CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 84-year-old
gentleman with a history of cerebrovascular accident and
hypertension with four to five day history of progressive
right-sided weakness who was admitted to an outside hospital
on [**2111-5-11**].  Reportedly MRI was done at the time and
was negative for an infarct.  The patient was also observed
to have facial numbness and tingling at the time and
complaints of mild dysarthria and mild word finding
difficulties.  He was transferred to rehabilitation on the
[**5-13**] but had intermittent worsening of the right-
sided weakness and mild dysarthria which continued and had
some lightheadedness with standing.  He was transferred to
[**Hospital1 69**] for further management.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Hemorrhage complicating a procedure,Acidosis,Injury to bladder and urethra, without mention of open wound into cavity,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Unspecified accident
Ocl crtd art wo infrct,Food/vomit pneumonitis,Hemorrhage complic proc,Acidosis,Bladder/urethra inj-clos,Abn react-surg proc NEC,Hypertension NOS,Hypothyroidism NOS,Accident NOS
Admission Date: [**2111-5-27**]        Discharge Date: [**2111-6-5**]


Service:  NSU


HISTORY OF PRESENT ILLNESS:  The patient is an 84-year-old
gentleman with a history of cerebrovascular accident and
hypertension with four to five day history of progressive
right-sided weakness who was admitted to an outside hospital
on [**2111-5-11**].  Reportedly MRI was done at the time and
was negative for an infarct.  The patient was also observed
to have facial numbness and tingling at the time and
complaints of mild dysarthria and mild word finding
difficulties.  He was transferred to rehabilitation on the
[**5-13**] but had intermittent worsening of the right-
sided weakness and mild dysarthria which continued and had
some lightheadedness with standing.  He was transferred to
[**Hospital1 69**] for further management.

PHYSICAL EXAMINATION:  Temperature was 98.1, blood pressure
160/80, heart rate 113, respiratory rate 20, sats 92 percent
on room air.  He is a pleasant elderly gentleman in no acute
distress.  His sclerae were anicteric.  Carotids with no
bruit.  Cardiovascular:  Regular rate and rhythm.  S1, S2.
No murmur, rub or gallop.  Chest was clear to auscultation
bilaterally.  Abdomen was soft, non-tender, non-distended,
positive bowel sounds.  Extremities:  No clubbing, cyanosis
or edema.  Neurologically, his speech was fluent with mild
dysarthria.  Pupils equal, round and reactive to light.
Extraocular movements intact.  Visual fields full to
confrontation.  Strength 5/5 in all muscle groups.  Tongue
was midline.  Slight right facial droop.  Deep tendon
reflexes 2 plus throughout.  His toes were mute.  Sensation
was intact to light touch.

HOSPITAL COURSE:  He was admitted to the Neurosurgery
Service.  The plan was for angiogram.  The patient underwent
arteriogram on [**2111-5-29**], which showed evidence of a right
ICA stenosis and left pica stroke.  The patient had high
grade right ICA stenosis in the cavernous portion.  There
were no complications to the procedure and it was decided
that the patient would wait for stent placement until
recovering from his most recent stroke.  He had a bedside
swallow evaluation which he failed and had a feeding tube in
place for feeding.  He had a repeat swallow evaluation two or
three days later and had a video swallow which, again, he was
aspirating all consistencies.  Therefore, it was decided to
place a PEG feeding tube.  The PEG tube was scheduled for
placement on [**2111-6-5**].  The patient's vital signs have
been stable.  He has been afebrile, awake, alert and oriented
times three, moving all extremities with good strength.
Continues with right-sided weakness.  Was also seen by the
Pulmonary Service for question of right lower lobe nodule
which they felt was most likely pneumonia by CT scan.
Therefore, the patient was started on clindamycin and
levofloxacin for a two week course of intravenous antibiotics
for Gram negative rods and for radiographic evidence of
pneumonia.  The patient's vital signs since that time have
remained stable.  He is afebrile.  He has been out-of-bed
ambulating with Physical Therapy and Occupational Therapy and
will require a short rehabilitation stay prior to discharge
to home.  His sodium level has also been low today down to
129.  He was started on 1000 fluid restriction, salt tabs one
gram p.o. t.i.d.

DISCHARGE MEDICATIONS:  Include salt tabs one gram p.o.
t.i.d., metoprolol 25 p.o. b.i.d., hold for blood pressure
less than 160, heart rate less than 60, levofloxacin
currently 500 mg IV q. 24h. which will be changed to p.o. and
clindamycin 600 mg IV q. 8h., heparin 5000 units subcu q.
12h., insulin sliding scale, hydrocodone one to two tabs p.o.
q. 4h. p.r.n. for headache, Zantac 150 p.o. b.i.d., Excedrin
aspirin-free one tab p.o. q. 6h. p.r.n.  Patient takes all
medications.  Aspirin 81 mg p.o. q. day, Plavix 75 mg p.o. q.
day, meclizine 25 p.o. q. 6h. p.r.n., Colace 100 mg p.o.
b.i.d., levothyroxine 125 mcg p.o. q. day, simvastatin 20
p.o. q. day, hydrochlorothiazide 25 p.o. q. day, lisinopril
20 p.o. q. day.

CONDITION ON DISCHARGE:  Stable.


FOLLOW UP:  He will follow up with Dr. [**Last Name (STitle) 1132**] in two weeks.



                        [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2111-6-4**] 17:15:39
T:  [**2111-6-4**] 17:38:51
Job#:  [**Job Number 58106**]


Name:  [**Known lastname **], [**Known firstname 63**]            Unit No:  [**Numeric Identifier 10780**]

Admission Date: [**2111-5-27**]        Discharge Date:

Date of Birth:  [**2026-12-30**]        Sex:  M

Service:  NSU


ADDENDUM:

HOSPITAL COURSE:  On [**2111-6-5**], the patient was taken by
Interventional Radiology to the operating room for PEG
placement.  He was brought back to the floor in stable
condition.  However, he developed a bleed later that day and
was experiencing hemodynamic instability.  Interventional
Radiology was called by Neurosurgery to deal with the problem
and they put some stitches in the wound, and hemodynamic
stability was restored.  Later on [**2111-6-5**], the patient was
experiencing mental status changes as a result of relative
hypotension.  It was decided at this time that the patient
would be better taken care of in the SICU.  The patient was
given a fluid bolus of 1 liter normal saline and transferred
to the SICU to presumably stay over.

While in the SICU, the patient had continued semi-occlusion
of the upper airway despite a nasal trumpet.  His ABG showed
he was acidotic and secretions were increasing, so it was
decided that the patient should be intubated for airway
protection.  On [**2111-6-6**], the patient had a head CT that
showed no acute changes; however, he was very lethargic,
opening the eyes to voice only, inconsistently following
commands now that he is intubated; however, he does withdraw
all extremities to pain.

On [**2111-6-7**], upon examination by Neurosurgery; all his vital
signs were stable.  His lab showed a white blood count of
12.6, hematocrit of 29.3, and platelet level of 4.66.  He
opened his eyes to voice.  He stuck out his tongue and showed
thumbs bilaterally.  At this point, the patient was following
commands and neurologically stable.  The plan at this point
was to keep his blood pressure greater than 150 to ensure
perfusion and keep his pCO2 between 35 and 45.  Neurosurgical
exam on [**2111-6-8**] showed all vital signs were stable.  The
patient was on 0.5 percent of Neo-Synephrine to maintain a
blood pressure greater than 140.  He was neurologically
stable at this point.

On [**2111-6-9**], on neurosurgical progress note, the patient was
awake and oriented x1.  Pupils were 4 to 3 bilaterally.  No
drift; [**3-25**] grip strength bilaterally.  His plan at this time
was to keep his pressure between 120 and 170, anticoagulate
with subcutaneous heparin, and was transferred out of the
SICU to the main floor on Far 5.  On [**2111-6-9**], the patient
was transferred out of the unit to the main floor.  However,
at this time, he pulled out his Foley catheter traumatically.
On [**2111-6-10**], the patient was neurologically stable, all his
vital signs were stable.  He was awake, alert, and oriented
x1.  He had no drift.  His IPs were [**2-23**].  His grip was [**3-25**].
The PEG site was clear without serosanguinous fluid
discharge.  There was a small hematoma, and after pulling the
Foley he has gross hematuria.  He is neurologically stable;
however, today, we will get a Urology consult and a rehab
________

DICTATION ENDED



                        [**Name6 (MD) **] [**Last Name (NamePattern4) 2483**], [**MD Number(1) 2484**]

Dictated By:[**Last Name (NamePattern1) 10242**]
MEDQUIST36
D:  [**2111-6-10**] 11:08:09
T:  [**2111-6-10**] 15:03:32
Job#:  [**Job Number 10781**]


Name:  [**Known lastname **], [**Known firstname 63**]            Unit No:  [**Numeric Identifier 10780**]

Admission Date: [**2111-5-27**]        Discharge Date: [**2111-6-16**]

Date of Birth:  [**2026-12-30**]        Sex:  M

Service:  NSU


The patient experienced hematuria after traumatic Foley
extraction.  The patient pulled out his Foley, and then
developed gross hematuria.  Urology was consulted, and a
three-way Foley was placed, and the patient was placed on
irrigation through the Foley catheter for 2-3 days with
clearing of his urine.  At this point, his urine is clear
with no evidence of blood.  The three-way Foley has remained
in place and should remain in place for another 2-3 days and
then be discontinued.

The patient's neurologic status is stable.  He is awake,
alert, and oriented times one.  He has no drift.  His IP's
were [**2-23**].  Grasps were [**3-25**].  His PEG site, where he had some
bleeding earlier on was clean, dry, and intact with no
evidence of serosanguinous drainage.  His vital signs and his
temperature have been stable.  He is ready for discharge with
followup with Dr. [**Last Name (STitle) 365**] in [**12-23**] weeks' time.

CONDITION ON DISCHARGE:  His condition was stable at the time
of discharge.



                        [**Name6 (MD) **] [**Last Name (NamePattern4) 2483**], [**MD Number(1) 2484**]

Dictated By:[**Last Name (NamePattern1) 2186**]
MEDQUIST36
D:  [**2111-6-15**] 13:53:29
T:  [**2111-6-15**] 14:18:23
Job#:  [**Job Number 10784**]
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Hemorrhage complicating a procedure,Acidosis,Injury to bladder and urethra, without mention of open wound into cavity,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Unspecified accident'}


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: 

PRESENT ILLNESS: The patient is an 84-year-old
gentleman with a history of cerebrovascular accident and
hypertension with four to five day history of progressive
right-sided weakness who was admitted to an outside hospital
on [**2111-5-11**].  Reportedly MRI was done at the time and
was negative for an infarct.  The patient was also observed
to have facial numbness and tingling at the time and
complaints of mild dysarthria and mild word finding
difficulties.  He was transferred to rehabilitation on the
[**5-13**] but had intermittent worsening of the right-
sided weakness and mild dysarthria which continued and had
some lightheadedness with standing.  He was transferred to
[**Hospital1 69**] for further management.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Occlusion and stenosis of carotid artery without mention of cerebral infarction,Pneumonitis due to inhalation of food or vomitus,Hemorrhage complicating a procedure,Acidosis,Injury to bladder and urethra, without mention of open wound into cavity,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Unspecified essential hypertension,Unspecified acquired hypothyroidism,Unspecified accident'}
