CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is an 82-year-old woman
transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital status post a left MCA
stroke on the [**3-28**].  The patient was treated with
steroids and osmotic therapy with some improvement, had some
right sided hemiparesis and expressive aphasia.  The patient was
transferred to [**Hospital1 69**] after
worsening on [**2178-8-3**].  Head CT showed increase in the left
MCA infarct and basal ganglia hemorrhage with impending uncal
herniation.  The patient was transferred to [**Hospital1 346**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension
Crbl art ocl NOS w infrc,Atrial fibrillation,Hyperosmolality,Hypertension NOS
Admission Date:  [**2178-8-4**]       Discharge Date:  [**2178-8-18**]


Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  Patient is an 82-year-old woman
transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital status post a left MCA
stroke on the [**3-28**].  The patient was treated with
steroids and osmotic therapy with some improvement, had some
right sided hemiparesis and expressive aphasia.  The patient was
transferred to [**Hospital1 69**] after
worsening on [**2178-8-3**].  Head CT showed increase in the left
MCA infarct and basal ganglia hemorrhage with impending uncal
herniation.  The patient was transferred to [**Hospital1 346**].

PHYSICAL EXAMINATION:  Temperature was 97.9, heart rate 67,
blood pressure 174/74, respiratory rate is 20, sat is 95% on
2 liters.  The patient does not speak, but follows commands,
nods yes and no appropriately.  Pupils are equal, round, and
reactive to light.  No facial droop.  Sticks out tongue, but
does not shrug shoulders.  Abdomen is soft, nontender,
nondistended.  Regular, rate, and rhythm for her heart.
Chest was clear to auscultation, no clubbing, cyanosis, or
edema in the lower extremities.  She will show two fingers on
the left side.  Her motor ability:  She does not move the
right side, upper or lower extremity.  She has a right sided
neglect and right facial droop.

Patient was admitted to the MICU for close neurologic
observation.  She was seen by the Neurology service who felt
that the patient would require an emergent craniectomy to
prevent uncal herniation.  Therefore, the patient was taken
to the operating room on [**2178-8-5**], and had a left
craniectomy.

Postoperatively, patient moving the left side spontaneously,
opening eyes spontaneously.  Grimaces to stimulation, attends
to the examiner on the left.  Pupils are equal, round, and
reactive to light.  Patient continues to be aphasic, briskly
localizes on the left upper, and plegic in the right upper.
Toes are up on the right, slight withdraws on the left lower.


Patient had a postoperative head CT which shows large left
hemorrhagic conversion from her infarct on [**2178-8-6**].  She
had a bedside swallow evaluation, which they recommended a
diet consists of nectar-thick liquids and puree solids with
strict aspiration precautions, however, patient became more
sleepy and required PEG placement that was done without
complication.  The patient remained in the Neuro Intensive
Care Unit for close neurologic observation and monitoring
with stable neurologic status.

The patient was fitted for a helmet due to the craniectomy
site.  Her incision is clean, dry, and intact.  She had a PEG
placed.  She was seen by Physical Therapy and Occupational
Therapy, and found to acquire acute rehab.  She was
transferred to the regular floor on [**2178-8-14**] after her PEG
placement.  She was to be at goal tube feeding as of 6 pm
tonight.  Her vital signs are stable.  She is afebrile.  She
continues to have right hemiparesis, following commands on
the left side, moving left side spontaneously.  Pupils are
equal, round, and reactive to light.  Her incisions are
clean, dry, and intact.

She will follow up with Dr. [**Last Name (STitle) 1132**] in two weeks' time with
repeat head CT at that time.

DISCHARGE MEDICATIONS:
1. Captopril 6.25 mg po tid, hold for systolic blood pressure
less than 100.
2. Dilantin 150 mg po bid.
3. Heparin 5,000 units subQ q12h.
4. Amiodarone 400 mg po tid.
5. Famotidine 20 mg po q day.
6. Colace 100 mg po bid.
7. Tylenol 650 po q4h prn.
8. Insulin-sliding scale.

CONDITION ON DISCHARGE:  Stable.

FOLLOW-UP INSTRUCTIONS:  She will follow up with Dr. [**Last Name (STitle) 1132**] in
two weeks' time.



                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2178-8-17**]  09:18
T:  [**2178-8-17**]  09:28
JOB#:  [**Job Number 51697**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension'}


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: Patient is an 82-year-old woman
transferred from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] Hospital status post a left MCA
stroke on the [**3-28**].  The patient was treated with
steroids and osmotic therapy with some improvement, had some
right sided hemiparesis and expressive aphasia.  The patient was
transferred to [**Hospital1 69**] after
worsening on [**2178-8-3**].  Head CT showed increase in the left
MCA infarct and basal ganglia hemorrhage with impending uncal
herniation.  The patient was transferred to [**Hospital1 346**].

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Atrial fibrillation,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension'}
