CHIEF COMPLAINT: Confusion

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 71166**] is a 58 year-old man with a complex past
medical history including hypertension, hepatocellular
carcinoma,
alcoholic cirrhosis, status post liver transplant, DVTs,
previous
stroke who was brought to the ED after episode of change in
mental status. He was in his usual state of health until 3pm
this
afternoon, when he was talking in the phone with one of his
co-workers, his wife noticed that he stopped speaking and looked
confused. She approached him and started to ask question. In two
occasions he seemed appropriate, but in the begining he was
repeating what she was asking him. She tested his face symmetry
and asked him to put his arms up, which he did without problems.
His wife decided to call 911 and when the team arrived he was
sitting in a chair and talking to he was adequately talking and
provide information. They decided to transport him to [**Hospital6 3873**], and in the ambulance he developed decerebrate
posturing. Concerning for new stroke, he was intubated to
protect
airway and sedated. CT scan was done in the OSH and patient was
transferred to continue his care.

MEDICAL HISTORY: PMH: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

MEDICATION ON ADMISSION: Outpatient Medications:
Kayelaxate as needed
Metoprolol 25mg [**Hospital1 **]
Furosemide 20mg [**Hospital1 **]
Clopidogrel 75mg daily
ASA 325mg daily
Keppra 750mg [**Hospital1 **]
Tacrolimus 1.5mg [**Hospital1 **]
Cellcept 1000mg
Prednisone 5mg
Valganciclovir 900mg daily
Bactrim 1 tablet daily
Fluconazole 400mg daily
pantoprazole 40mg QAM
Colace 100mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 102X68mmHg HR 70bpm
Genl: intubated and sedated with versed and fentanyl
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
CV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops
Ext: No lower extremity edema bilaterally

FAMILY HISTORY: significant for colon cancer in his father as well as seizures
in his brother

SOCIAL HISTORY: Married and lives with his wife, who is in good health.  He is
employed as a telecommunications technician.  He has no
children.  He reports that he smoked cigarettes for about 10
years but quit approximately 30 years ago.  He has no history of
use of intravenous or illicit drugs.
Other convulsions,Acute respiratory failure,Other venous embolism and thrombosis of inferior vena cava,Liver replaced by transplant,Other complications due to other vascular device, implant, and graft,Ostium secundum type atrial septal defect,Surgical or other procedure not carried out because of contraindication,Esophageal reflux,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Personal history of malignant neoplasm of liver,Other and unspecified alcohol dependence, in remission
Convulsions NEC,Acute respiratry failure,Oth inf vena cava thromb,Liver transplant status,Comp-oth vasc dev/graft,Secundum atrial sept def,No proc/contraindication,Esophageal reflux,Abn react-procedure NEC,Accident in place NEC,Hx of liver malignancy,Alcoh dep NEC/NOS-remiss
Admission Date:  [**2154-3-11**]              Discharge Date:   [**2154-3-15**]

Date of Birth:  [**2095-10-7**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Confusion

Major Surgical or Invasive Procedure:
IVC filter removal and ASD closure([**2154-3-15**]) attempted but not
completed


History of Present Illness:
[**Known firstname **] [**Known lastname 71166**] is a 58 year-old man with a complex past
medical history including hypertension, hepatocellular
carcinoma,
alcoholic cirrhosis, status post liver transplant, DVTs,
previous
stroke who was brought to the ED after episode of change in
mental status. He was in his usual state of health until 3pm
this
afternoon, when he was talking in the phone with one of his
co-workers, his wife noticed that he stopped speaking and looked
confused. She approached him and started to ask question. In two
occasions he seemed appropriate, but in the begining he was
repeating what she was asking him. She tested his face symmetry
and asked him to put his arms up, which he did without problems.
His wife decided to call 911 and when the team arrived he was
sitting in a chair and talking to he was adequately talking and
provide information. They decided to transport him to [**Hospital6 3873**], and in the ambulance he developed decerebrate
posturing. Concerning for new stroke, he was intubated to
protect
airway and sedated. CT scan was done in the OSH and patient was
transferred to continue his care.

Upon arrival he had another head CT. In comparision with
previous
studies [**2154-2-27**] no changes were observed.

ROS: He denies fevers, chills, nausea, SOB, CP, cough, abdominal
pain, bowel or bladder problems, rash


Past Medical History:
PMH: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically


Social History:
Married and lives with his wife, who is in good health.  He is
employed as a telecommunications technician.  He has no
children.  He reports that he smoked cigarettes for about 10
years but quit approximately 30 years ago.  He has no history of
use of intravenous or illicit drugs.


Family History:
significant for colon cancer in his father as well as seizures
in his brother


Physical Exam:
VS: 102X68mmHg HR 70bpm
Genl: intubated and sedated with versed and fentanyl
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
CV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops
Ext: No lower extremity edema bilaterally

Neurologic examination:
Mental status: intubated sedated. not folowing commands. Eyes in
the midline. Responding well to noxious stimulation, localizing
source of dyscomfort

Cranial Nerves: Pupils equally round and sluggish reactive to
light. Extraocular movements seemed intact. No nystagmus. Facial
movement symmetric. Tongue midline.

Motor: No observed myoclonus, asterixis, or tremor. No pronator
drift. Moving all extremities anti-gravity.

Sensation: withdraw of the four limbs with noxious stim.

Reflexes: 2+ and symmetric throughout. Toe upgoing in the left
side.

Coordination: no tremor.

Gait: not tested.


Pertinent Results:
[**2154-3-11**] 07:08PM   GLUCOSE-189* UREA N-13 CREAT-0.7 SODIUM-141
POTASSIUM-4.7 CHLORIDE-105 TOTAL CO2-26 ANION GAP-15
[**2154-3-11**] 07:08PM   estGFR-Using this
[**2154-3-11**] 07:08PM   ALT(SGPT)-19 AST(SGOT)-22 ALK PHOS-67 TOT
BILI-0.7 DIR BILI-0.3 INDIR BIL-0.4
[**2154-3-11**] 07:08PM   ALBUMIN-3.6
[**2154-3-11**] 07:08PM   WBC-5.4 RBC-3.91* HGB-12.3* HCT-36.0* MCV-92
MCH-31.5 MCHC-34.3 RDW-15.7*
[**2154-3-11**] 07:08PM   NEUTS-81.8* LYMPHS-13.9* MONOS-3.5 EOS-0.3
BASOS-0.6
[**2154-3-11**] 07:08PM   PT-14.3* PTT-24.1 INR(PT)-1.2*
[**2154-3-11**] 07:08PM   PLT COUNT-109*
[**2154-3-11**] 11:00AM   GLUCOSE-120*
[**2154-3-11**] 11:00AM   UREA N-11 CREAT-0.7 SODIUM-138 POTASSIUM-3.9
CHLORIDE-100 TOTAL CO2-28 ANION GAP-14
[**2154-3-11**] 11:00AM   estGFR-Using this
[**2154-3-11**] 11:00AM   CALCIUM-9.1
[**2154-3-11**] 11:00AM   AFP-3.7
[**2154-3-11**] 11:00AM   WBC-6.8 RBC-4.21* HGB-13.0* HCT-40.0 MCV-95
MCH-30.9 MCHC-32.5 RDW-15.5
[**2154-3-11**] 11:00AM   PLT COUNT-123*
[**2154-3-11**] 11:00AM   PT-13.4 INR(PT)-1.1
[**2154-3-14**] 04:25AM BLOOD WBC-5.0 RBC-3.84* Hgb-12.1* Hct-35.4*
MCV-92 MCH-31.5 MCHC-34.2 RDW-15.6* Plt Ct-95*
[**2154-3-13**] 04:20AM BLOOD WBC-4.9 RBC-3.84* Hgb-11.6* Hct-34.7*
MCV-90 MCH-30.2 MCHC-33.4 RDW-15.5 Plt Ct-96*

[**2154-3-12**] 03:46AM BLOOD WBC-5.9 RBC-3.37* Hgb-10.5* Hct-31.1*
MCV-92 MCH-31.2 MCHC-33.8 RDW-15.7* Plt Ct-90*
[**2154-3-11**] 07:08PM BLOOD WBC-5.4 RBC-3.91* Hgb-12.3* Hct-36.0*
MCV-92 MCH-31.5 MCHC-34.3 RDW-15.7* Plt Ct-109*
[**2154-3-12**] 03:46AM BLOOD Neuts-70.2* Lymphs-22.8 Monos-4.7 Eos-1.9
Baso-0.5
[**2154-3-14**] 08:15PM BLOOD PT-14.2* PTT-51.5* INR(PT)-1.2*
[**2154-3-14**] 01:30PM BLOOD PT-14.2* PTT-62.5* INR(PT)-1.2*
[**2154-3-14**] 04:25AM BLOOD Plt Ct-95*
[**2154-3-14**] 04:25AM BLOOD PT-13.8* PTT-118.4* INR(PT)-1.2*
[**2154-3-13**] 09:15PM BLOOD PT-13.4 PTT-108.5* INR(PT)-1.1
[**2154-3-13**] 04:20AM BLOOD Plt Ct-96*
[**2154-3-12**] 03:46AM BLOOD Plt Smr-LOW Plt Ct-90*
[**2154-3-12**] 03:46AM BLOOD PT-15.3* PTT-30.5 INR(PT)-1.3*
[**2154-3-11**] 07:08PM BLOOD PT-14.3* PTT-24.1 INR(PT)-1.2*
[**2154-3-11**] 07:08PM BLOOD Plt Ct-109*
[**2154-3-11**] 11:00AM BLOOD Plt Ct-123*
[**2154-3-11**] 11:00AM BLOOD PT-13.4 INR(PT)-1.1
[**2154-3-14**] 04:25AM BLOOD Glucose-89 UreaN-12 Creat-0.6 Na-138
K-3.8 Cl-103 HCO3-28 AnGap-11
[**2154-3-13**] 04:20AM BLOOD Glucose-92 UreaN-10 Creat-0.7 Na-139
K-3.9 Cl-103 HCO3-29 AnGap-11
[**2154-3-12**] 06:41PM BLOOD UreaN-6 Creat-0.7 Na-136 K-5.0
[**2154-3-12**] 03:46AM BLOOD Glucose-102* UreaN-9 Creat-0.6 Na-140
K-3.2* Cl-109* HCO3-26 AnGap-8
[**2154-3-12**] 03:46AM BLOOD ALT-17 AST-17 CK(CPK)-45* AlkPhos-54
TotBili-0.6
[**2154-3-12**] 03:46AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2154-3-14**] 04:25AM BLOOD Calcium-8.8 Phos-3.6 Mg-1.6
[**2154-3-13**] 04:20AM BLOOD Calcium-8.3* Phos-4.3 Mg-2.0
[**2154-3-12**] 06:41PM BLOOD Mg-1.7
[**2154-3-12**] 03:46AM BLOOD Calcium-7.6* Phos-3.0 Mg-1.5*
[**2154-3-12**] 03:46AM BLOOD %HbA1c-5.2 eAG-103
[**2154-3-12**] 03:46AM BLOOD TSH-2.8
[**2154-3-11**] 11:00AM BLOOD AFP-3.7
[**2154-3-14**] 04:25AM BLOOD tacroFK-6.2
[**2154-3-13**] 04:20AM BLOOD tacroFK-5.2
[**2154-3-12**] 09:12AM BLOOD tacroFK-5.2

[**2154-3-11**]:
CXRAY: IMPRESSION:
1. Endotracheal and nasogastric tubes in appropriate position.
2. Right costophrenic angle not included on the image,
3. Elevation of the left hemidiaphragm with overlying left mid
to lower lung
atelectasis. Trace left pleural effusion not excluded.
4. Prominent ectatic appearing ascending aorta, particularly
given patient
age. Retrospective review of the patient's prior chest CT shows
mildly
dilated ascending aorta (3.6 cm).


[**2154-3-11**]
CT HEAD:
FINDINGS: There is bilateral hypodensity in the occipital lobes,
right greater
than left. Again noted is an area of increased hyperdensity
measuring
approximately 1.6 x 3.3 cm (2, 16) in the right occipital lobe
in the area of
prior infarction. There is an old lacunar infarct in left basal
ganglia.
There is prominence of the ventricles and sulci consistent with
age-related
atrophy. There is no evidence of hydrocephalus. There is no
intraventricular
hemorrhage or subarachnoid hemorrhage identified. There is no
shift of
normally midline structures. There is otherwise normal
[**Doctor Last Name 352**]-white matter
differentiation. The basilar cisterns are preserved. The
visualized
paranasal sinuses are clear. Extensive secretions are seen in
the posterior
nasopharynx. Mucosal thickening in the ethmoid air cells is
noted.

IMPRESSION:
No significant change in hemorrhagic right occipital lobe
infarct. No change in left occipital lobe infarct.

EEG: IMPRESSION: This is a normal routine EEG in the waking and
sleeping
states. There were no focal, lateralized, or epileptiform
abnormalities
noted.

MRI BRAIN: [**2154-3-13**]
IMPRESSION:
1. Findings consistent with subacute infarction within the
bilateral
posterior cerebral artery distributions involving the occipital
lobes as well as within the anterior circulation involving the
left caudate head and internal capsule. There is no evidence of
acute infarction.

2. Central and cortical involutional changes slightly advanced
for the
patient's age of 58 years.

3. Microangiopathic ischemic white matter disease.


Brief Hospital Course:
Brief Hospital Course:

Neurologic: He was admitted to the ICU intubated. He was quickly
extubated and neurologic exam improved. He was transferred to
the floor. MRI brain did not show evidence of new infarction.
Clinical history most consistant with seizure. EEG did not show
seizures. Keppra increased from 750 mg to 1000mg PO BID. Patient
was started on anticoagulation with PTT goal (50-70)given
history of DVT.  Patient also started on coumadin and dose kept
low given interaction with fluconazole/Bactrim. INR was 1.5 at
discharge. He was trained to administer himself lovenox and
instructed to use it q 12 hours until INR therapuetic between
[**2-13**]. Aspirin and plavix discontinued.

CV: EKG showed: NSR. Evaluated by cardiovascular surgery and
taken to cath lab [**2154-3-15**] for closure of ASD and also removal of
IVC filter. Rt IJ and IVC showed clotting and procedure was
aborted to avoid showering of emboli. Plan was to anticoagualte
for another month before attempting procedure again. He will
have venous duplex imaging in 3 weeks. Hypercoaguable workup
will be sent as an outpatient. Metoprolol changed to propranolol
because of improved control of tremor with the later medication.


GI: Transplant team followed the patient since he is s/p liver
transplant [**1-20**]. Tacrolimus level monitored and dosing adjusted
daily. He was discharged [**2154-3-15**] with a level of 6.7 and a dose
of 3mg at 6Pm and 6am. He is on antifungals and antibiotics that
interfere with coumadin and therfore recommendation was to keep
coumadin dose at 2 mg daily. He will have his standing order of
labs drawn on [**2154-3-18**].

Discharge plan discussed with transplant and cardiology teams.
[**Hospital 6435**] medical assistant also informed of plan and follow up
scheduled in PCP's office and stroke clinic on [**2154-3-18**]. Home PT
and VNA services arranged.


Medications on Admission:
Outpatient Medications:
Kayelaxate as needed
Metoprolol 25mg [**Hospital1 **]
Furosemide 20mg [**Hospital1 **]
Clopidogrel 75mg daily
ASA 325mg daily
Keppra 750mg [**Hospital1 **]
Tacrolimus 1.5mg [**Hospital1 **]
Cellcept 1000mg
Prednisone 5mg
Valganciclovir 900mg daily
Bactrim 1 tablet daily
Fluconazole 400mg daily
pantoprazole 40mg QAM
Colace 100mg [**Hospital1 **]


Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
2. Propranolol 40 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
Disp:*90 Tablet(s)* Refills:*2*
3. Lovenox 80 mg/0.8 mL Syringe Sig: One (1)  Subcutaneous every
twelve (12) hours.
Disp:*8 * Refills:*0*
4. Valganciclovir 450 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours).
8. Sulfamethoxazole-Trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
9. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
10. Prednisone 5 mg Tablet Sig: 2.5 Tablets PO DAILY (Daily).
11. Tacrolimus 1 mg Capsule Sig: Three (3) Capsule PO BID (2
times a day) for 2 doses: at 6pm and 6 am.
12. Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4
PM.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 1110**] VNA

Discharge Diagnosis:
Seizure
history of occipital and caudate infarction with hemorrhagic
transformation
s/p liver transplant
history of DVT
history of cirrhosis
Hypertension
GERD


Discharge Condition:
MS: awake alert
CN: dense left [**Location (un) **] field cut (inferior quadrant)
Motor: [**5-15**] throughout
Gait: wide based steady gait


Discharge Instructions:
You were admitted to the hospital for an episode concerning for
seizure. Given your recent history of stroke, you had an MRI
that did not show a new stroke or bleed. You were felt to have
had a seizure and your Keppra medication has been increased to
1000mg twice a day. Your EEG was normal.

Since you had a DVT, you were started on heparin and coumadin.
You were taken to the cath lab for removal of the IVC filter
recently placed and closure of your ASD, but the procedure was
not completed because of clotting found and we wanted to avoid
further complications. You will need to stay anticoagulated and
then followup for repeat imaging in 3 weeks (a venous duplex
will be scheduled and we will call you with the date) to
consider removal of the IVC in one month. Another appointment in
the cath lab will be scheduled in one month.  We will need
additional labs drawn for a hypercoaguable workup and you have
been given a lab slip to have these drawn.

You tacrolimus medication was adjusted in the hospital and you
were followed by the transplant team. You should have your
Tacrolimus levels drawn as typically scheduled on Monday and
Thursday. Current dose is  3  mg  at 6pm and 6 am.

You should go to all follow up appointments.
It is important to take all of your medications and make all
follow up appointments.

Changes to your medications include an increase in the dose of
keppra, a switch from metoprolol to propranolol, and you have
been started on coumadin. You do not need to take aspirin or
plavix any longer. Your tacrolimus dose is 3 mg at 6pm and 6 am.
You will be administered subcutaneous heparin for the next
several days until your INR becomes therapuetic. You should have
your INR drawn in [**2-13**] days at your PCP's office. INR goal is
([**2-13**]) and you should not stop lovenox injections until coumadin
is therapuetic. You have been given a list of foods to avoid
while on coumadin.

Your cardiologist would like you to have a hypercoaguable workup
and you have been given a lab slip to have this drawn as an
outpatient as well as your PT/PTT/INR and tacrolimus level on
[**2154-3-18**].  All lab results should be sent to [**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 8147**].

Followup Instructions:
[**2154-4-5**]  02:20p   [**Doctor Last Name **]-CC7  [**Doctor Last Name **]-CC7
  SC [**Hospital Ward Name **] CLINICAL CTR, [**Location (un) **]
  CC7 CARDIOLOGY (SB)

Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2154-3-18**] 2:00.  [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 82654**] (case management)
stated it is ok to attend this appointment in stroke clinic.

We have spoken to the Medical Assistant [**Male First Name (un) **] of Dr. [**Last Name (STitle) 11427**]
who will follow INR Monday [**2154-3-18**]. You  also have follow up with
Dr. [**Last Name (STitle) 11427**] at 10:00 am on [**2154-3-18**].

[**First Name4 (NamePattern1) 1060**] [**Last Name (NamePattern1) 8147**] will also be made aware so that she can follow INR
while on ocumadin.

Provider: [**First Name11 (Name Pattern1) 819**] [**Last Name (NamePattern4) 820**], MD Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2154-3-25**]
10:00
Provider: [**Name10 (NameIs) **] FIELD SCREENING Phone:[**Telephone/Fax (1) 253**]
Date/Time:[**2154-4-5**] 10:00


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]

Completed by:[**2154-3-15**]

Name:  [**Known lastname 13213**],[**Known firstname 856**] E                 Unit No:   [**Numeric Identifier 13214**]

Admission Date:  [**2154-3-11**]              Discharge Date:   [**2154-3-15**]

Date of Birth:  [**2095-10-7**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3326**]
Addendum:
Cardiology:

Patient had attempted ASD closure [**2154-3-15**] but aborted secondary
to Right IJ/cephalic thrombus and IVC filter thrombus. There
were no complications following attempt.

TEE [**3-15**]:
 left atrium is normal in size. No spontaneous echo contrast or
thrombus is seen in the body of the left atrium or left atrial
appendage. A patent foramen ovale is present. A left-to-right
shunt across the interatrial septum is seen at rest. Left
ventricular wall thicknesses and cavity size are normal. The
right ventricular cavity is mildly dilated with borderline
normal free wall function. The ascending, transverse and
descending thoracic aorta are normal in diameter and free of
atherosclerotic plaque. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. The mitral valve appears structurally normal with
trivial mitral regurgitation. There is no pericardial effusion.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 437**] VNA

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD [**MD Number(2) 3327**]

Completed by:[**2154-3-15**]
{'Other convulsions,Acute respiratory failure,Other venous embolism and thrombosis of inferior vena cava,Liver replaced by transplant,Other complications due to other vascular device, implant, and graft,Ostium secundum type atrial septal defect,Surgical or other procedure not carried out because of contraindication,Esophageal reflux,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Personal history of malignant neoplasm of liver,Other and unspecified alcohol dependence, in remission'}


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: Confusion

PRESENT ILLNESS: [**Known firstname **] [**Known lastname 71166**] is a 58 year-old man with a complex past
medical history including hypertension, hepatocellular
carcinoma,
alcoholic cirrhosis, status post liver transplant, DVTs,
previous
stroke who was brought to the ED after episode of change in
mental status. He was in his usual state of health until 3pm
this
afternoon, when he was talking in the phone with one of his
co-workers, his wife noticed that he stopped speaking and looked
confused. She approached him and started to ask question. In two
occasions he seemed appropriate, but in the begining he was
repeating what she was asking him. She tested his face symmetry
and asked him to put his arms up, which he did without problems.
His wife decided to call 911 and when the team arrived he was
sitting in a chair and talking to he was adequately talking and
provide information. They decided to transport him to [**Hospital6 3873**], and in the ambulance he developed decerebrate
posturing. Concerning for new stroke, he was intubated to
protect
airway and sedated. CT scan was done in the OSH and patient was
transferred to continue his care.

MEDICAL HISTORY: PMH: cirrhosis, HTN, GI bleeding, GERD, history of basal and
squamous cell carcinomas treated topically and surgically

MEDICATION ON ADMISSION: Outpatient Medications:
Kayelaxate as needed
Metoprolol 25mg [**Hospital1 **]
Furosemide 20mg [**Hospital1 **]
Clopidogrel 75mg daily
ASA 325mg daily
Keppra 750mg [**Hospital1 **]
Tacrolimus 1.5mg [**Hospital1 **]
Cellcept 1000mg
Prednisone 5mg
Valganciclovir 900mg daily
Bactrim 1 tablet daily
Fluconazole 400mg daily
pantoprazole 40mg QAM
Colace 100mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 102X68mmHg HR 70bpm
Genl: intubated and sedated with versed and fentanyl
HEENT: Sclerae anicteric, no conjunctival injection, oropharynx
clear
CV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops
Ext: No lower extremity edema bilaterally

FAMILY HISTORY: significant for colon cancer in his father as well as seizures
in his brother

SOCIAL HISTORY: Married and lives with his wife, who is in good health.  He is
employed as a telecommunications technician.  He has no
children.  He reports that he smoked cigarettes for about 10
years but quit approximately 30 years ago.  He has no history of
use of intravenous or illicit drugs. 

### Response:
{'Other convulsions,Acute respiratory failure,Other venous embolism and thrombosis of inferior vena cava,Liver replaced by transplant,Other complications due to other vascular device, implant, and graft,Ostium secundum type atrial septal defect,Surgical or other procedure not carried out because of contraindication,Esophageal reflux,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in other specified places,Personal history of malignant neoplasm of liver,Other and unspecified alcohol dependence, in remission'}
