CHIEF COMPLAINT: Right-sided weakness.

PRESENT ILLNESS: This is an 87 year old woman
with a history of hypertension who was recently admitted to
[**Hospital3 2558**] Nursing Home after an admission for a fall and
was found at [**Hospital3 2558**] to not be moving her right arm as
well as the left.  Not many details are available at this
time.  It did appear that she was seen by nursing staff to
not be moving her right side as well as the left.  There was
no apparent increased level of confusion.  She was admitted
to the [**Hospital6 256**] Intensive Care
Unit after her blood pressure in the Emergency Department was
found to be 220/170 and a computerized tomography scan showed
a left frontal lobar hemorrhage.  It is known that she did
get up to go to the bathroom and was noted not to be able to
walk and not be able to talk.  We know at baseline from her
family that she is normally able to walk on her own and is
very talkative up until the fall and admission to [**Hospital 8503**] in early [**Month (only) 404**], she was cooking on her own
and living on her own in an apartment in [**Location (un) **] Square.  She
was reportedly not having any memory difficulty.

MEDICAL HISTORY: 1.  Hypertension; 2.  History of
gastrointestinal bleed in [**2170-1-8**]; 3.  Paroxysmal
atrial fibrillation found on the recent admission to [**Hospital 14852**], treated with just Atenolol; 4.  Fall
with L2 vertebral fracture.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
2.  Protonix 40 mg p.o. q.d.
3.  Atenolol 50 mg p.o. q.d.
4.  Multivitamins

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Not obtained at this time.

SOCIAL HISTORY: Extensive family that lives in the area,
however, the patient does live on her own in an apartment.
She did attend Daycare Senior Program.
Intracerebral hemorrhage,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Malignant essential hypertension,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Unspecified circulatory system disorder
Intracerebral hemorrhage,Atrial fibrillation,Food/vomit pneumonitis,Malignant hypertension,Urin tract infection NOS,DMII wo cmp nt st uncntr,Hypothyroidism NOS,Circulatory disease NOS
Admission Date:  [**2174-12-25**]       Discharge Date:  [**2174-12-30**]


Service:  Neurology

CHIEF COMPLAINT:  Right-sided weakness.

HISTORY OF PRESENT ILLNESS:  This is an 87 year old woman
with a history of hypertension who was recently admitted to
[**Hospital3 2558**] Nursing Home after an admission for a fall and
was found at [**Hospital3 2558**] to not be moving her right arm as
well as the left.  Not many details are available at this
time.  It did appear that she was seen by nursing staff to
not be moving her right side as well as the left.  There was
no apparent increased level of confusion.  She was admitted
to the [**Hospital6 256**] Intensive Care
Unit after her blood pressure in the Emergency Department was
found to be 220/170 and a computerized tomography scan showed
a left frontal lobar hemorrhage.  It is known that she did
get up to go to the bathroom and was noted not to be able to
walk and not be able to talk.  We know at baseline from her
family that she is normally able to walk on her own and is
very talkative up until the fall and admission to [**Hospital 8503**] in early [**Month (only) 404**], she was cooking on her own
and living on her own in an apartment in [**Location (un) **] Square.  She
was reportedly not having any memory difficulty.

PAST MEDICAL HISTORY:  1.  Hypertension; 2.  History of
gastrointestinal bleed in [**2170-1-8**]; 3.  Paroxysmal
atrial fibrillation found on the recent admission to [**Hospital 14852**], treated with just Atenolol; 4.  Fall
with L2 vertebral fracture.

MEDICATIONS ON ADMISSION:
1.  Aspirin 325 mg p.o. q.d.
2.  Protonix 40 mg p.o. q.d.
3.  Atenolol 50 mg p.o. q.d.
4.  Multivitamins

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  Not obtained at this time.

SOCIAL HISTORY:  Extensive family that lives in the area,
however, the patient does live on her own in an apartment.
She did attend Daycare Senior Program.

HABITS:  Not known.

PHYSICAL EXAMINATION:  Temperature afebrile.  Blood pressure
220/130.  Heartrate 62.  Respiratory rate 18.  In general,
she is well developed, and in no apparent distress.  Head,
eyes, ears, nose and throat reveals a supple neck with no
lymphadenopathy or thyromegaly.  The cardiovascular
examination revealed a regular rate and rhythm with no
murmurs, rubs or gallops.  The lungs were clear bilaterally.
The abdomen was soft and nontender and nondistended with no
hepatosplenomegaly.  Extremities showed no cyanosis, clubbing
or edema.  Neurological examination, mental status was alert,
answers "yes" to any question.  Left gaze preference.  Does
not mimick or follow commands.  Cranial nerves, blinks to
threat on the left but not to the right.  Vestibulo-ocular
reflexes, able to initiate the extraocular movements to the
right, she does have a left gaze preference.  Her corneals
are intact bilaterally.  Has no facial droop.  Motor:  Normal
bulk, no tremors.  There is decreased tone in the right leg.
There is mildly decreased tone in the right arm and she can
move the arm in the plane of gravity on extension.  Deep
tendon reflexes are notable for 2+ reflexes in the
right-sided biceps, brachioradialis, triceps, patella and
ankle.  They are all 1+ on the left.  The toes are downgoing.
There is no clonus at the ankles.  Coordination was not
tested due to cooperation.  Sensory:  There was initially no
withdrawal from pain in the right hand but later she did do
so.  She withdrew both feet from painful stimuli.  Her gait
was not tested.

LABORATORY DATA:  Significant laboratory data included a
white count of 16,000 and a hematocrit of 42.  Her platelets
were about 500,000.  Imaging:  Head computerized tomography
scan showed a left frontoparietal lobar hemorrhage and
possible small lytic lesions.

HOSPITAL COURSE:  The patient was admitted to Intensive Care
Unit for blood pressure control given the left frontal lobar
hemorrhage, although it was small in size.  She had plain
films of the hips which did not reveal any evidence of
fracture on the right although it is not stated on the
radiology report.  She had a chest x-ray which showed no
evidence of pneumonia but did show cardiomegaly and tortuous
vessels.  She also had an magnetic resonance imaging scan of
the head which showed an acute right thalamic lacune in
addition to a 1.5 cm acute cortical lobar hemorrhage in the
left parietal region.  On GRE sequencing she showed many
areas of chronic hemorrhages throughout the parenchyma and
this was consistent with amyeloid angiopathy.  She was
observed in the Intensive Care Unit briefly but then
transferred to the Neurology Floor after her blood pressure
remained under control without the need for Labetalol drip.
She was also ruled out for an myocardial infarction with
cardiac enzymes times three.  Notable she had an elevated TSH
on admission with a normal T4 and a T3 is pending at this
time.

The patient was kept on aspiration precautions and had a
nasogastric tube placed for medications.  She was
administered intravenous fluids to prevent dehydration.  She
was evaluated by the swallowing group who eventually felt
that her swallowing had improved to the point where she could
take a diet of pureed foods and nectar-thickened liquids.
She needs to have supervised feedings as well as fully
upright position for eating and drinking.  She was cleared
for medications, question pureed foods.  It was recommended
that a video swallow be completed at rehabilitation to
further evaluate any improvement in her swallowing.  On the
third hospital day she developed a fever to 101 and was
pancultured.  Urine cultures grew out Oxacillin resistant
Staphylococcus aureus which was coagulase positive.  From the
time of initial fever she was started empirically on
Vancomycin as well as Levofloxacin and Flagyl for presumed
aspiration pneumonia due to the development of coarse wet
lung sounds.  A chest x-ray was obtained at the time but no
overt radiographic evidence of pneumonia was evident.  Her
white count climbed as high as 38,000 but after the
initiation of antibiotics her white count decreased.  She was
no longer febrile and she initially had an encephalopathy
which improved after the continuation of antibiotics.  She
was able at this point to participate with physical therapy
activities and walk to the bathroom.  She was also seen
numerous times by her family and was able to recognize them,
however, they did note that she was still having problems
with memory in that she did not really realize while she was
at the hospital.  Due to the language barrier and the lack of
interpreter services it was not quite clear day to day how
her mental status functions improved, but on the day before
discharge she was noted by her family to be speaking fluently
and appeared to understand instructions to her about her diet
in Cantanese.  Finally, on the day before discharge she had a
PICC line placed for the administration of Vancomycin for a
total course of two weeks.  She is to complete a total of a
seven day course of Levofloxacin and Flagyl for presumed
aspiration pneumonia.  Finally, to complete the infectious
workup she was noted to have some loose stools which appeared
somewhat tarry.  These were guaiac positive but her serial
hematocrit checks showed hematocrit was stable.  The stool
was sent for Clostridium difficile and the first set is
negative.  Additional sets of Clostridium difficile toxins
from the stool are pending at this time.

From a cardiovascular standpoint the patient was fairly
hypertension and Captopril 25 mg p.o. t.i.d. was added onto
her regimen and she tolerated this well with fairly good
blood pressure control, to systolic of 130s.  She was
continued on Atenolol for heartrate control for paroxysmal
atrial fibrillation and she was observed to go into
paroxysmal atrial fibrillation with RVR only once and this
was brief and asymptomatic.

With regards to Aspirin, given the evidence of the amyeloid
angiopathy on magnetic resonance imaging scan and the fact
that she came in with a cerebral bleed, it was decided that
she should hold off on Aspirin for several weeks and it could
be restarted as an adult dose of 325 mg p.o. q.d. in about
three to four weeks time.  Her primary care physician's
office was contact[**Name (NI) **] to notify him of this change in her
medications.  She will follow up with her primary care
physician within approximately one months time.

DISCHARGE CONDITION:  Good.

DISCHARGE DIAGNOSIS:
1.  Left frontal and parietal lobar hemorrhage with previous
evidence of micro bleeds on magnetic resonance imaging scan
consistent with amyeloid angiopathy.
2.  Hypertension.
3.  Paroxysmal atrial fibrillation.
4.  History of gastrointestinal bleed.
5.  Status post recent fall with L2 vertebral fracture.
6.  Methicillin-resistant Staphylococcus aureus urinary tract
infection.
7.  Hypertension.

DISCHARGE MEDICATIONS:
1.  Vancomycin 1 gm intravenously q. 12 hours to end on
[**2175-1-11**].
2.  Captopril 25 mg p.o. t.i.d.
3.  Heparin 5000 units q. 8 hours for deep vein thrombosis
prophylaxis.
4.  Metronidazole 500 mg p.o. t.i.d. to end on [**2175-1-2**].
5.  Levofloxacin 500 mg p.o. q. 24 hours to end on [**2175-1-2**].
6.  Pantoprazole 40 mg p.o. q.d.
7.  Atenolol 50 mg p.o. q.d.
8.  Tylenol 325 to 650 mg p.o. q. 4-6 hours prn, back pain or
fever.


                            [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 5930**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 6125**]

Dictated By:[**Name8 (MD) 4064**]
MEDQUIST36

D:  [**2174-12-29**]  21:39
T:  [**2174-12-29**]  21:10
JOB#:  [**Job Number 52743**]


Admission Date:  [**2174-12-25**]       Discharge Date:  [**2174-12-31**]


Service:  Neurology

ADDENDUM:  This is a Discharge Summary Addendum.

CONCISE SUMMARY OF HOSPITAL COURSE (CONTINUED):  The patient
had a peripherally inserted central catheter line placed by
Interventional Radiology on the day before discharge without
any difficulties.  She was also observed to be hypertensive,
and her captopril was increased to 50 mg by mouth three times
per day.

In addition, it was noted that her fingerstick checks were
elevated even while fasting.  This likely represents a new
diagnosis of diabetes.  No new oral antihypoglycemic
medications were initiated at this time, as this was a new
diagnosis.  This will require some followup and counseling
with regard to diabetic teaching.

In addition, the T3 on her thyroid function tests came back
as low.  This likely also represents a new diagnosis of
hypothyroidism.  Levothyroxine was not initiated on this
admission but should be followed and probably initiated upon
her discharge to rehabilitation.

Finally, [**1-10**] Clostridium difficile toxins were negative; with
the last one pending.  She was already on Flagyl for
aspiration pneumonia treatment, and was unlikely to have
Clostridium difficile.  She did not have any further tarry
stools, and her hematocrit remained stable.

Regarding instructions for aspirin, it was felt by the Stroke
team that she likely had amyloid angiopathy, and although she
has been observed to be in paroxysmal atrial fibrillation she
did present on this admission with a new cortical hemorrhage
on adult-dose aspirin.  It was felt that she should abstain
from aspirin for about a 3-week to 4-week period of time and
have that reinitiated.  She was to follow up with her primary
care physician (Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]) who was contact[**Name (NI) **].






                        DR.[**Last Name (STitle) **],[**First Name3 (LF) 4224**] 13-303

Dictated By:[**Name8 (MD) 4064**]
MEDQUIST36

D:  [**2174-12-31**]  11:10
T:  [**2174-12-31**]  11:18
JOB#:  [**Job Number 52744**]
{'Intracerebral hemorrhage,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Malignant essential hypertension,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Unspecified circulatory system disorder'}


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-sided weakness.

PRESENT ILLNESS: This is an 87 year old woman
with a history of hypertension who was recently admitted to
[**Hospital3 2558**] Nursing Home after an admission for a fall and
was found at [**Hospital3 2558**] to not be moving her right arm as
well as the left.  Not many details are available at this
time.  It did appear that she was seen by nursing staff to
not be moving her right side as well as the left.  There was
no apparent increased level of confusion.  She was admitted
to the [**Hospital6 256**] Intensive Care
Unit after her blood pressure in the Emergency Department was
found to be 220/170 and a computerized tomography scan showed
a left frontal lobar hemorrhage.  It is known that she did
get up to go to the bathroom and was noted not to be able to
walk and not be able to talk.  We know at baseline from her
family that she is normally able to walk on her own and is
very talkative up until the fall and admission to [**Hospital 8503**] in early [**Month (only) 404**], she was cooking on her own
and living on her own in an apartment in [**Location (un) **] Square.  She
was reportedly not having any memory difficulty.

MEDICAL HISTORY: 1.  Hypertension; 2.  History of
gastrointestinal bleed in [**2170-1-8**]; 3.  Paroxysmal
atrial fibrillation found on the recent admission to [**Hospital 14852**], treated with just Atenolol; 4.  Fall
with L2 vertebral fracture.

MEDICATION ON ADMISSION: 1.  Aspirin 325 mg p.o. q.d.
2.  Protonix 40 mg p.o. q.d.
3.  Atenolol 50 mg p.o. q.d.
4.  Multivitamins

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Not obtained at this time.

SOCIAL HISTORY: Extensive family that lives in the area,
however, the patient does live on her own in an apartment.
She did attend Daycare Senior Program. 

### Response:
{'Intracerebral hemorrhage,Atrial fibrillation,Pneumonitis due to inhalation of food or vomitus,Malignant essential hypertension,Urinary tract infection, site not specified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified acquired hypothyroidism,Unspecified circulatory system disorder'}
