CHIEF COMPLAINT: intermittent garbled speech, vertigo

PRESENT ILLNESS: Mr. [**Known lastname **] is a 72 year old right handed male who presents with
garbled speech and vertigo. He has a history of CAD s/p MI [**89**]
years ago, amaurosis fugax s/p left carotid endarterectomy. He
was well until 7pm this evening when he was seated next to his
wife at a [**Name (NI) **] post. He was midsentence, when he produced
completely garbled speech. He knew what he wanted to say, and
understood others, but produced incomprehensible speech. This
episode last three minutes. His wife drove him to [**Name (NI) **]
hospital for evaluation. While in the car he became profusely
diaphoretic, and then noted that he felt quite dizzy, as in the
room spinning everytime he stood up. Head CT performed at
[**Location (un) **]
was negative. He had a reportedly normal examination there. He
was given 1mg Ativan IV and Zofran IV, and he was transferred to
[**Hospital1 18**] for evaluation.

MEDICAL HISTORY: Left CEA- ([**2181**]) presented with amaurosis fugax.
Peripheral neuropathy- burning pain at toes for the last few
years.
Restless Legs Syndrome- improves with Ativan 2mg QHS.
Glaucoma- s/p R eye surgery.

MEDICATION ON ADMISSION: Lipitor 40mg daily
Synthroid 175mcg daily
Ativan 2mg QHS for RLS
Aspirin 81mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 96.8, HR 57, BP 160/75, R 18, 98% RA
Gen- laying on his right side of gurney in a darkened room,
squints to light, "feels tired," obese gentleman.
HEENT: NCAT, anicteric, MMM, OP clear
Neck- L CEA scar, no carotid or vertebral bruits bilaterally.
CV- RRR, no MRG
Abd- soft, NT, ND, BS+
Extrem- 1+ pitting edema to knees bilaterally.
Skin- no rashes

FAMILY HISTORY: Brother- had seizure disorder since age 10.
Sister- died of brain cancer
[**Name (NI) 8614**] CAD

SOCIAL HISTORY: lives with his wife, he is retired from the departmetn of
public works, >50 py smoking hx, quit 4 years ago, however now
smokes 2 cigars per day, he does not drink alcohol. he denies
illicit or IV drug use.
Cerebral artery occlusion, unspecified with cerebral infarction,Cerebral edema,Coronary atherosclerosis of native coronary artery,Unspecified hereditary and idiopathic peripheral neuropathy,Restless legs syndrome (RLS),Atrial fibrillation
Crbl art ocl NOS w infrc,Cerebral edema,Crnry athrscl natve vssl,Idio periph neurpthy NOS,Restless legs syndrome,Atrial fibrillation
Admission Date:  [**2186-7-9**]              Discharge Date:   [**2186-7-13**]

Date of Birth:  [**2114-4-5**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
intermittent garbled speech, vertigo

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname **] is a 72 year old right handed male who presents with
garbled speech and vertigo. He has a history of CAD s/p MI [**89**]
years ago, amaurosis fugax s/p left carotid endarterectomy. He
was well until 7pm this evening when he was seated next to his
wife at a [**Name (NI) **] post. He was midsentence, when he produced
completely garbled speech. He knew what he wanted to say, and
understood others, but produced incomprehensible speech. This
episode last three minutes. His wife drove him to [**Name (NI) **]
hospital for evaluation. While in the car he became profusely
diaphoretic, and then noted that he felt quite dizzy, as in the
room spinning everytime he stood up. Head CT performed at
[**Location (un) **]
was negative. He had a reportedly normal examination there. He
was given 1mg Ativan IV and Zofran IV, and he was transferred to
[**Hospital1 18**] for evaluation.

On arrival to [**Hospital1 18**] ~9:30pm the patient had a second episode of
similar garbled speech lasting 2-3 minutes, with complete and
sudden resolution.

At present he reports feeling the room spinning when rolling
over. He feels very fatigued since the onset of his symptoms. he
reports being sensitive to the lights in the room. He denies any
headache or neck pain. No recent travel or sick contacts. [**Name (NI) **]
reports chronic burning neuropathy in his feet bilaterally for
several years, but he is unsure why. He denies any weakness. He
denies any incoordination. No urinary retention.

He had an episode of suddenly beconming very diaphoretic at a
baseball game about 4 weeks ago resulting to admission at
[**Hospital3 35296**]. There an MRI was performed and reportedly normal.

On review of systems, the pt denied recent fever or chills.  No
night sweats or recent weight loss or gain. Denied cough,
shortness of breath.  Denied chest pain or tightness,
palpitations.  He is nauseated at present. No diarrhea,
constipation or abdominal pain.  No recent change in bowel or
bladder habits.  No dysuria.  Denied arthralgias or myalgias.
Denied rash.


Past Medical History:
Left CEA- ([**2181**]) presented with amaurosis fugax.
Peripheral neuropathy- burning pain at toes for the last few
years.
Restless Legs Syndrome- improves with Ativan 2mg QHS.
Glaucoma- s/p R eye surgery.


Social History:
lives with his wife, he is retired from the departmetn of
public works, >50 py smoking hx, quit 4 years ago, however now
smokes 2 cigars per day, he does not drink alcohol. he denies
illicit or IV drug use.


Family History:
Brother- had seizure disorder since age 10.
Sister- died of brain cancer
[**Name (NI) 8614**] CAD

Physical Exam:
T 96.8, HR 57, BP 160/75, R 18, 98% RA
Gen- laying on his right side of gurney in a darkened room,
squints to light, "feels tired," obese gentleman.
HEENT: NCAT, anicteric, MMM, OP clear
Neck- L CEA scar, no carotid or vertebral bruits bilaterally.
CV- RRR, no MRG
Abd- soft, NT, ND, BS+
Extrem- 1+ pitting edema to knees bilaterally.
Skin- no rashes

Neurologic exam:
Mental Status-
He is alert, oriented to person, place time, his speech is
fluent
with intact naming and repitition.  His [**Location (un) 1131**] is intact. He is
able to name the [**Doctor Last Name 1841**] backwards. Correctly interprets cookie
theft
picture. No apraxia or neglect.

Cranial Nerves-
Olfaction not tested. R pupil surgical ~6mm-5mm, L pupil 5--3mm,
EOMI, no nystagmus. VFF to confrontation.  There is no ptosis
bilaterally. Funduscopic exam could not be performed given
photphobia.  Normal saccades. Facial sensation intact to
pinprick. No facial droop, facial musculature symmetric. Hearing
intact to finger-rub bilaterally.  Palate elevates
symmetrically.
5/5 strength in trapezii and SCM bilaterally. Tongue protrudes
in
midline.

Motor-
Normal bulk, tone throughout. No adventitious movements noted.
No
asterixis noted.
No pronator drift bilaterally.

  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5    5  5    5  5  5  5   5   5  5    5     5    5
R  5    5    5  5    5  5  5  5   5   5  5    5     5    5

-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.

-Coordination: No intention tremor, dysdiadochokinesia noted. No
dysmetria on FNF or HKS bilaterally.

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2   2   2    2   1
R  2   2   2    2   1

Plantar response was flexor bilaterally.

-Gait: Good initiation. Narrow-based, normal stride and arm
swing.  Able to walk in tandem without difficulty. Romberg
absent.


Pertinent Results:
[**2186-7-11**] 09:30AM BLOOD WBC-11.7* RBC-4.63 Hgb-14.4 Hct-40.4
MCV-87 MCH-31.0 MCHC-35.6* RDW-13.4 Plt Ct-295
[**2186-7-10**] 02:39AM BLOOD WBC-14.5* RBC-4.65 Hgb-13.8* Hct-40.7
MCV-88 MCH-29.8 MCHC-34.0 RDW-13.7 Plt Ct-288
[**2186-7-9**] 08:35AM BLOOD WBC-13.0* RBC-4.69 Hgb-14.1 Hct-41.3
MCV-88 MCH-30.1 MCHC-34.3 RDW-13.7 Plt Ct-272
[**2186-7-8**] 09:30PM BLOOD WBC-13.4* RBC-4.70 Hgb-13.8* Hct-41.6
MCV-88 MCH-29.3 MCHC-33.2 RDW-13.8 Plt Ct-243
[**2186-7-8**] 09:30PM BLOOD Neuts-74.1* Lymphs-19.5 Monos-5.1 Eos-0.8
Baso-0.6
[**2186-7-13**] 06:20AM BLOOD PT-30.0* PTT-32.9 INR(PT)-3.1*
[**2186-7-12**] 07:40PM BLOOD PT-24.5* PTT-77.7* INR(PT)-2.4*
[**2186-7-12**] 06:10AM BLOOD PT-17.1* PTT-71.4* INR(PT)-1.5*
[**2186-7-11**] 09:30AM BLOOD Plt Ct-295
[**2186-7-11**] 09:30AM BLOOD PT-13.9* PTT-60.3* INR(PT)-1.2*
[**2186-7-10**] 08:00PM BLOOD PT-14.3* PTT-68.9* INR(PT)-1.2*
[**2186-7-10**] 08:00PM BLOOD PT-13.7* PTT-65.7* INR(PT)-1.2*
[**2186-7-10**] 12:15PM BLOOD PTT-55.3*
[**2186-7-10**] 02:39AM BLOOD Plt Ct-288
[**2186-7-10**] 02:39AM BLOOD PT-13.8* PTT-55.8* INR(PT)-1.2*
[**2186-7-9**] 08:21PM BLOOD PTT-60.2*
[**2186-7-9**] 01:44PM BLOOD PTT-61.0*
[**2186-7-9**] 08:35AM BLOOD Plt Ct-272
[**2186-7-9**] 08:35AM BLOOD PT-13.4 PTT-53.1* INR(PT)-1.2*
[**2186-7-8**] 09:30PM BLOOD Plt Ct-243
[**2186-7-8**] 09:30PM BLOOD PT-12.6 PTT-23.4 INR(PT)-1.1
[**2186-7-12**] 06:10AM BLOOD Glucose-97 UreaN-13 Creat-0.8 Na-139
K-3.7 Cl-105 HCO3-24 AnGap-14
[**2186-7-11**] 09:30AM BLOOD Glucose-124* UreaN-14 Creat-0.8 Na-137
K-3.7 Cl-105 HCO3-22 AnGap-14
[**2186-7-10**] 02:39AM BLOOD Glucose-122* UreaN-14 Creat-0.7 Na-139
K-3.9 Cl-105 HCO3-23 AnGap-15
[**2186-7-9**] 08:35AM BLOOD Glucose-147* UreaN-15 Creat-0.8 Na-137
K-4.1 Cl-103 HCO3-24 AnGap-14
[**2186-7-8**] 09:30PM BLOOD Glucose-137* UreaN-16 Creat-0.8 Na-140
K-4.3 Cl-107 HCO3-22 AnGap-15
[**2186-7-10**] 02:39AM BLOOD CK(CPK)-58
[**2186-7-9**] 08:21PM BLOOD CK(CPK)-58
[**2186-7-9**] 01:44PM BLOOD CK(CPK)-61
[**2186-7-8**] 09:30PM BLOOD CK(CPK)-61
[**2186-7-10**] 02:39AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2186-7-9**] 08:21PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2186-7-9**] 01:44PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2186-7-9**] 08:35AM BLOOD CK-MB-4 cTropnT-<0.01
[**2186-7-8**] 09:30PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2186-7-12**] 06:10AM BLOOD Phos-2.8 Mg-2.1
[**2186-7-11**] 09:30AM BLOOD Calcium-8.9 Phos-2.0* Mg-2.0
[**2186-7-10**] 02:39AM BLOOD Calcium-8.8 Phos-2.5* Mg-2.2
[**2186-7-9**] 08:35AM BLOOD TotProt-7.3 Calcium-9.4 Phos-2.9 Mg-1.9
Cholest-146
[**2186-7-8**] 09:30PM BLOOD Calcium-9.5 Phos-3.2 Mg-1.9
[**2186-7-9**] 08:35AM BLOOD VitB12-188*
[**2186-7-9**] 08:35AM BLOOD %HbA1c-6.3*
[**2186-7-9**] 08:35AM BLOOD Triglyc-104 HDL-44 CHOL/HD-3.3 LDLcalc-81
Homocys-7.7
[**2186-7-9**] 08:35AM BLOOD TSH-<0.02*
[**2186-7-9**] 08:35AM BLOOD PEP-NO SPECIFIC ABNORMALITIES SEEN
[**2186-7-9**] 12:26AM BLOOD Lactate-1.5

Brief Hospital Course:
This 72 yo man was admitted with the sudden onset of headache,
vertigo and nausea and was found to have a right cerebellar
infarct with occlusion of the right vertebral artery. He was
noted to be in atrial fibrillation on tele and was started on a
heparin gtt and bridged to coumadin. His echocardiogram was
normal with normal EF and no source of embolus noted. Several
days after admission, he underewent repeat CTA head and was
found to have reconstitution of the V3 segment of the vertebral
artery with persistent occlusion of the V4 segment of the
vetebral artery. Repeat NCHCT showed increased cerebellar edema
without bleed or shift of the normally midline structures.
   His course was complicatd initially by severe headache which
was controlled with low dose IV dilaudid and later with tylenol
orally. He also experienced persistent hiccups which were
controlled with thorzine and restless legs which were controlled
with requip.
   Over the course of days, his INR became therapeutic and his
heprain gtt was DC'd, and the pt continued to work with PT/OT.
He still complained of quite a bit of vertigo, but was able to
take about [**1-22**] steps with PT before losing balance.
  Pt was discharged on [**2186-7-13**].

Medications on Admission:
Lipitor 40mg daily
Synthroid 175mcg daily
Ativan 2mg QHS for RLS
Aspirin 81mg daily


Discharge Medications:
1. Atorvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO TID (3
times a day).
5. Ropinirole 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily).

6. Warfarin 4 mg Tablet Sig: Two (2) 2-mg-tablets PO at bedtime.

7. Chlorpromazine 50 mg Tablet Sig: One (1) Tablet PO TID PRN as
needed for hiccups.
8. Ondansetron HCl (PF) 4 mg/2 mL Solution Sig: Four (4) mg
Injection Q8H (every 8 hours) as needed.
9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
right cerebellar ischemic infarct


Discharge Condition:
stable


Discharge Instructions:
You have had a small stroke, affecting your right cerebellum. In
order to prevent future strokes, it is important to modify your
risk factors. You were found to have atrial fibrillation, and
have been started on the medicine coumadin to thin your blood.
It will be important to have your INR monitored regularly, which
is a blood test that measures the thinness of your blood. Your
INR goal should be between 2.0 and 3.0. Please return to the ER
if you experience any sudden headaches, vertigo, double vision,
limb clumbsiness, focal weakness, or changes in sensation,
vision, or speech.

Followup Instructions:
Please Follow up with your PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 40076**]
for management of your INR and coumadin dose.

Neurological follow up with Dr. [**First Name (STitle) **] [**Name (STitle) **] [**Telephone/Fax (1) 2574**].


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2186-7-13**]

Name:  [**Known lastname **],[**Known firstname **] A                Unit No:   [**Numeric Identifier 12744**]

Admission Date:  [**2186-7-9**]              Discharge Date:   [**2186-7-13**]

Date of Birth:  [**2114-4-5**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 608**]
Addendum:
addendum for MRI

Brief Hospital Course:
Repeat MRI before discharge showed some increased area of
infarct, which was suspected already based on hypodensities seen
on [**7-11**] CT.  There was also a small area of the lateral medulla
involved which accounted for his hiccups, face numbness and
likely his diploplia.  His INR was already 3.1 and symptoms had
been stable for at least 48 hours.  There was no other
intervention to be done and he was allowed to be discharged.

Discharge Disposition:
Extended Care

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

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 610**]

Completed by:[**2186-7-13**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Cerebral edema,Coronary atherosclerosis of native coronary artery,Unspecified hereditary and idiopathic peripheral neuropathy,Restless legs syndrome (RLS),Atrial fibrillation'}


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: intermittent garbled speech, vertigo

PRESENT ILLNESS: Mr. [**Known lastname **] is a 72 year old right handed male who presents with
garbled speech and vertigo. He has a history of CAD s/p MI [**89**]
years ago, amaurosis fugax s/p left carotid endarterectomy. He
was well until 7pm this evening when he was seated next to his
wife at a [**Name (NI) **] post. He was midsentence, when he produced
completely garbled speech. He knew what he wanted to say, and
understood others, but produced incomprehensible speech. This
episode last three minutes. His wife drove him to [**Name (NI) **]
hospital for evaluation. While in the car he became profusely
diaphoretic, and then noted that he felt quite dizzy, as in the
room spinning everytime he stood up. Head CT performed at
[**Location (un) **]
was negative. He had a reportedly normal examination there. He
was given 1mg Ativan IV and Zofran IV, and he was transferred to
[**Hospital1 18**] for evaluation.

MEDICAL HISTORY: Left CEA- ([**2181**]) presented with amaurosis fugax.
Peripheral neuropathy- burning pain at toes for the last few
years.
Restless Legs Syndrome- improves with Ativan 2mg QHS.
Glaucoma- s/p R eye surgery.

MEDICATION ON ADMISSION: Lipitor 40mg daily
Synthroid 175mcg daily
Ativan 2mg QHS for RLS
Aspirin 81mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 96.8, HR 57, BP 160/75, R 18, 98% RA
Gen- laying on his right side of gurney in a darkened room,
squints to light, "feels tired," obese gentleman.
HEENT: NCAT, anicteric, MMM, OP clear
Neck- L CEA scar, no carotid or vertebral bruits bilaterally.
CV- RRR, no MRG
Abd- soft, NT, ND, BS+
Extrem- 1+ pitting edema to knees bilaterally.
Skin- no rashes

FAMILY HISTORY: Brother- had seizure disorder since age 10.
Sister- died of brain cancer
[**Name (NI) 8614**] CAD

SOCIAL HISTORY: lives with his wife, he is retired from the departmetn of
public works, >50 py smoking hx, quit 4 years ago, however now
smokes 2 cigars per day, he does not drink alcohol. he denies
illicit or IV drug use. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Cerebral edema,Coronary atherosclerosis of native coronary artery,Unspecified hereditary and idiopathic peripheral neuropathy,Restless legs syndrome (RLS),Atrial fibrillation'}
