CHIEF COMPLAINT: Aphasia

PRESENT ILLNESS: 50 y/o M with known history of dural AV fistula presented to
OSH today s/p one episode of aphasia. Patient states that he all
of a sudden felt ill with pressure in his face and seeing
speckles suddenly bent over and was unable to speak. His wife
found him slouched over and unresponsive. He states that he was
able to hear her, but was not able to respond. He reports that
this incident lasted for 2-3 minutes and then he was taken to
the
OSH. Once at the OSH, patient had a head CT which revealed a R
frontal hypodensity and was treated with aspirin. His symptoms
have since resolved. He was transferred to [**Hospital1 18**] for further
evaluation. Patient denies any headache, n/v, dizziness, change
in vision or speech currently.

MEDICAL HISTORY: hernia and cleft palate repair

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: O: T:98.6  BP:118/94   HR:81    R: 22    O2Sats:98% 2L
Gen: WD/WN, comfortable, NAD.
HEENT: atraumatic, normocephalic
Pupils: 3-2mm bilaterally        EOMs: intact

FAMILY HISTORY: diabetes and HTN

SOCIAL HISTORY: test engineer, drinks EOTH socially
Anomalies of cerebrovascular system,Cerebral artery occlusion, unspecified with cerebral infarction
Cerebrovascular anomaly,Crbl art ocl NOS w infrc
Admission Date:  [**2111-3-22**]              Discharge Date:   [**2111-3-27**]

Date of Birth:  [**2060-4-25**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Aphasia

Major Surgical or Invasive Procedure:
[**2111-3-25**]: Cerebral angiogram with embolization


History of Present Illness:
50 y/o M with known history of dural AV fistula presented to
OSH today s/p one episode of aphasia. Patient states that he all
of a sudden felt ill with pressure in his face and seeing
speckles suddenly bent over and was unable to speak. His wife
found him slouched over and unresponsive. He states that he was
able to hear her, but was not able to respond. He reports that
this incident lasted for 2-3 minutes and then he was taken to
the
OSH. Once at the OSH, patient had a head CT which revealed a R
frontal hypodensity and was treated with aspirin. His symptoms
have since resolved. He was transferred to [**Hospital1 18**] for further
evaluation. Patient denies any headache, n/v, dizziness, change
in vision or speech currently.


Past Medical History:
hernia and cleft palate repair

Social History:
test engineer, drinks EOTH socially


Family History:
diabetes and HTN


Physical Exam:
O: T:98.6  BP:118/94   HR:81    R: 22    O2Sats:98% 2L
Gen: WD/WN, comfortable, NAD.
HEENT: atraumatic, normocephalic
Pupils: 3-2mm bilaterally        EOMs: intact

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**4-18**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**6-20**] throughout. No pronator drift

Sensation: Intact to light touch

Handedness Right

Upon discharge:
Nonfocal exam

Pertinent Results:
MRI/MRA Brain [**3-22**]
Area of increased signal in the right frontal lobe involving the
cortical and
subcortical regions with some foci of enhancement and a linear
focus of
suceptibility artifact may represent a subacute venous infarct .
There are
some prominent vessels surrounding the lesion likely
representing collateral
veins or venous hyperemia.

EEG
Negative for seizure

ECHO [**3-23**]
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). No masses or thrombi
are seen in the left ventricle. Transmitral and tissue Doppler
imaging suggests normal diastolic function, and a normal left
ventricular filling pressure (PCWP<12mmHg). Right ventricular
chamber size and free wall motion are normal. The aortic root is
mildly dilated at the sinus level. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion. No
aortic regurgitation is seen. The mitral valve appears
structurally normal with trivial mitral regurgitation. There is
no mitral valve prolapse. The pulmonary artery systolic pressure
could not be determined. There is no pericardial effusion.


Brief Hospital Course:
Patient presented to [**Hospital1 18**] following an episode of aphasia and a
Head Ct that showed a right frontal hypodensity. He was seen by
neurology who recommended an MRI/A of the brain, EEG, ASA, and
cardiac labs. His MRI/A was done on the evening of [**3-22**] and it
showed a potential subacute venous infarct. His exam was
nonfocal on morning rounds of [**3-23**] and he is planned to undergo
angio for his known dural AV fistula on [**3-25**]. He remained stable
overnight in the ICU into [**3-24**]. On morning rounds his exam
continued to be nonfocal and he was awaiting placement of EEG to
assess for seizure activity. He had a 20 minute EEG which showed
no seizure activity. Later in the evening a 24 hour EEG was
placed and he was planned to undergo angiogram for intervention
for his AV fistula. On [**3-25**] his exam was stable and he was taken
to the angio suite for repair of his AV fistula. He toelrated
the procedure well and returned to the intensive care unit
post-operatively. He remained stable into [**3-26**] and was deemed fit
for transfer out of the ICU to the floor. On [**3-27**] his exam was
nonfocal, he was tolerating a PO diet, and he was ambulatory
independently.

He was discharged home.

Medications on Admission:
None

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
2. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*3*


Discharge Disposition:
Home

Discharge Diagnosis:
Dural AV fistula
R frontal infarct


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


Discharge Instructions:
Medications:
??????       Take Aspirin 325mg (enteric coated) once daily.
??????       Continue Keppra as recommended by Neurology for at least
6 months.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room!


Followup Instructions:
Please follow-up with Dr [**First Name (STitle) **] in 4 weeks, you do not need
imaging at that time. Please call [**Telephone/Fax (1) 4296**] to make this
appointment.

Please follow-up with Dr [**Last Name (STitle) **] of Stroke Neurology in [**5-22**]
weeks. Please call ([**Telephone/Fax (1) 7394**] to make this appointment.



Completed by:[**2111-3-27**]
{'Anomalies of cerebrovascular system,Cerebral artery occlusion, unspecified with cerebral infarction'}


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: Aphasia

PRESENT ILLNESS: 50 y/o M with known history of dural AV fistula presented to
OSH today s/p one episode of aphasia. Patient states that he all
of a sudden felt ill with pressure in his face and seeing
speckles suddenly bent over and was unable to speak. His wife
found him slouched over and unresponsive. He states that he was
able to hear her, but was not able to respond. He reports that
this incident lasted for 2-3 minutes and then he was taken to
the
OSH. Once at the OSH, patient had a head CT which revealed a R
frontal hypodensity and was treated with aspirin. His symptoms
have since resolved. He was transferred to [**Hospital1 18**] for further
evaluation. Patient denies any headache, n/v, dizziness, change
in vision or speech currently.

MEDICAL HISTORY: hernia and cleft palate repair

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: O: T:98.6  BP:118/94   HR:81    R: 22    O2Sats:98% 2L
Gen: WD/WN, comfortable, NAD.
HEENT: atraumatic, normocephalic
Pupils: 3-2mm bilaterally        EOMs: intact

FAMILY HISTORY: diabetes and HTN

SOCIAL HISTORY: test engineer, drinks EOTH socially 

### Response:
{'Anomalies of cerebrovascular system,Cerebral artery occlusion, unspecified with cerebral infarction'}
