CHIEF COMPLAINT: Left hemispheric CVA.

PRESENT ILLNESS: This patient is a 66-year-old
male, with past medical history as below, who was transferred
from an outside hospital status post left hemispheric stroke
with dense right hemiplegia and aphasia for possible
craniectomy for cerebral edema.  On [**2133-6-10**], the patient had
been admitted to an outside hospital with right arm weakness
and numbness, and was found to have a left parietal stroke.
Within that work-up, he was found to have a left internal
carotid artery stenosis of 65 percent, and thus was taken for
left carotid endarterectomy on [**2133-6-18**].  Following
procedure, the patient went to the PACU and was noted to have
a right hemiparesis and was unable to speak.  He was taken
emergently back to the operating room for thrombectomy;
however, his clinical status did not improve.  Due to edema
developing around the infarct, the patient was started on
Decadron and mannitol, as well as heparin infusion, and was
transferred to [**Hospital1 18**] for neurosurgical evaluation.

MEDICAL HISTORY: Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smokes approximately 1 pack per
day and drinks 1 drink of alcohol per day.  He is a retired
executive from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].
Cerebral artery occlusion, unspecified with cerebral infarction,Tobacco use disorder,Other and unspecified hyperlipidemia
Crbl art ocl NOS w infrc,Tobacco use disorder,Hyperlipidemia NEC/NOS
Admission Date: [**2133-6-19**]        Discharge Date: [**2133-6-26**]

Date of Birth:  [**2067-2-17**]        Sex:  M

Service:  MED


CHIEF COMPLAINT:  Left hemispheric CVA.

HISTORY OF PRESENT ILLNESS:  This patient is a 66-year-old
male, with past medical history as below, who was transferred
from an outside hospital status post left hemispheric stroke
with dense right hemiplegia and aphasia for possible
craniectomy for cerebral edema.  On [**2133-6-10**], the patient had
been admitted to an outside hospital with right arm weakness
and numbness, and was found to have a left parietal stroke.
Within that work-up, he was found to have a left internal
carotid artery stenosis of 65 percent, and thus was taken for
left carotid endarterectomy on [**2133-6-18**].  Following
procedure, the patient went to the PACU and was noted to have
a right hemiparesis and was unable to speak.  He was taken
emergently back to the operating room for thrombectomy;
however, his clinical status did not improve.  Due to edema
developing around the infarct, the patient was started on
Decadron and mannitol, as well as heparin infusion, and was
transferred to [**Hospital1 18**] for neurosurgical evaluation.

PAST MEDICAL HISTORY:  Hyperlipidemia.

History of DVT.

History of osteomyelitis.

Status post right tibia fracture, [**11-18**].

Chronic back pain.

DJD.

Status post appendectomy.

Tobacco use.

ALLERGIES:  Penicillin.

MEDICATIONS AT TIME OF TRANSFER:
1. Decadron.
2. Protonix.
3. Aspirin.


SOCIAL HISTORY:  The patient smokes approximately 1 pack per
day and drinks 1 drink of alcohol per day.  He is a retired
executive from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].

PHYSICAL EXAM AT ADMISSION AS DOCUMENTED BY NEUROLOGY
ADMISSION NOTE:  Temperature 99.5, blood pressure 154/66,
heart rate 83, respiratory rate 22, oxygen saturation 96
percent on room air.
GENERAL:  He appeared comfortable and awake.
PERTINENT PHYSICAL FINDINGS:  Revealed a regular heart rhythm
with a II/VI systolic murmur.  His neurologic exam was
significant for speech which consisted only of mumbling,
occasionally saying the word "yes," but at inappropriate
times.  He did not follow commands, and he did not answer
questions.  He had a left-sided gaze preference, but was
attentive to activity on his right side.  His pupils were
equal and reactive.  His extraocular muscles were intact
without nystagmus.  He would blink to threat.  Corneal reflex
was intact.  He had a right facial droop suggestive of an
upper motor neuron lesion.  Motor revealed flaccid right
upper and lower extremities.  Tone was normal on the left
side, and he spontaneously moved both extremities on the
left.  His reflexes were diminished in the right upper and
lower extremity, but normal on the left side.  Toes were
upgoing bilaterally.  He was seen to withdraw to pain in all
extremities, though more briskly on the left than the right.

LABS AT ADMISSION:  White blood cell count 16.1, hematocrit
30.4, platelets 213.  Coags were within normal limits.
CT HEAD:  Showed extensive brain edema in the left frontal,
temporal and parietal regions.  There was no intracranial
mass lesion, hydrocephalus, or shift of the midline.  This
suggested an acute left MCA territory infarction with
heretofore no signs of herniation.

HOSPITAL COURSE:  NEURO:  The patient was admitted to the
intensive care unit where mannitol was continued in hopes of
lowering intracranial pressure.  MRI of the brain was done to
further evaluate his acute infarction.  This again showed a
left middle cerebral artery territorial infarct involving the
cortical and subcortical regions with petechial hemorrhages
in the left parietal region.  There was then mild mass effect
in the left lateral ventricle without midline shift.  There
were moderate changes of brain atrophy, as well as small
vessel disease.  After extensive conversations with the
neurology staff, the patient's primary medical doctor, as
well as the patient's family, it was decided that in
accordance with the patient's wishes, as referenced by his
living will, which was that surgery would not be indicated,
and that the patient's care goals would be changed to
concentrate on his comfort.  He had stated very clearly that
if he had a reversible condition in which he was unable to
return to normal, that he would not want to be kept alive by
artificial means, or by "heroic measures."  His code status
was changed to DNR/DNI, and surgery was deferred.  His code
status was further changed to comfort measures only, at which
time the patient was transferred out of the intensive care
unit to the medical floor where all medications were
discontinued except for those which would insure his comfort.
This included morphine to be given around-the-clock, Ativan
on an as needed basis.

Throughout the remainder of the [**Hospital 228**] hospital stay, he
appeared comfortable.  He showed minimal, if any improvement,
from a neurologic standpoint, again uttering only the words
"yes" and occasionally "no," sometimes seemingly at
appropriate times, but others not.  At one point, he was
coherent enough to speak to his family, in which he actually
said that he did not want to live any longer which provided a
great deal of comfort for both the family, as well as the
medical team that the plan of care was appropriate.  The
patient remained comfortable and was discharged to an
inpatient hospice facility for further care.

DISCHARGE DIAGNOSES:  Left hemispheric cerebrovascular
accident with residual right-sided hemiparesis and aphasia.

DISCHARGE MEDICATIONS:
1. Roxanol 20 mg/ml to five 5-10 mg po or sublingual q 1-3 h
   prn.
2. Scopolamine patch 1 patch q 72 h prn secretions.
3. Ativan 1-2 mg IV subcu prn agitation.
4. Tylenol suppositories prn pain or fever.


DISCHARGE CONDITION:  Critical.




                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], [**MD Number(1) 109701**]

Dictated By:[**Name8 (MD) 6166**]
MEDQUIST36
D:  [**2133-6-25**] 16:02:58
T:  [**2133-6-25**] 16:51:35
Job#:  [**Job Number **]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Tobacco use disorder,Other and unspecified hyperlipidemia'}


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 hemispheric CVA.

PRESENT ILLNESS: This patient is a 66-year-old
male, with past medical history as below, who was transferred
from an outside hospital status post left hemispheric stroke
with dense right hemiplegia and aphasia for possible
craniectomy for cerebral edema.  On [**2133-6-10**], the patient had
been admitted to an outside hospital with right arm weakness
and numbness, and was found to have a left parietal stroke.
Within that work-up, he was found to have a left internal
carotid artery stenosis of 65 percent, and thus was taken for
left carotid endarterectomy on [**2133-6-18**].  Following
procedure, the patient went to the PACU and was noted to have
a right hemiparesis and was unable to speak.  He was taken
emergently back to the operating room for thrombectomy;
however, his clinical status did not improve.  Due to edema
developing around the infarct, the patient was started on
Decadron and mannitol, as well as heparin infusion, and was
transferred to [**Hospital1 18**] for neurosurgical evaluation.

MEDICAL HISTORY: Hyperlipidemia.

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient smokes approximately 1 pack per
day and drinks 1 drink of alcohol per day.  He is a retired
executive from [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Tobacco use disorder,Other and unspecified hyperlipidemia'}
