CHIEF COMPLAINT: right hemiparesis, neglect, aphasia

PRESENT ILLNESS: 81yo man with PMH significant for MI, prostate cancer, [**Hospital 11491**]
transferred from an OSH after presentation with right
hemiparesis, neglect, and aphasia, and treatment with tPA. Per
previous reports, he was in his USOH until the day of admission,
when he acutely slumped over to the right and stopped speaking.
He was taken to an OSH, where he had L gaze preference, global
aphasia, and right hemiplegia, and a head CT showed a hyperdense
L MCA. He was given IV tPA and transferred to the [**Hospital1 18**] ICU.

MEDICAL HISTORY: prostate ca [**2119**]
s/p MI [**2112**] with medical management
asthma/COPD
lower back problems

MEDICATION ON ADMISSION: ASA 81mg daily
mucinase 600mg [**Hospital1 **]
theophylline ER 200mg [**Hospital1 **]
flovent 2puffs [**Hospital1 **]
duoneb qid
ambien 10mg qhs
vicodin 5/500 1-2tabs q4h prn
colace 100mg [**Hospital1 **]
flomax 0.4mg every other day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: P/E on admission
Afebrile (temp not taken yet) 95 175-187/83 28 95%
Gen elderly man lying in bed
CV rrr
Pulm ctab
Abd soft nt/nd
Ext no edema

FAMILY HISTORY: not elicited

SOCIAL HISTORY: lives in [**Location **] with his wife, uses some assistance to walk. No
tobacco or alcohol use.
Cerebral thrombosis with cerebral infarction,Chronic obstructive asthma, unspecified,Pneumonitis due to inhalation of food or vomitus,Personal history of malignant neoplasm of prostate,Coronary atherosclerosis of native coronary artery
Crbl thrmbs w infrct,Chronic obst asthma NOS,Food/vomit pneumonitis,Hx-prostatic malignancy,Crnry athrscl natve vssl
Admission Date:  [**2124-9-16**]              Discharge Date:   [**2124-9-27**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
right hemiparesis, neglect, aphasia

Major Surgical or Invasive Procedure:
PEG tube placement

History of Present Illness:
81yo man with PMH significant for MI, prostate cancer, [**Hospital 11491**]
transferred from an OSH after presentation with right
hemiparesis, neglect, and aphasia, and treatment with tPA. Per
previous reports, he was in his USOH until the day of admission,
when he acutely slumped over to the right and stopped speaking.
He was taken to an OSH, where he had L gaze preference, global
aphasia, and right hemiplegia, and a head CT showed a hyperdense
L MCA. He was given IV tPA and transferred to the [**Hospital1 18**] ICU.

Past Medical History:
prostate ca [**2119**]
s/p MI [**2112**] with medical management
asthma/COPD
lower back problems


Social History:
lives in [**Location **] with his wife, uses some assistance to walk. No
tobacco or alcohol use.

Family History:
not elicited

Physical Exam:
P/E on admission
Afebrile (temp not taken yet) 95 175-187/83 28 95%
Gen elderly man lying in bed
CV rrr
Pulm ctab
Abd soft nt/nd
Ext no edema

NEURO
MS Awake, eyes open. Turns his head to the left when his son
called out "Dad!" Does not do so to my voice on the right.
Reaches to left to grab a hat with his left hand. Does not
follow
commands. No verbal output.

CN optic discs clear. Blinks to threat on the right, not the
left. Pupils 3->2 b/l. Gaze conjugate in primary position and
looking to the left (does not look to the right). Unable to
doll's eye. R facial droop includes upper face as well as lower
face.

Motor decreased tone in R arm, increased in R leg. Normal on
left. Allows R arm to fall onto his chest; when his left arm is
lifted, he moves it back to his side. Unable to cooperate with
exam. Withdraws L leg to noxious stimuli purposefully; does not
do so with right.

Sensory: withdraws L arm/leg to noxious stimuli. None on right.

Coordination: unable to assess

Gait: unable to assess

Reflexes: unable to obtain on left due to inability to get the
patient to relax his arm. 2+ on the right. Toes down b/l.


Pertinent Results:
Admission labs:
WBC-13.9* RBC-4.87 Hgb-15.1 Hct-42.3 MCV-87 MCH-31.1 MCHC-35.8*
RDW-13.4 Plt Ct-246
Neuts-92.5* Bands-0 Lymphs-5.5* Monos-1.5* Eos-0.3 Baso-0.1
PT-11.5 PTT-22.6 INR(PT)-1.0
Glucose-129* UreaN-14 Creat-0.8 Na-137 K-4.2 Cl-103 HCO3-22
Calcium-9.4 Phos-3.1 Mg-2.0
ALT-13 AST-17 CK(CPK)-77 AlkPhos-69 TotBili-0.7 Albumin-4.3
Cardiac enzymes (r/o)- negative x 3, on tele
Lipids LDL 154
HbA1C 5.4

Imaging:
- MRI/A - Acute left middle cerebral artery infarct with
possible thrombus within the left middle cerebral artery. No
evidence of hemorrhage. MRA w/ L M1 occlusion.
- TTE - "extensive regional LV systolic dysfunction c/w CAD"


Brief Hospital Course:
81yo man with CAD, prostate cancer, presented with right
hemiparesis, gaze deviation, and aphasia, and transferred here
after CT with L MCA sign and treatment with IV tPA. Exam notable
for right sided weakness, left gaze preference, and global
aphasia, MRI confirms acute L MCA infarct with occlusion at L
M1.

While in the ICU, he was monitored frequently. An MRI/A was
perfromed showing an acute L MCA infarct with occlusion at M1. A
TTE showed LV systolic dysfunction. Labs were drawn. He failed a
swallow evaluation and had an NGT placed, which he removed. He
was then transferred to the floor. He was stable s/p tPA and
remained minimally interactive, though not following commands.

Stroke workup included MRI/A, showing acute left middle cerebral
artery infarct with possible thrombus within the left middle
cerebral artery, MRA w/ L M1 occlusion, TTE with "extensive
regional LV systolic dysfunction c/w CAD", negative cardiac
enzymes, lipid panel that was elevated with resulting initiation
of a statin once taking po, and a normal HbA1c. He was started
on a daily ASA, and aggrenox was started after G-tube was
placed.  It was felt that his stroke was cardioembolic secondary
to significant wall motion abnormalities.  We did not start
anticoagulation given the large size of his infarct.  Coumadin
will be discussed at first clinic visit..

Incidentally, he was noted to have a PNA, likely aspiration
secondary to the stroke. He was started on levofloxacin on [**9-19**],
and to complete a 10 day course.

He failed multiple swallow evaluations and had placement of an
NGT. He pulled this and it was replaced. After he pulled it
again, it was unable to be replaced. He went for PEG by
interventional radiology but this was unsuccessful as his colon
was anterior to his stomach. Surgery was called for G tube
placement, and recommended GI placement with endoscopy.  PEG was
placed by EGD [**9-25**] without complications, and was confirmed in
place the following morning.  Test bolus of TF was given and
tube feeds were started.


Medications on Admission:
ASA 81mg daily
mucinase 600mg [**Hospital1 **]
theophylline ER 200mg [**Hospital1 **]
flovent 2puffs [**Hospital1 **]
duoneb qid
ambien 10mg qhs
vicodin 5/500 1-2tabs q4h prn
colace 100mg [**Hospital1 **]
flomax 0.4mg every other day


Discharge Medications:
1. Insulin Regular Human 100 unit/mL Solution Sig: per RISS
Injection ASDIR (AS DIRECTED).
Disp:*1 1* Refills:*2*
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
Disp:*1 1* Refills:*0*
4. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours).
Disp:*1 1* Refills:*2*
5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
Disp:*60 Tablet(s)* Refills:*2*
6. Aspirin 300 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily).
Disp:*30 Suppository(s)* Refills:*2*
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
Disp:*90 1* Refills:*2*
8. Pneumococcal 23-ValPS Vaccine 25 mcg/0.5 mL Injectable Sig:
One (1) ML Injection ONCE (Once) for 1 doses.
Disp:*1 1* Refills:*0*
9. Pantoprazole 40 mg IV Q24H
10. ChlorproMAZINE 12.5 mg IV Q4H:PRN hiccups


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 19504**] of [**Location (un) 1514**] - [**Location (un) 1514**], NH

Discharge Diagnosis:
Right MCA infarct

Discharge Condition:
Good.  Making progress but still with deficits of aphasia, left
sided neglect and paresis.


Discharge Instructions:
Return to [**Hospital1 18**] or contact EMS if any acute changes in mental
status or new deficits.  Please follow up with appointments as
listed below.

Followup Instructions:
Follow up with [**First Name8 (NamePattern2) **] [**Name8 (MD) **], MD: Phone:[**Telephone/Fax (1) 657**]
Date/Time:[**2124-10-24**] 3:00  .


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Cerebral thrombosis with cerebral infarction,Chronic obstructive asthma, unspecified,Pneumonitis due to inhalation of food or vomitus,Personal history of malignant neoplasm of prostate,Coronary atherosclerosis of native coronary artery'}


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: right hemiparesis, neglect, aphasia

PRESENT ILLNESS: 81yo man with PMH significant for MI, prostate cancer, [**Hospital 11491**]
transferred from an OSH after presentation with right
hemiparesis, neglect, and aphasia, and treatment with tPA. Per
previous reports, he was in his USOH until the day of admission,
when he acutely slumped over to the right and stopped speaking.
He was taken to an OSH, where he had L gaze preference, global
aphasia, and right hemiplegia, and a head CT showed a hyperdense
L MCA. He was given IV tPA and transferred to the [**Hospital1 18**] ICU.

MEDICAL HISTORY: prostate ca [**2119**]
s/p MI [**2112**] with medical management
asthma/COPD
lower back problems

MEDICATION ON ADMISSION: ASA 81mg daily
mucinase 600mg [**Hospital1 **]
theophylline ER 200mg [**Hospital1 **]
flovent 2puffs [**Hospital1 **]
duoneb qid
ambien 10mg qhs
vicodin 5/500 1-2tabs q4h prn
colace 100mg [**Hospital1 **]
flomax 0.4mg every other day

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: P/E on admission
Afebrile (temp not taken yet) 95 175-187/83 28 95%
Gen elderly man lying in bed
CV rrr
Pulm ctab
Abd soft nt/nd
Ext no edema

FAMILY HISTORY: not elicited

SOCIAL HISTORY: lives in [**Location **] with his wife, uses some assistance to walk. No
tobacco or alcohol use. 

### Response:
{'Cerebral thrombosis with cerebral infarction,Chronic obstructive asthma, unspecified,Pneumonitis due to inhalation of food or vomitus,Personal history of malignant neoplasm of prostate,Coronary atherosclerosis of native coronary artery'}
