CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 80-year-old
woman who presents with her family to the Emergency Room with
chief complaint of complete deterioration of ability to
perform daily activities due to progressive myelopathy in all
four extremities.  The patient was diagnosed with C1 pannus
due to arthritis and was scheduled for surgery in two weeks.
However, the patient's condition deteriorated, and the
patient could no longer care for herself at home.

MEDICAL HISTORY: Bipolar disorder.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: The patient was afebrile, awake, alert and
oriented x 3.  Cranial nerves II through XII were grossly
intact.  Upper extremity strength - deltoids 3 plus on the
right side and 4 minus on the right; bilateral biceps - 3
plus to 4 minus; triceps 3 plus to 4 minus; brachioradialis
bilaterally were 3.  Lower extremity strength - 4's in all
muscle groups bilaterally.  Her reflexes were brisk, 3 plus
throughout.

FAMILY HISTORY: 

SOCIAL HISTORY: 
Ankylosing spondylitis,Urinary tract infection, site not specified,Pneumonia due to other gram-negative bacteria,Cervical spondylosis with myelopathy,Anticoagulants causing adverse effects in therapeutic use,Bipolar I disorder, most recent episode (or current) unspecified,Unspecified essential hypertension
Ankylosing spondylitis,Urin tract infection NOS,Pneumo oth grm-neg bact,Cerv spondyl w myelopath,Adv eff anticoagulants,Bipolor I current NOS,Hypertension NOS
Admission Date: [**2190-10-7**]        Discharge Date: [**2190-11-9**]


Service:  NSU


HISTORY OF PRESENT ILLNESS:  The patient is an 80-year-old
woman who presents with her family to the Emergency Room with
chief complaint of complete deterioration of ability to
perform daily activities due to progressive myelopathy in all
four extremities.  The patient was diagnosed with C1 pannus
due to arthritis and was scheduled for surgery in two weeks.
However, the patient's condition deteriorated, and the
patient could no longer care for herself at home.

Her original issues began in [**2190-6-10**] when she presented
with bilateral paresthesias and was sent to a neurologist for
work-up of question of myelopathy, neuropathy, or carpal
tunnel syndrome.  The patient finally had an MRI done which
showed a large mass perhaps arising from the clivus impinging
on the ventral medulla, and extending all the way down to the
dens and arch of C1, encroaching on the ventral cord, with
posterior thecal sac and cord impingement, and abnormal cord
signal.  It also showed evidence of C3-C4 cord impingement
due to a herniated disk also contributing to her myelopathy.

PAST MEDICAL HISTORY:  Bipolar disorder.

PAST SURGICAL HISTORY:  Bowel obstruction.

Infertility procedure.

C-section x 3.

PHYSICAL EXAM:  The patient was afebrile, awake, alert and
oriented x 3.  Cranial nerves II through XII were grossly
intact.  Upper extremity strength - deltoids 3 plus on the
right side and 4 minus on the right; bilateral biceps - 3
plus to 4 minus; triceps 3 plus to 4 minus; brachioradialis
bilaterally were 3.  Lower extremity strength - 4's in all
muscle groups bilaterally.  Her reflexes were brisk, 3 plus
throughout.

HOSPITAL COURSE:  The patient was therefore admitted for Solu-
Medrol, and more emergent surgery was planned.  The patient
was evaluated by Dr. [**Last Name (STitle) 1327**] and Dr. [**Last Name (STitle) 1906**], and on
[**2190-10-13**] underwent a transoral resection of odontoid and
associated pannus with posterior fusion.  The patient had
anterior and posterior C3-C4 fusion.  The patient postop was
intubated and sedated.  Vital signs were stable.  Moving all
extremities spontaneously.  Toes were downgoing bilaterally.
The patient's dressing on the back was clean, dry and intact,
and she was in a hard collar.  The patient remained in the
recovery room in an ICU for 3-4 days before being transferred
to the ICU.

On 11/40/[**2189**], the patient opened her eyes, was not following
commands, moved all extremities spontaneously, with overall
decreased spontaneous movement of the right upper extremity,
as she was preop.  She was able to grip bilaterally with good
strength, flex bilateral legs at the hips at lease
antigravity strength.  She did have a severely swollen
tongue, and remained intubated.  The patient was extubated on
[**2190-10-19**] and tolerated it well, remained in the ICU setting
for several days, and then was transferred to the Stepdown
Unit on [**2190-10-25**].

She had an episode of respiratory distress on [**10-27**] and was
intubated and transferred back to the ICU setting.  She was
therefore then trached and had a swallow eval done which
showed gross aspiration.  The patient, therefore, had a
feeding tube placement.  At the time of the respiratory
distress, ENT evaluated the patient, and the patient had
stridor, and they thought it was likely due to poor
oropharyngeal and sympathetic muscle tone and edema.
Therefore, the patient was trached.  She also, during her
second ICU stay, had a decrease in her platelet count.  A HIT
panel was sent and came back positive for HIT antibody.
Therefore, all heparin medications were discontinued.  She
also had an IVC filter placed on [**2190-10-28**].  She also had a
CT of the neck done which was negative for any abscess and
just showed soft tissue swelling.

The patient had trach placed on [**2190-11-2**] without
complication.  The patient had PEG placed on [**2190-11-1**]
without intraop complication.  The patient still has the
cotton swab in place around the G-tube site which will be
removed prior to discharge.  Her neurologic status remained
stable.  She was moving all extremities, following commands,
and was transferred back to the regular floor on

DICTATION ENDED



                        [**Name6 (MD) **] [**Last Name (NamePattern4) **], [**MD Number(1) 12001**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2190-11-9**] 11:30:56
T:  [**2190-11-9**] 12:17:29
Job#:  [**Job Number 23894**]


Admission Date: [**2190-10-7**]        Discharge Date: [**2190-11-9**]


Service:  NSU


CONTINUATION:  The patient was transferred from the ICU to
the Step-Down Unit on [**2190-11-6**] after receiving PEG and
trach. She remained neurologically stable and was transferred
out to the Step-Down Unit on the regular floor. Vital signs
remained stable. She was receiving chest physical therapy and
physical therapy. She remained neurologically stable and was
seen by Physical Therapy and Occupational Therapy and felt to
be safe for discharge to Rehab. She also was evaluated for
Passy-Muir valve with Speech and Swallow. However, she was
not able to tolerate that and she will continue to be
followed by Speech Therapy in Rehab. She was started on
Levaquin for UTI, awaiting a urine culture result. As of
today, she remains neurologically stable, moving all
extremities and continues with extreme right upper extremity
weakness.

DISCHARGE MEDICATIONS:  Her medications at the time of
discharge are hydralazine 10 mg po q6h, hold for SBP less
than 110 and heart rate less than 60, metoprolol 37.5 mg po
qam and 50 mg po qhs, levofloxacin 500 mg po q24h for a total
of five days, started on [**2190-11-8**], lorazepam 0.5- 1 mg po
q4-6h prn per G-tube prn, lansoprazole 30 cc po per G-tube
daily, lithium carbonate 300 mg per G-tube daily, Tylenol #3
one to two tabs po per G-tube q4h prn, estrogen 0.3 mg per G-
tube daily, Colace 100 mg per G-tube [**Hospital1 **], Dulcolax 10 mg per
G-tube daily prn.

The patient's condition was stable at the time of discharge.
She will follow up with Dr. [**Last Name (STitle) 1327**] in two weeks with repeat
AP and lateral cervical films.



                        [**Name6 (MD) **] [**Last Name (NamePattern4) **], [**MD Number(1) 12001**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2190-11-9**] 11:35:14
T:  [**2190-11-9**] 11:54:53
Job#:  [**Job Number 23972**]
{'Ankylosing spondylitis,Urinary tract infection, site not specified,Pneumonia due to other gram-negative bacteria,Cervical spondylosis with myelopathy,Anticoagulants causing adverse effects in therapeutic use,Bipolar I disorder, most recent episode (or current) unspecified,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: The patient is an 80-year-old
woman who presents with her family to the Emergency Room with
chief complaint of complete deterioration of ability to
perform daily activities due to progressive myelopathy in all
four extremities.  The patient was diagnosed with C1 pannus
due to arthritis and was scheduled for surgery in two weeks.
However, the patient's condition deteriorated, and the
patient could no longer care for herself at home.

MEDICAL HISTORY: Bipolar disorder.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: The patient was afebrile, awake, alert and
oriented x 3.  Cranial nerves II through XII were grossly
intact.  Upper extremity strength - deltoids 3 plus on the
right side and 4 minus on the right; bilateral biceps - 3
plus to 4 minus; triceps 3 plus to 4 minus; brachioradialis
bilaterally were 3.  Lower extremity strength - 4's in all
muscle groups bilaterally.  Her reflexes were brisk, 3 plus
throughout.

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Ankylosing spondylitis,Urinary tract infection, site not specified,Pneumonia due to other gram-negative bacteria,Cervical spondylosis with myelopathy,Anticoagulants causing adverse effects in therapeutic use,Bipolar I disorder, most recent episode (or current) unspecified,Unspecified essential hypertension'}
