CHIEF COMPLAINT: transfer from OSH for cerebellar bleed

PRESENT ILLNESS: HPI:  [**Age over 90 **] yo woman on coumadin for MI, "minor stroke in past" who
became acutely nauseous and dizzy (spinning sensation) at 4pm
today after doing lots of housework (moving winter clothes in
boxes up stairs). She laid down to take a nap, was still
symptomatic, unable to arise from bed, so called 911.  She was
taken to [**Hospital3 5365**] and given aspirin, then head CT was
performed and showed a left cerebellar hemorrhage. Had episode
of
emesis at OSH. Transferred here for further care.

MEDICAL HISTORY: 1.  MI, CAD, on coumadin x 20 years (family will bring PCP's
name
and number in AM as they have no further information)
2.  "minor stroke" in past with residual ? left sided weakness
3. Macular degeneration
4.  HTN
5.  Lumbar vertebral fracture s/p fall

MEDICATION ON ADMISSION: coumadin
vitamins
mobic
metoprolol
pentoxyfylline

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN:  sleepy but no acute distress, pleasant elderly woman
sitting upright in stretcher
SKIN:  no rash
HEENT:  NC/AT, anicteric sclera, dry mm
NECK: supple, no pain with movement
CHEST:  normal respiratory pattern, crackles at bases
bilaterally
CV:  regular rate and rhythm with harsh systolic murmur best
heard at RUSB
ABD:  soft, nontender, nondistended, +BS, smell of stool
EXTREM:  no edema, thin extremities

FAMILY HISTORY: CAD

SOCIAL HISTORY: lives independently with her [**Age over 90 **] yo husband, no kids, nieces
and nephews are active in her life and care and multiple are at
the bedside now.  no tob/etoh/drugs.  retired receptionist. FULL
CODE.  Contact: [**Name (NI) 53767**] [**Name (NI) **] [**Name (NI) **]:  [**Telephone/Fax (1) 93016**].
Intracerebral hemorrhage,Congestive heart failure, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Old myocardial infarction,Personal history of other diseases of circulatory system
Intracerebral hemorrhage,CHF NOS,Hypertension NOS,Crnry athrscl natve vssl,Pure hypercholesterolem,Old myocardial infarct,Hx-circulatory dis NEC
Admission Date:  [**2142-6-1**]              Discharge Date:   [**2142-6-5**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
transfer from OSH for cerebellar bleed


Major Surgical or Invasive Procedure:

CT head
MRI/A head


History of Present Illness:
HPI:  [**Age over 90 **] yo woman on coumadin for MI, "minor stroke in past" who
became acutely nauseous and dizzy (spinning sensation) at 4pm
today after doing lots of housework (moving winter clothes in
boxes up stairs). She laid down to take a nap, was still
symptomatic, unable to arise from bed, so called 911.  She was
taken to [**Hospital3 5365**] and given aspirin, then head CT was
performed and showed a left cerebellar hemorrhage. Had episode
of
emesis at OSH. Transferred here for further care.

Here, patient is a little sleepy, but just states the above
information about nausea/dizziness/emesis.  She currently is
asymptomatic, no headache, visual changes, numbness or weakness.

On ROS, she may have had some diarrhea day before yesterday but
denies this now.  No fevers, chills, illnesses, chest pain, SOB,
belly pain, dysuria or other symptoms.


Past Medical History:
1.  MI, CAD, on coumadin x 20 years (family will bring PCP's
name
and number in AM as they have no further information)
2.  "minor stroke" in past with residual ? left sided weakness
3. Macular degeneration
4.  HTN
5.  Lumbar vertebral fracture s/p fall

No h/o blood clots or spontaneous abortions.


Social History:
lives independently with her [**Age over 90 **] yo husband, no kids, nieces
and nephews are active in her life and care and multiple are at
the bedside now.  no tob/etoh/drugs.  retired receptionist. FULL
CODE.  Contact: [**Name (NI) 53767**] [**Name (NI) **] [**Name (NI) **]:  [**Telephone/Fax (1) 93016**].


Family History:
CAD

Physical Exam:
GEN:  sleepy but no acute distress, pleasant elderly woman
sitting upright in stretcher
SKIN:  no rash
HEENT:  NC/AT, anicteric sclera, dry mm
NECK: supple, no pain with movement
CHEST:  normal respiratory pattern, crackles at bases
bilaterally
CV:  regular rate and rhythm with harsh systolic murmur best
heard at RUSB
ABD:  soft, nontender, nondistended, +BS, smell of stool
EXTREM:  no edema, thin extremities

NEURO:
Mental status:
Patient is sleepy but awake and conversant, keeps eyes closed
but
opens them when asked, pleasant affect.
Oriented to person, place, time and president.
Poor attention - unable to name all MOYB, stops at [**Month (only) 462**]
Language is fluent with good comprehension, repitition, naming
(including stem of watch), no dysarthria.
No apraxia (salutes), no neglect.  Able to calculate 4x3, no
left/right mismatch.
Registration [**3-15**] objects.  Recalls 0/3 objects after 3 minutes
(inattentive)

Cranial Nerves:
I:  deferred
II:   Visual fields: ? left hemianopsia (mild). Fundoscopic
exam:
discs flat, fundi clear, no hemorrhages or exudates. Pupils:2->1
mm with left pupil being irregular (post surgical), consenual
constriction to light.
III, IV, VI:  EOMS full, gaze conjugate.  + nystagmus on left
lateral gaze, some mild rotary nystagmus when looking up, no
ptosis.
 V:  facial sensation slightly increased to pin over V2 on the
left, intact to LT.
VII:  symmetric nasolabial folds
VIII: decreased hearing left worse than right
IX, X:  Symmetric elevation of palate.
[**Doctor First Name 81**]:  trapezius [**5-17**] bilaterally
XII:  tongue midline without atrophy or fasciulations.

Sensory:
Increased sesation increased over left face (V2) and left leg to
pin, decreased vibration sense left foot.  Otherwise intact to
LT
and symmetric bilaterally. No extinction to double simultaneous
stimulation.

Motor:
Normal bulk, tone.  No fasciculations, + left drift.  No
adventitious movements.  Mild asterixis R>L.
Strength:
     Delt Tri [**Hospital1 **] WE WF FE FF IP QD Ham DF PF Toe
LEFT: 5    5  5  5  5   5  5  5  5  4+  4+ 5  NT

Reflexes:
       [**Hospital1 **] BR Tri Pat Ach Toes
RT:    2  2   2  2   2    down
LEFT:  2  2   2  2   0    down

Coordination:
Markedly ataxic finger-to-nose, heel-to-shin on the left, normal
on the right.

Gait: Not tested due to sleepy, inattentive, bleed.


Pertinent Results:
[**2142-6-1**] 11:17PM   PT-12.4 PTT-22.7 INR(PT)-1.0
[**2142-6-1**] 04:07AM   GLUCOSE-162* UREA N-17 CREAT-0.8 SODIUM-140
POTASSIUM-4.1 CHLORIDE-100 TOTAL CO2-27 ANION GAP-17
[**2142-6-1**] 04:07AM   ALT(SGPT)-31 AST(SGOT)-38 CK(CPK)-82 ALK
PHOS-86 TOT BILI-0.4
[**2142-6-1**] 04:07AM   CK-MB-NotDone cTropnT-<0.01
[**2142-6-1**] 04:07AM   CALCIUM-9.7 PHOSPHATE-3.7 MAGNESIUM-2.0
CHOLEST-217*
[**2142-6-1**] 04:07AM   TRIGLYCER-60 HDL CHOL-79 CHOL/HDL-2.7
LDL(CALC)-126
[**2142-6-1**] 04:07AM   WBC-8.7 RBC-3.06* HGB-9.7* HCT-29.2* MCV-96
MCH-31.6 MCHC-33.1 RDW-13.1
[**2142-6-1**] 04:07AM   NEUTS-91.3* BANDS-0 LYMPHS-6.3* MONOS-2.4
EOS-0 BASOS-0
[**2142-6-1**] 04:07AM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2142-6-1**] 04:07AM   PLT SMR-NORMAL PLT COUNT-183
[**2142-6-1**] 12:55AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.015
[**2142-6-1**] 12:55AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-TR KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 LEUK-NEG
[**2142-6-1**] 12:55AM URINE  RBC-3* WBC-0 BACTERIA-NONE YEAST-NONE
EPI-0

ECG [**2142-5-31**]:
Sinus rhythm
Left axis deviation
Conduction defect of left bundle branch block type
Possible inferior infarct - age undetermined
Rate PR QRS QT/QTc P QRS T
85 176 138 428/470.14 64 -39 123

NONCONTRAST HEAD CT [**2142-6-1**]: There is hemorrhage seen within the
left cerebellar hemisphere with surrounding low attenuation
consistent with edema. Hemorrhage is also seen within the third
and fourth ventricle, and extending anterior to the cerebral
hemispheres. The ventricles are prominent, but part of this
could be due to age-related atrophy. There is low attenuation of
the periventricular white matter. This is likely secondary to
chronic microvascular ischemia, as opposed to transependymal
edema. There is low attenuation in the right caudate nucleus
consistent with a lacunar infarct. The sulci do not appear
effaced. There is preservation of the [**Doctor Last Name 352**]-white matter
differentiation of the cerebral hemispheres. There is no
evidence of infarction. There is no evidence of shift of
normally midline structures or definite uncal herniation at this
time. There are no fractures. The sinuses are well aerated.
Cerebellar hemisphere hemorrhage with hemorrhage in the third
and fourth ventricles.
Conclusion: Left cerebellar hematoma and intraventricular
hemorrhage. The differential diagnosis includes a hemorrhagic
cerebellar neoplasm, an aneurysm, perhaps arising from the PICA,
an arteriovenous malformation, or hypertension.

MRI HEAD [**2142-6-2**]:A left-sided cerebellar hemorrhage is
identified with indentation and deformity of the fourth
ventricle and mild surrounding edema. On diffusion images, no
evidence of acute infarct is identified. Following gadolinium,
no evidence of abnormal enhancement is seen. There is moderate
prominence of sulci and moderate prominence of ventricles.
Fluid, fluid levels are identified in both lateral ventricles
indicating small amount of hemorrhage. There is also moderate
dilatation of the temporal horns. Moderate periventricular
changes of small vessel disease are identified. Following
gadolinium, no evidence of abnormal parenchymal vascular or
meningeal enhancement is noted.
IMPRESSION: Left cerebellar hemorrhage without evidence of
abnormal enhancement or vascular structures in the area.
Moderate ventriculomegaly with fluid, fluid levels in the
ventricles indicating small amount of intraventricular blood.
Moderate changes of small vessel disease. No evidence of acute
infarct.

MRA OF THE HEAD [**2142-6-2**]:
The head MRA demonstrates mild atherosclerotic disease involving
both supraclinoid internal carotid arteries without evidence of
high-grade stenosis or occlusion. A hypoplastic A1 segment of
the left anterior cerebral artery is incidentally noted.
IMPRESSION: No abnormalities on the MRA of the head except for
mild atherosclerotic disease.

CT HEAD w/o contrast [**2142-6-2**]:
The left medial ventral cerebellar hemisphere hemorrhage is
unchanged. Intraventricular blood is again appreciated. The size
and configuration of the ventricles is stable.
other parenchymal attenuation abnormalities are unchanged.
IMPRESSION: Stable appearance of the brain and left cerebellar
hemorrhage since the previous study of [**2142-6-1**].

CHEST X RAY [**2142-6-1**]:
 Cardiac and mediastinal silhouettes appear within normal
limits. There are no focal pulmonary opacities, pleural
effusions, or evidence of pneumothorax. Osseous structures
appear unremarkable.
IMPRESSION: No evidence of acute cardiopulmonary disease.
CHEST X RAY [**2142-6-4**]:
There is blunting of the costophrenic angles
bilaterally, consistent with pleural effusions, which are new
from the prior study. The pulmonary vasculature is stable in
appearance, and within normal limits. The heart size and
mediastinal contours are stable. Soft tissue and osseous
structures are unchanged. No other opacities are identified.
IMPRESSION: Interval appearance of bilateral pleural effusions.
No evidence of pneumonia.




Brief Hospital Course:
[**Age over 90 **] yo lady, known case of CAD, HTN,AF? on Coumadin with previous
HX of MI, HX of previous stroke with residual left sided
weakness, presenting with vertigo and dizziness:
neurology: pt presenting with vertigo, dizziness, emesis, with
left gaze nystagmus, and positive cerebellar signs on the left
side, and was found to have left cerebellar bleeding with
surrounding edema and ventricular extension on CT head, INR was
2.6 on admission, pt was given FFP, Proplex, and vitamin K, pt
was admitted to ICU for 3 days, was seen by neurosurgeon, and a
repeated CT head showed no change in findings, pt was
transferred back to word, symptoms improved , but still drowsy.
most probable cause is HTN , or Coumadin or combination of both,
a question of underlying mass was investigated with MRI which
confirmed prior findings.
risk factor modification: patient was found to have high
cholesterol and was started on atorvastatin.
CVS: known hypertensive, increase metoprolol to 50 mg [**Hospital1 **] for
better control.
patient was having NSR along admission, will stop warfarin, the
history of paroxysmal AF should be clarified with her PCP, [**Name10 (NameIs) **]
once it is clarified she should be started back on warfarin
within 2 weeks period with an INR goal of [**2-14**].5
patient had a transient elevation of the WBC, which was repeated
and was normal, and is probably a false result.
disposition: rehabilitation program, evaluated by PT/OT.

Medications on Admission:
coumadin
vitamins
mobic
metoprolol
pentoxyfylline


Discharge Medications:
1. Atorvastatin Calcium 20 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*3*
2. Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One
(1) Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
3. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
4. Erythromycin 5 mg/g Ointment Sig: One (1) drop Ophthalmic
QID (4 times a day) for 10 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Left cerrebellar hemorrhagic stroke
hypercholestremia

Discharge Condition:
stable

Discharge Instructions:
take medication as prescribed
follow up appointments as schadueled
if you develop similar symptoms or new symptoms, call your PCP

Followup Instructions:
Provider: [**Name10 (NameIs) 4267**] [**Last Name (NamePattern4) 4268**], MD, PHD[**MD Number(3) **]: [**Hospital6 29**]
NEUROLOGY Phone:[**Telephone/Fax (1) 657**] Date/Time:[**2142-7-18**] 2:00
follow up with PCP [**Name Initial (PRE) 176**] 1-2 weeks


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

Completed by:[**2142-6-5**]

Name:  [**Known lastname 14648**],[**Known firstname 1073**]                   Unit No:   [**Numeric Identifier 14649**]

Admission Date:  [**2142-6-1**]              Discharge Date:   [**2142-6-5**]

Date of Birth:  [**2048-9-26**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1886**]
Addendum:
Exam upon discharge:
Pt was somewhat tired and had a depressed mood, but was alert
and oriented x3. She had L gaze evoked nystagmus and upgaze
nystagmus, but none at midline/rest. She had a mild L pronator
drift and some dystmetria on FNF on L. She also had dysmetria on
heel-knee-shin on the L and unsteadiness of gait with subjective
dizziness with gait. Overall she was much improved.

Plan for discharge:
She will be discharged off of coumadin. The recommendation with
regards to her anticoagulation is to discuss the actual
diagnosis of paroxysmal atrial fibrillation with the PCP. [**Name10 (NameIs) **] was
never in atrial fibrillation during her admission here, and if
she truly does not have PAF she will not need to be restarted on
her coumadin. If the history of PAF is certain, then we
recommend restarting coumadin in 2 weeks (around [**6-20**]), can
start at 5 mg qhs, check INR daily with goal INR 2-2.5

Also, she was notably depressed at the time of discharge. We
recommend starting an SSRI that has stimulant properties, such
as prozac, in rehab.

Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1174**] [**Hospital **] Hospital - [**Location (un) **]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 1887**] MD, [**MD Number(3) 1888**]

Completed by:[**2142-6-5**]
{'Intracerebral hemorrhage,Congestive heart failure, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Old myocardial infarction,Personal history of other diseases of circulatory system'}


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: transfer from OSH for cerebellar bleed

PRESENT ILLNESS: HPI:  [**Age over 90 **] yo woman on coumadin for MI, "minor stroke in past" who
became acutely nauseous and dizzy (spinning sensation) at 4pm
today after doing lots of housework (moving winter clothes in
boxes up stairs). She laid down to take a nap, was still
symptomatic, unable to arise from bed, so called 911.  She was
taken to [**Hospital3 5365**] and given aspirin, then head CT was
performed and showed a left cerebellar hemorrhage. Had episode
of
emesis at OSH. Transferred here for further care.

MEDICAL HISTORY: 1.  MI, CAD, on coumadin x 20 years (family will bring PCP's
name
and number in AM as they have no further information)
2.  "minor stroke" in past with residual ? left sided weakness
3. Macular degeneration
4.  HTN
5.  Lumbar vertebral fracture s/p fall

MEDICATION ON ADMISSION: coumadin
vitamins
mobic
metoprolol
pentoxyfylline

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: GEN:  sleepy but no acute distress, pleasant elderly woman
sitting upright in stretcher
SKIN:  no rash
HEENT:  NC/AT, anicteric sclera, dry mm
NECK: supple, no pain with movement
CHEST:  normal respiratory pattern, crackles at bases
bilaterally
CV:  regular rate and rhythm with harsh systolic murmur best
heard at RUSB
ABD:  soft, nontender, nondistended, +BS, smell of stool
EXTREM:  no edema, thin extremities

FAMILY HISTORY: CAD

SOCIAL HISTORY: lives independently with her [**Age over 90 **] yo husband, no kids, nieces
and nephews are active in her life and care and multiple are at
the bedside now.  no tob/etoh/drugs.  retired receptionist. FULL
CODE.  Contact: [**Name (NI) 53767**] [**Name (NI) **] [**Name (NI) **]:  [**Telephone/Fax (1) 93016**]. 

### Response:
{'Intracerebral hemorrhage,Congestive heart failure, unspecified,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Old myocardial infarction,Personal history of other diseases of circulatory system'}
