CHIEF COMPLAINT: Left hemiparesis

PRESENT ILLNESS: The pt is a 61 year-old right-handed man transferred from an OSH
after acute left sided weakness, found to have R
frontal-parietal bleed.

MEDICAL HISTORY: Psoriasis

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.2 P: 90  R: 16 BP: 157/87 SaO2: 97% on 2L NC

FAMILY HISTORY: -mother: pacemaker
-father: HTN

SOCIAL HISTORY: -lives with his girlfriend, [**Name (NI) 4248**] [**Name (NI) **] (c) [**Telephone/Fax (1) 79858**]; (h)
[**Telephone/Fax (1) 79859**]; daughter [**Name (NI) **] [**Name (NI) 79860**] (pt does not know her
number); no HCP
-remote tobacco
-EtOH 1-2 beers per night
-denies drugs
-works as a trucker
Intracerebral hemorrhage,Anomalies of cerebrovascular system,Iron deficiency anemia, unspecified,Other psoriasis,Benign essential hypertension
Intracerebral hemorrhage,Cerebrovascular anomaly,Iron defic anemia NOS,Other psoriasis,Benign hypertension
Admission Date:  [**2182-10-3**]              Discharge Date:   [**2182-10-18**]

Date of Birth:  [**2121-1-21**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
Left hemiparesis

Major Surgical or Invasive Procedure:
Cerebral Angiography


History of Present Illness:
The pt is a 61 year-old right-handed man transferred from an OSH
after acute left sided weakness, found to have R
frontal-parietal bleed.

He was in his USOH today until 1715h when, upon finishing w/
bowel movement, noticed he couldn't stand d/t left leg weakness.
Subsequently he noticed arm weakness.  He denied associated
headache, n/v or any other symptoms prior to onset of noticed
weakness.  He had never had such symptoms before.  He called for
his girlfriend who helped him off the toilet and called EMS.  No
facial weakness, dysarthria or confusion was noted.  At OSH, SBP
180s, exam reportedly stable.  Once IPH was identified, he was
transferred to [**Hospital1 18**] for additional care.

ROS:  The pt denied headache, loss of vision, blurred vision,
diplopia, dysarthria, dysphagia, lightheadedness, vertigo,
tinnitus or hearing difficulty. Denied difficulties producing or
comprehending speech.  No bowel or bladder incontinence or
retention. The pt denied recent fever or chills. No night sweats
or recent weight loss or gain.  Denied cough, shortness of
breath. Denied chest pain or tightness, palpitations. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. No dysuria. Denied
arthralgias or myalgias.

Past Medical History:
Psoriasis

Social History:
-lives with his girlfriend, [**Name (NI) 4248**] [**Name (NI) **] (c) [**Telephone/Fax (1) 79858**]; (h)
[**Telephone/Fax (1) 79859**]; daughter [**Name (NI) **] [**Name (NI) 79860**] (pt does not know her
number); no HCP
-remote tobacco
-EtOH 1-2 beers per night
-denies drugs
-works as a trucker

Family History:
-mother: pacemaker
-father: HTN


Physical Exam:
Vitals: T: 98.2 P: 90  R: 16 BP: 157/87 SaO2: 97% on 2L NC

GCS=15

NIHSS= 10
1a. Level of Consciousness: 0
1b. LOC questions: 0
1c. LOC commands: 0
2. Best gaze: 0
3. Visual: 0
4. Facial palsy: 1
5a. Motor arm, left: 4
5b. Motor arm, right: 0
6a. Motor leg, left: 4
6b. Motor leg, right: 0
7. Limb ataxia: 0
8. Sensory: 0
9. Best language: 0
10. Dysarthria: 0
11. Extinction and inattention: 1

General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, there are a few
white patches along the tongue that do no scrape off
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity

Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: no pedal edema
Skin: diffuse patches and plaques of erythema and diffusely

Neurologic:
-Mental Status: Alert, oriented x 3. Able to relate history
without difficulty. Attentive. Language is fluent with intact
repetition and comprehension. Normal prosody. There were no
paraphasic errors. Pt. was able to name both high and low
frequency objects. Able to read without difficulty. Speech was
not dysarthric. Able to follow both midline and appendicular
commands. The pt. had good knowledge of current events. There
was no evidence of apraxia or neglect.

CN
I: not tested
II,III: VFF to confrontation, L pupil 4mm->2mm, R pupil 3.5-2mm,
fundi normal but narrowing of the vessels diffusely;
III,IV,V: EOMI, no ptosis. No nystagmus
V: sensation intact V1-V3 to LT
VII: L facial droop but able to smile almost symmetrically
VIII: hears finger rub bilaterally
IX,X: palate elevates symmetrically, uvula midline
[**Doctor First Name 81**]: SCM 5 bilaterally but the L trapezeii does not move
XII: tongue protrudes midline, no dysarthria

Motor: Normal bulk and tone; no asterixis or myoclonus. No
pronator drift on the R. L is plegic.

  Delt [**Hospital1 **] Tri WE FE Grip  IO
  C5   C6 C7  C6 C7 C8/T1 T1
L  0 --------------- 4    0
R 5    5  5   5  5  5     5

  IP Quad Hamst DF [**Last Name (un) 938**] PF
  L2  L3  L4-S1 L4 L5  S1/S2
R 5   5   5     5  5   5

  Reflex: No clonus
  [**Hospital1 **] Tri Bra Pat An Plantar
  C5 C7 C6 L4 S1 CST
L 1 --------- 0  0  mute
R 1 --------- 0  0  flexor

-Sensory: + decreased light touch over entire L leg, intact
pinprick throughout; + extinction to DSS on the L.

-Coordination: No intention tremor. No dysmetria on FNF or HKS
on the R.

-Gait: negative

Pertinent Results:
LABS:
[**2182-10-3**] 10:19PM BLOOD WBC-12.6* RBC-4.84 Hgb-13.6* Hct-37.7*
MCV-78* MCH-28.2 MCHC-36.1* RDW-14.2 Plt Ct-308
[**2182-10-17**] 06:20AM BLOOD WBC-8.2 RBC-4.72 Hgb-13.3* Hct-38.6*
MCV-82 MCH-28.1 MCHC-34.4 RDW-15.0 Plt Ct-324
[**2182-10-3**] 10:19PM BLOOD Neuts-93.7* Lymphs-3.2* Monos-2.9 Eos-0.1
Baso-0.1
[**2182-10-3**] 11:30PM BLOOD PT-13.2 PTT-25.2 INR(PT)-1.1
[**2182-10-3**] 10:19PM BLOOD Glucose-146* UreaN-11 Creat-0.7 Na-138
K-3.9 Cl-101 HCO3-26 AnGap-15
[**2182-10-17**] 06:20AM BLOOD Glucose-87 UreaN-15 Creat-0.9 Na-137
K-4.0 Cl-98 HCO3-30 AnGap-13
[**2182-10-3**] 10:19PM BLOOD ALT-11 AST-15 CK(CPK)-40 AlkPhos-78
TotBili-0.4
[**2182-10-4**] 02:14AM BLOOD CK(CPK)-40
[**2182-10-3**] 10:19PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2182-10-4**] 02:14AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2182-10-3**] 10:19PM BLOOD Lipase-16
[**2182-10-4**] 02:14AM BLOOD Calcium-9.0 Phos-2.6* Mg-2.0 Cholest-122
[**2182-10-17**] 06:20AM BLOOD Calcium-9.1 Phos-3.8 Mg-2.2
[**2182-10-4**] 02:14AM BLOOD Triglyc-59 HDL-26 CHOL/HD-4.7 LDLcalc-84
[**2182-10-4**] 02:14AM BLOOD %HbA1c-5.4
[**2182-10-10**] 06:20AM BLOOD Iron-64
[**2182-10-10**] 06:20AM BLOOD calTIBC-329 Ferritn-81 TRF-253
[**2182-10-3**] 10:19PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2182-10-4**] 01:33AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG
[**2182-10-4**] 01:33AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.036*
[**2182-10-4**] 01:33AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG

MICRO:
Stool Cx ([**10-11**]): Negative for C. diff toxin A&B

Brief Hospital Course:
The pt is a 61 year-old right-handed man with a history of
psoriasis who intially presented to an OSH after acute left
sided weakness after having a bowel movement, and CT head showed
a 6.8 x 1.5 cm acute hematoma in the right cerebral hemisphere
above the level of the right lateral ventricle. His blood
pressure on admission to the OSH was 147/67 but reportedly was
up to SBP 180. He was transferred to [**Hospital1 18**] for further
evaluation. At [**Hospital1 18**], his bp was 157/87 on admission, and in the
ED he was given Dilantin 1 gm IV x1, Hydralazine 5 mg IV x1, and
Nicardipine gtt. CTA head/neck at [**Hospital1 18**] showed large right
frontoparietal intraparenchymal hemorrhage with other scattered
smaller adjacent intraparenchymal hemorrhages identified. There
was no obvious aneurysm or AVM, but there was an adjacent
developmental venous anomaly that may herald an occult
arteriovenous malformation as the cause of this lesion.
Neurosurgery was consulted on admission, and the patient went
for cerebral angiography on [**10-4**]. This showed a developmental
venous anomaly in the right frontal region in the demonstrated
area of hemorrhage as seen on CT and CTA, and no evidence for
aneurysm/AVM associated with this. The neurosurgeon did not feel
he could safely intervene on it.
He was transferred to the NeuroICU for monitoring overnight. He
was started on Metoprolol tartrate 25 mg PO tid for blood
pressure control. All antiplatelets and anticoagulants were
held. Dilantin was discontinued on day 1 of admission. FLP Chol:
122, TG 59, HDL 26, LDL 84, CEs: CK 40-40, TropT <0.01x2, HgA1c
5.4%, serum/urine tox negative. His strength on the left side
continued to improve during the hospitalization, and at the time
of discharge was: Right: Full, Left: Delt 4, [**Hospital1 **] 4+, Tri 4+, WE
5, FE 5, IP 4-, H 3, Q 3, PF 1, DF 1. He has a follow up
appointment with Dr. [**First Name (STitle) **] in Neurology as an outpatient.
He was also found to have a microcytic anemia (Hct 36-39), but
iron studies showed  Fe 64, TIBC 329, ferritin 81. This can be
monitored as an outpatient.

Medications on Admission:
None

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for fever or pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 17921**] Center - [**Location (un) 5450**], NH

Discharge Diagnosis:
Right Frontal-Parietal hemorrhagic stroke, likely due to DVA
(developmental venous anomaly)
Microcytic anemia


Discharge Condition:
Weakness of left deltoids, biceps triceps, IP, hamstrings,
quadriceps, PF, and DF, but much improved from admission


Discharge Instructions:
You were transferred to this hospital because you could not move
the left side of your body. You were found to have a hemorraghe
in the right side of your brain in the frontal-parietal lobe.
You were initially in the NeuroICU for monitoring. You had a
cerebral angiogram that did not reveal an aneurysm but did show
a venous malformation that could have caused the bleeding. The
neurosurgical team deemed that this lesion should not be
intervened. You were transferred to the Neurology floor.

The following change were made to your medications: You were
started on Metoprolol 25 mg three times a day.

If you develop weakness or numbness, confusion, difficulty
speaking or swallowing, decreased vision or blurry vision, or
any other symptoms that concern you, call your PCP or return to
the ED.


Followup Instructions:
You have a follow up appointment with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 162**] in
Neurology ([**Telephone/Fax (1) 44**]) on [**2182-11-11**] at 2:00 in the [**Hospital Ward Name 23**]
Center, [**Location (un) 858**].
{'Intracerebral hemorrhage,Anomalies of cerebrovascular system,Iron deficiency anemia, unspecified,Other psoriasis,Benign 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: Left hemiparesis

PRESENT ILLNESS: The pt is a 61 year-old right-handed man transferred from an OSH
after acute left sided weakness, found to have R
frontal-parietal bleed.

MEDICAL HISTORY: Psoriasis

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.2 P: 90  R: 16 BP: 157/87 SaO2: 97% on 2L NC

FAMILY HISTORY: -mother: pacemaker
-father: HTN

SOCIAL HISTORY: -lives with his girlfriend, [**Name (NI) 4248**] [**Name (NI) **] (c) [**Telephone/Fax (1) 79858**]; (h)
[**Telephone/Fax (1) 79859**]; daughter [**Name (NI) **] [**Name (NI) 79860**] (pt does not know her
number); no HCP
-remote tobacco
-EtOH 1-2 beers per night
-denies drugs
-works as a trucker 

### Response:
{'Intracerebral hemorrhage,Anomalies of cerebrovascular system,Iron deficiency anemia, unspecified,Other psoriasis,Benign essential hypertension'}
