 8.8 Mg: 1.7 P: 2.8
Serum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc Negative

Comments: 80 (These Units) = 0.08 (% By Weight)

Urine Benzos, Barbs, Opiates, Cocaine, Amphet, Mthdne Negative

 78
5.3
12.9
160

34.9

 N:80.3 L:15.3 M:2.0 E:1.9 Bas:0.3

PT: 12.2  PTT: 22.8  INR: 1.0

Color
Yellow  Appear
Clear  SpecGr
1.016  pH
6.5  Urobil
Neg  Bili
Neg
Leuk
Neg  Bld
Neg  Nitr
Neg  Prot
Neg  Glu
1000  Ket
Neg


Brief Hospital Course:
Ms. [**Known lastname 3234**] was admitted to the floor with basal ganglia stroke
and repeat CT showed this infarct.  Subsequent MRI and MRA
showed bilateral ACA territory infarcts with MRA evidence of ACA
occlusion, and LMCA superior division infarct with occlusion as
well as basal ganglia infarct.  Exam over the next several days
had initially been stable, but she deteriorated subsequently,
with mental status decline, respiratory distress requiring
intubation and transfer to the ICU.  Head CTs showed increased
swelling, evolving infarcts, and early signs of herniation.
Mannitol was used to decrease intracranial pressure.  On [**1-30**]
head CT with slt progression of ant L aca and L mca, with
effacement of sulci, ml shift (as prior) -more compromise of
bilateral lateral vents; no new hemorrhage; R caudate head with
evolving infarct; still with signs of uncal and transtentorial
herniation.  On [**1-31**], pupils were fixed and dilated, with minimal
brainstem response.  Legs still withdrew to stimuli.  Sodium and
osmoles trended up to Na>170 on mannitol (which had been held)
and vasopressin drip was started.  On [**2-1**], a repeat CT showed
diffuse cerebral edema, herniation, and strokes in the PCA
territory as well as hemorrhage.  Her pupils remained fixed and
dilated, and she had limited brainstem reflexes.  Blood pressure
dropped and she eventually required high doses of two pressors.
A family discussion was held, and new information about a
possible medical history of malignancy was mentioned.  The
family felt that recently she had been doing many things "as if
preparing for death," such as visiting the cemetery, seeing many
family members, and even traveling to [**Male First Name (un) 1056**] to visit
family.  She had also lost a lot of weight recently, had been
quite fatigued, and had been injecting herself with a mysterious
medication that she told family members was insulin.  The family
felt that she should be made comfortable at the end of her life,
given the poor prognosis, and considering a possible underlying
process.  She was extubated and was pronounced dead at 2300 on
[**2108-2-1**].  She did not breathe on her own after extubation.  The
family requested an autopsy.  They declined donation.

Medications on Admission:
Glyburide 20 [**Hospital1 **], Omeprazole 20 qd


Discharge Medications:
expired

Discharge Disposition:
Expired

Discharge Diagnosis:
expired.  Cause of death: respiratory arrest due to cerebral
infarction

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2108-2-2**]
{'Cerebral embolism with cerebral infarction,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux'}


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: CVA with R hemiparesis and R facial, slurred speech x 11hours

PRESENT ILLNESS: 57yo RFHM with h/o NIDDM, no CAD/HTN/HL/MI who presents from
[**Hospital3 2568**] for CVA at L basal ganglia on MRI.  Story starts
several days ago.  Pt had been in [**Male First Name (un) 1056**] for a week, fine,
no illness.  Returned 3 d PTA and was well.  Then 2 d PTA she
was
looking tired, with less expression, rather quiet.  1d PTA
family
went to McDonald's and on the drive home for one hour she was
really quiet, no focal movments, or eye deviation, just not very
talkative, around 3 pm on [**1-26**].  Then at home she was doing
laundry, cooking, seeming normal.  Aroudn 5pm she suddenly c/o
feeling very dizzy but only for about 30 seconds and she was
hold
her cooking spoon with both hands in front of her for a few
seconds without moving, again very quiet.  Then she came back to
normal, finished cooking, serving and eating and went to bed at
usual time an hour later.
 She slept separately fr husband [**3-1**] not feeling well, and the
next morning she got up to go the bathroom and fell, and told
her
husband she fell (around 8AM on DOA).  They went to eat
breakfast
and huband noted slurred nonsensical, jibberish and she was
producing less speech.  At that time she was noted to have a L
facial droop but no other weakness.  Husband checked [**Name2 (NI) 31567**] at 42
and gave wife coffee, toast, chocolate, which she ate without
drooling or difficultiy.  They called a relative who said she
should go to the [**Name (NI) **].

MEDICAL HISTORY: NIDDM, unclear how good her control was.  GERD, knee
surgery.  See above

MEDICATION ON ADMISSION: Glyburide 20 [**Hospital1 **], Omeprazole 20 qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:    T:   97 BP:    120/80  P:   67  RR:  18   O2 sat:  97  NC

FAMILY HISTORY: DM

SOCIAL HISTORY: Tob: [**1-30**] cig qd for [**11-8**] yers, quit years ago
           EtOH:    no                IVDA: no 

### Response:
{'Cerebral embolism with cerebral infarction,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Esophageal reflux'}
