CHIEF COMPLAINT: Left-sided weakness.

PRESENT ILLNESS: Mr. [**Known lastname 88171**] is a 64 yo man with a history of HTN, HLD, DMII
(recent diagnosis) who presnts today following a stroke.  The
patient states he was in his kitchen with his friend [**Name (NI) **] at 10:30
in the morning making coffee when he proceeded to spill it on
the floor.  His friend noticed that something wasn't right, had
him sit on the floor for a few seconds.  It was then noticed
that the
patient's left arm was "limp and floppy", his left face drooped
and the patient appeared to be having a stroke.  EMS was called
and the patient was initially taken to [**Hospital **] hospital.  Vitals
on presentation were BP 190/110, EKG showed Afib with a rate of
87.  Labs were all normal.  He was evaluated by [**Hospital1 2025**] telestroke
system and though details of his initial exam are not clear, the
patient's friend and EMS state the patient wasinitially unable
to move his left arm at all and had a forced right eye
deviation.

MEDICAL HISTORY: 1. Hypertension
2. Hyperlipidemia (last total cholesterol 164)
3. Type II DM
4. Chronic pain (DJD of the spine, s/p epidural injections last
week).
5. s/p right rotator cuff surgery
6. s/p right meniscal repair
7. Atrial fibrillation noted during this admission - likely new
diagnosis of paroxysmal atrial fibrillation.

MEDICATION ON ADMISSION: Metamucil 1 per day
Calcium 1 per day
Magnesium-zinc daily
Percocet 10-325mg for pain at night PRN
Celebrex 200mg daily
Toprolol xl 100mg daily
Omega-3 2pills daily
ASA 81 mg daily
simvastatin 20
metformin 500mg at night

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.6 BP 156/114  HR 108 RR 18  95% on 2LO2%
General: Awake, emotional, NAD.
Head and Neck: no cranial abnormalities, no scleral icterus
noted, mmm, no lesions noted in oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs clear to auscultation bilaterally
Cardiac: regular rate and rhythm, normal s1/s2. No murmurs,
rubs, or gallops appreciated.
Abdomen: soft, non-tender, normoactive bowel sounds, no masses
or organomegaly noted.
Extremities: 2+ radial, DP pulses bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Father died of a stroke at age 82
Mother died of CHF
Has sisters who are healthy

SOCIAL HISTORY: Lives alone.  Works in construction.  No smoking or drugs.
Reports past heavy EtOH use but denies any hx of withdrawal
seizures or DTs.  Currently drinks 2~3 beers and 2~3 glasses of
wine nightly.
Cerebral embolism with cerebral infarction,Alcohol withdrawal,Hemiplegia, unspecified, affecting unspecified side,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Physical restraints status
Crbl emblsm w infrct,Alcohol withdrawal,Unsp hemiplga unspf side,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,TPA adm status 24 hr pta,Physical restrain status
Admission Date:  [**2184-9-15**]              Discharge Date:   [**2184-9-21**]

Date of Birth:  [**2120-3-12**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
Left-sided weakness.

Major Surgical or Invasive Procedure:
Administration of intravenous tissue plasminogen activator.
Placement of [**Last Name (un) **]-gastric tube but discontinued after passing
the video-swallowing examination.


History of Present Illness:
Mr. [**Known lastname 88171**] is a 64 yo man with a history of HTN, HLD, DMII
(recent diagnosis) who presnts today following a stroke.  The
patient states he was in his kitchen with his friend [**Name (NI) **] at 10:30
in the morning making coffee when he proceeded to spill it on
the floor.  His friend noticed that something wasn't right, had
him sit on the floor for a few seconds.  It was then noticed
that the
patient's left arm was "limp and floppy", his left face drooped
and the patient appeared to be having a stroke.  EMS was called
and the patient was initially taken to [**Hospital **] hospital.  Vitals
on presentation were BP 190/110, EKG showed Afib with a rate of
87.  Labs were all normal.  He was evaluated by [**Hospital1 2025**] telestroke
system and though details of his initial exam are not clear, the
patient's friend and EMS state the patient wasinitially unable
to move his left arm at all and had a forced right eye
deviation.

IVtPA was bolused at 12:15 and his friend noted improvement in
symptoms within 15 minutes. The remaining dose was infused and
due to space, the patient was referred to [**Hospital1 18**] for further care
and ICU management post tPA.

On neurologic review of systems, the patient denied any current
deficits of weakness or sensory loss though he can report the
history without problem.  [**Name (NI) **] denies headache, loss of vision,
blurred vision, diplopia, dysphagia, lightheadedness, vertigo,
tinnitus or hearing difficulty. No bowel or bladder incontinence
or retention.  On general review of systems, the patient denied
recent fever or chills.  Denied cough, shortness of breath.
Denied chest pain or tightness, palpitations.  Denied nausea,
vomiting, diarrhea, constipation or abdominal pain.

Past Medical History:
1. Hypertension
2. Hyperlipidemia (last total cholesterol 164)
3. Type II DM
4. Chronic pain (DJD of the spine, s/p epidural injections last
week).
5. s/p right rotator cuff surgery
6. s/p right meniscal repair
7. Atrial fibrillation noted during this admission - likely new
diagnosis of paroxysmal atrial fibrillation.

Social History:
Lives alone.  Works in construction.  No smoking or drugs.
Reports past heavy EtOH use but denies any hx of withdrawal
seizures or DTs.  Currently drinks 2~3 beers and 2~3 glasses of
wine nightly.


Family History:
Father died of a stroke at age 82
Mother died of CHF
Has sisters who are healthy


Physical Exam:
T 97.6 BP 156/114  HR 108 RR 18  95% on 2LO2%
General: Awake, emotional, NAD.
Head and Neck: no cranial abnormalities, no scleral icterus
noted, mmm, no lesions noted in oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs clear to auscultation bilaterally
Cardiac: regular rate and rhythm, normal s1/s2. No murmurs,
rubs, or gallops appreciated.
Abdomen: soft, non-tender, normoactive bowel sounds, no masses
or organomegaly noted.
Extremities: 2+ radial, DP pulses bilaterally.
Skin: no rashes or lesions noted.

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.  Did not have glasses to read well but could
read some larger prints informally.  Speech was dysarthric. He
had good knowledge of current events.  There was no evidence of
apraxia but there was clear sensory neglect to the left and a
visual preference to the right but he could be directed to
attend visually to the left. Calculations intact. Registered [**1-21**]
and recalled [**12-24**] at 5 minutes.

Cranial Nerves:
I: Olfaction not tested.
II: PERRL 4 to 2mm and brisk.  Visual fields full on bedside
testing to finger counting.
III, IV, VI: EOMI with limited leftward gaze but can cross the
midline on smooth persuit.
V: Facial sensation impaired to light touch on left
VII: Left facial droop affecting lower face predominantely
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and sternocleidomastoid
bilaterally.
XII: Tongue with slight right deviation.

Motor: Normal bulk, decreased tone in left arm compared to
slightly increased tone in legs. No pronator drift on right, arm
with sensory ataxia and unable to clearly asess drift. No
tremors
noted. No asterixis.

  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5   5   5   5  4  5  5   5    5  5    5     5    5
R  5    5   5   5   5  5  5  5   5    5  5    5     5    5

Sensory: No sensation on the left leg, arm or face to light
touch, pinprick, cold sensation. Extinction to double
simultaneous stimuli.  *****states he can feel you if he sees
you administering stimuli to his left side, but does not
acknowledge when looking away).

Deep tendon reflexes:
    [**Hospital1 **] Tri [**Last Name (un) 1035**] Pat Ach
L   1   1    1    1   1
R   1   1    1    1   1
Plantar response was extensor bilaterally.

Coordination: No intention tremor on right.  Left arm unable to
complete FNF testing

Gait: deferred.

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


Pertinent Results:
[**2184-9-19**] 07:20AM BLOOD WBC-5.9 RBC-5.11 Hgb-15.7 Hct-45.4 MCV-89
MCH-30.6 MCHC-34.4 RDW-13.6 Plt Ct-194
[**2184-9-20**] 09:15AM BLOOD PT-14.4* PTT-25.9 INR(PT)-1.2*
[**2184-9-19**] 07:20AM BLOOD Glucose-93 UreaN-20 Creat-0.8 Na-140
K-4.0 Cl-106 HCO3-23 AnGap-15
[**2184-9-15**] 02:35PM BLOOD ALT-35 AST-29 LD(LDH)-182 CK(CPK)-78
AlkPhos-54 TotBili-0.5
[**2184-9-17**] 02:01PM BLOOD cTropnT-<0.01
[**2184-9-16**] 02:24AM BLOOD CK-MB-4 cTropnT-<0.01
[**2184-9-15**] 02:35PM BLOOD CK-MB-5 cTropnT-<0.01
[**2184-9-19**] 07:20AM BLOOD Calcium-8.3* Phos-3.4 Mg-2.1
[**2184-9-15**] 02:35PM BLOOD Albumin-4.3
[**2184-9-15**] 03:40PM BLOOD %HbA1c-6.6* eAG-143*
[**2184-9-16**] 02:24AM BLOOD Triglyc-235* HDL-65 CHOL/HD-3.3
LDLcalc-104

MRI of head:
1. Acute infarct in the right frontotemporal lobe with small
focus of
petechial hemorrhage.
2. Small microhemorrhage in the left temporal lobe, age
indeterminate.
3. Extensive chronic small vessel ischemic changes and old
lacunar infarcts.

Echocardiogram:
Mild symmetric left ventricular hypertrophy with low normal
systolic function. No ASD or PFO identified

EKG: Atrial fibrillation. Left ventricular hypertrophy with
secondary
repolarization abnormalities. Poor R wave progression. Consider
prior
anteroseptal myocardial infarction. No previous tracing
available for
comparison.

Brief Hospital Course:
Patient is a 64 year old RHM with hx of HTN, EM, hyperlipidemia
who presented with acute L sided weakness and numbness found to
have atrial fibrillation.  He initially presented to an OSH and
received IVtPA upon discussion with stroke telemedicine with
[**Hospital1 2025**].  He then was transferred here for further care.

He was initially admitted to the ICU.  He had significant
improvement of his L sided weakness with the IVtPA but MRI did
showed acute stroke in the L MCA/inferior division territory.
He stayed in the ICU for EtOH withdrawal symptoms including
agitation but there was no evidence of seizures or DTs.

He was transferred to the floor.  He was also started on
Coumadin for newly diagnosed Afib and given the stroke with
IVtPA, it was decided to bridge with ASA 325mg daily until INR
therapeutic.

He had significant swallowing trouble hence he required NGT for
meds and nutrition but he was started on a diet with
restrictions on [**9-21**], the day of his discharge to acute rehab
for inpatient physical, occupational and speech/swallowing
therapy.

He needs daily INR checks until INR 2~3 then his ASA can be
decreased to 81mg daily in addition to Coumadin for his Afib.
Additionally, given that his LDL was > 100, his Simvastatin was
increased to 40mg daily.

Medications on Admission:
Metamucil 1 per day
Calcium 1 per day
Magnesium-zinc daily
Percocet 10-325mg for pain at night PRN
Celebrex 200mg daily
Toprolol xl 100mg daily
Omega-3 2pills daily
ASA 81 mg daily
simvastatin 20
metformin 500mg at night

Discharge Medications:
1. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO twice a day as
needed for anxiety: Patient was not taking at home - please stop
when not needed. .
2. Metamucil     Powder Oral
3. calcium carbonate 500 mg (1,250 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO TID w/ meals.
4. insulin regular human 100 unit/mL Solution Sig: Per sliding
scale  Injection ASDIR (AS DIRECTED): Was on metformin 500 mg
QHS at home.
5. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as
needed for stroke: Will continue at 325 until INR therapeutic.
Please use enteric coated. Once INR therapeutic, his ASA dose
can be reduced to 81mg once daily.
6. metoprolol tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day).
7. Omega-3 Fish Oil 1,000 (120-180) mg Capsule Sig: One (1)
Capsule PO twice a day.
8. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
as needed for HL/stroke.
10. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
11. multivitamin,tx-minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
12. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
13. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

15. clonidine 0.2 mg/24 hr Patch Weekly Sig: One (1) Patch
Weekly Transdermal QFRI (every Friday).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7665**]

Discharge Diagnosis:
Primary
Stroke - ischemic
Atrial fibrillation

Secondary
Alcohol use and withdrawal
Hypertension
Hyperlipidemia
Diabetes, type II


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You came to the hospital after having a stroke. You were given
intravenous TPA to reopen the blocked blood vessel - this was
effective. Given this treatment, you stayed in the intensive
care unit. You also demonstrated some physical signs that were
attributed to alcohol withdrawal. You recovered well during your
stay here, but still suffered from some left facial weakness and
difficulty swallowing. For this, a tube was placed through your
nose into your stomach. Given some left sided weakness and
difficulty swallowing you will go to inpatient rehabilitation on
discharge.

Followup Instructions:
Please attend the following appointments:

1. Please see Dr. [**Last Name (STitle) 88172**] on Monday [**10-4**] at 11:20
a.m. Dr. [**Last Name (STitle) 88172**] will also be following your oral
anticoagulation with coumadin.

2. Please see your primary care doctor: Dr. [**Last Name (STitle) **] on [**Month (only) **]

3. Please also see the Neurologist that you saw here:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 640**] [**Last Name (NamePattern4) 3445**], MD Phone:[**Telephone/Fax (1) 2574**]
Date/Time:[**2184-10-20**] 3:00
Level 8
[**Hospital Ward Name 23**] Building, [**Hospital1 69**], [**Location (un) 86**]



Completed by:[**2184-9-21**]
{'Cerebral embolism with cerebral infarction,Alcohol withdrawal,Hemiplegia, unspecified, affecting unspecified side,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Physical restraints status'}


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-sided weakness.

PRESENT ILLNESS: Mr. [**Known lastname 88171**] is a 64 yo man with a history of HTN, HLD, DMII
(recent diagnosis) who presnts today following a stroke.  The
patient states he was in his kitchen with his friend [**Name (NI) **] at 10:30
in the morning making coffee when he proceeded to spill it on
the floor.  His friend noticed that something wasn't right, had
him sit on the floor for a few seconds.  It was then noticed
that the
patient's left arm was "limp and floppy", his left face drooped
and the patient appeared to be having a stroke.  EMS was called
and the patient was initially taken to [**Hospital **] hospital.  Vitals
on presentation were BP 190/110, EKG showed Afib with a rate of
87.  Labs were all normal.  He was evaluated by [**Hospital1 2025**] telestroke
system and though details of his initial exam are not clear, the
patient's friend and EMS state the patient wasinitially unable
to move his left arm at all and had a forced right eye
deviation.

MEDICAL HISTORY: 1. Hypertension
2. Hyperlipidemia (last total cholesterol 164)
3. Type II DM
4. Chronic pain (DJD of the spine, s/p epidural injections last
week).
5. s/p right rotator cuff surgery
6. s/p right meniscal repair
7. Atrial fibrillation noted during this admission - likely new
diagnosis of paroxysmal atrial fibrillation.

MEDICATION ON ADMISSION: Metamucil 1 per day
Calcium 1 per day
Magnesium-zinc daily
Percocet 10-325mg for pain at night PRN
Celebrex 200mg daily
Toprolol xl 100mg daily
Omega-3 2pills daily
ASA 81 mg daily
simvastatin 20
metformin 500mg at night

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.6 BP 156/114  HR 108 RR 18  95% on 2LO2%
General: Awake, emotional, NAD.
Head and Neck: no cranial abnormalities, no scleral icterus
noted, mmm, no lesions noted in oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs clear to auscultation bilaterally
Cardiac: regular rate and rhythm, normal s1/s2. No murmurs,
rubs, or gallops appreciated.
Abdomen: soft, non-tender, normoactive bowel sounds, no masses
or organomegaly noted.
Extremities: 2+ radial, DP pulses bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Father died of a stroke at age 82
Mother died of CHF
Has sisters who are healthy

SOCIAL HISTORY: Lives alone.  Works in construction.  No smoking or drugs.
Reports past heavy EtOH use but denies any hx of withdrawal
seizures or DTs.  Currently drinks 2~3 beers and 2~3 glasses of
wine nightly. 

### Response:
{'Cerebral embolism with cerebral infarction,Alcohol withdrawal,Hemiplegia, unspecified, affecting unspecified side,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Physical restraints status'}
