CHIEF COMPLAINT: slurred speech, L sided weakness

PRESENT ILLNESS: Mrs. [**Known lastname 103135**] is an 89 y/o with HTN, hyperlipidemia, type II
DM, hx Amarosis, who presents as Code Stroke for acute onset
slurred speech and L sided weakness today.  She reports that she
was at the dentist's office today from 1:00-1:30, and was in her
USOH before the appointment.  Around the time the
appointment ended (1:30-2:00) she started noticing that her
speech was slurred.  Shortly thereafter (around 2:00 - 2:30) she
started noticing that her left side was weak.  She called Dr.
[**First Name (STitle) 1313**], her PCP, [**Name10 (NameIs) **] his office and he directed her to come
directly to the ED.

MEDICAL HISTORY: OA in hips and knees
R hip replacement
HTN
Hyperlipidemia
Type II DM
Amarosis fugax, on Coumadin for awhile but this was stopped
after
a fall and shoulder fracture many years ago
Hashimoto's Thyroiditis
MI s/p angioplasty to LAD
Diverticulosis
Osteoporosis

MEDICATION ON ADMISSION: Zocor 10 mg QD
Triamcinolone 0.025% cream [**Hospital1 **]
Glucovance 5-500 mg [**Hospital1 **]
Synthroid 0.112 mg QD
Lisinopril 2.5 mg QD
Metoprolol 25 mg [**Hospital1 **]
Folic acid 1 mg QD
Provigil 100 mg QD
Plavix 75 mg QD
Miacalcin 200 IU QD

ALLERGIES: Aspirin / Bactrim

PHYSICAL EXAM: T- BP- 170/100 HR- 92 RR- 17 O2Sat- 98% on RA
Gen: Lying in bed, NAD, thin, frail
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: coarse transmitted upper airway sounds throughout
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: unknown

SOCIAL HISTORY: [**Doctor Last Name 6165**] in [**State **], widowed, remote tobacco (quit > 30 yrs ago)
Intracerebral hemorrhage,Compression of brain,Transient retinal arterial occlusion,Osteoporosis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hip joint replacement,Other and unspecified hyperlipidemia,Unspecified essential hypertension
Intracerebral hemorrhage,Compression of brain,Transient arterial occlu,Osteoporosis NOS,DMII wo cmp nt st uncntr,Joint replaced hip,Hyperlipidemia NEC/NOS,Hypertension NOS
Admission Date:  [**2114-4-10**]              Discharge Date:   [**2114-4-12**]


Service: NEUROLOGY

Allergies:
Aspirin / Bactrim

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
slurred speech, L sided weakness


Major Surgical or Invasive Procedure:
Endotracheal Intubation.

History of Present Illness:
Mrs. [**Known lastname 103135**] is an 89 y/o with HTN, hyperlipidemia, type II
DM, hx Amarosis, who presents as Code Stroke for acute onset
slurred speech and L sided weakness today.  She reports that she
was at the dentist's office today from 1:00-1:30, and was in her
USOH before the appointment.  Around the time the
appointment ended (1:30-2:00) she started noticing that her
speech was slurred.  Shortly thereafter (around 2:00 - 2:30) she
started noticing that her left side was weak.  She called Dr.
[**First Name (STitle) 1313**], her PCP, [**Name10 (NameIs) **] his office and he directed her to come
directly to the ED.

Code Stroke was called at 3:05 and Neurology was at the bedside
within 5 minutes.  Head CT was performed and showed a R
frontoparietal hemorrhage, therefore tPA was not pursued.


Past Medical History:
OA in hips and knees
R hip replacement
HTN
Hyperlipidemia
Type II DM
Amarosis fugax, on Coumadin for awhile but this was stopped
after
a fall and shoulder fracture many years ago
Hashimoto's Thyroiditis
MI s/p angioplasty to LAD
Diverticulosis
Osteoporosis


Social History:
[**Doctor Last Name 6165**] in [**State **], widowed, remote tobacco (quit > 30 yrs ago)


Family History:
unknown

Physical Exam:
T- BP- 170/100 HR- 92 RR- 17 O2Sat- 98% on RA
Gen: Lying in bed, NAD, thin, frail
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: coarse transmitted upper airway sounds throughout
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: Awake and alert, cooperative with exam.  Oriented
to person, place, and date.  Speech is fluent with normal
comprehension and repetition, naming intact, but markedly
dysarthric, difficult to understand.  [**Location (un) **] intact.  + L sided
neglect.

Cranial Nerves:
R pupil irregular, surgical, 5 mm, but briskly reactive.  L
pupil
4 -> 3.  Extraocular movements intact bilaterally, no nystagmus.

R gaze preference.  L UMN facial droop.  Palate elevation
symmetrical.  Shrug symmetric. Tongue midline, movements intact

Motor:
Diminished bulk throughout. Tone normal. No observed myoclonus
or
tremor.  Lifts R arm and leg off bed easily.  No movement of L
arm with pain.  Attempts to lift L leg on command, just barely
lifts off bed for a second, contracts at IPs and bends knee but
not anti-gravity.

Sensation: Intact to light touch throughout.  + extinction to
DSS
in L arm and leg.

Reflexes:
+1 and symmetric throughout.
Toes downgoing on R, upgoing on L

Coordination: not assessed

Gait: not assessed


Pertinent Results:
Labs:
Trop-T: <0.01

141  103  13
------------< 136
4.2  27  0.7

CK: 65 Ca: 9.5 Mg: 2.1 P: 3.1

WBC 8.5 Hgb 13.8 Plt 206 Hct 40.5 MCV 93
 N:62.3 L:30.7 M:3.9 E:2.6 Bas:0.5

PT: 12.2  PTT: 25.0  INR: 1.0

Imaging
Head CT [**2114-4-10**]: CT HEAD: There is a large, acute right
temporoparietal intraparenchymal hemorrhage measuring 4.4 x 3.6
cm with fluid-fluid levels, a small amount of surrounding edema,
and with small regions of adjacent subarachnoid hemorrhage.
There is some mass effect along the right lateral ventricle with
minimal, 3-mm leftward shift of normally midline structures.
There is no hydronephrosis and the basal cisterns are preserved.
Regions of periventricular and subcortical white matter
hypodensities likely relate to chronic small vessel ischemic
change. Otherwise, the [**Doctor Last Name 352**]-white matter differentiation is
preserved.

A 5-mm density along the inner table of the left frontal region
likely represents a meningioma. No fracture or region of bony
destruction is seen in the skull. Bilateral lens replacements
are noted. A small mucous retention cyst is noted in the left
maxillary sinus. Otherwise, the visualized paranasal sinuses and
mastoid air cells are well aerated.

IMPRESSION: Large right temporoparietal intraparenchymal
hemorrhage with fluid-fluid level and adjacent small
subarachnoid hemorrhage. There is associated minimal leftward
shift.
<br>
Head CT [**2114-4-10**]: CT HEAD WITHOUT IV CONTRAST: Compared to the
study performed 4.5 hours prior, there is interval increase in
size of large right temporoparietal intraparenchymal hemorrhage.
A surrounding rim of edema, fluid-fluid levels, and adjacent
regions of small subarachnoid hemorrhage are again seen. There
is increased compression of the right lateral ventricle, with
increased leftward shift of normally midline structures, from 4
to now 9 mm. In addition, there is increased loss of the right
basal cistern, consistent with early uncal herniation. The
remainder of the exam is largely unchanged.

IMPRESSION: Interval enlargement of the large right
temporoparietal intraparenchymal hemorrhage with increased
leftward shift and early uncal herniation.
<br>
Head CT [**2114-4-11**]:
FINDINGS: Again demonstrated is a large right temporoparietal
intraparenchymal hemorrhage, with a slight increase in
associated edema. This overall collection measures approximately
7 cm x 6 cm, largely unchanged in size from [**2114-4-10**].
Leftward shift of midline structures, with an 8- mm subfalcine
herniation, is unchanged.

Diffuse subarachnoid hemorrhage in the cortical sulci and along
the interhemispheric fissure, and layering blood within the
occipital horns of the lateral ventricles, are more apparent
from prior study, likely reflecting redistribution. Apparent
thickening of the tentorium is likely artifactual rather than
representing a subdural component.

There is no evidence of a major vascular territorial infarction.
The ventricular system is unchanged without evidence of
hydrocephalus. Patchy mucosal thickening of the ethmoidal
sinuses is seen. Atherosclerotic calcification of the cavernous
portion of the carotid arteries is seen. Osseous structures are
unremarkable.

IMPRESSION:
1. Large right intraparenchymal hemorrhage, not significantly
changed in size from [**2114-4-10**]. However, associated edema is
more apparent.
2. Diffuse subarachnoid hemorrhage and intraventricular blood is
more apparent, likely reflecting redistribution of blood.


Brief Hospital Course:
Mrs. [**Known lastname 103135**] was admitted initially to the Neuro ICU for
close monitoring and blood pressure management. As documented in
the CT reports, her bleed got significantly worse after initial
presentation despite tight control of her blood pressure. After
many family discussions with careful explanations of her likely
disabilities if she were to survive and the severe complications
that were likely to occur in the acute and subacute periods, her
family decided to make her code status Comfort Measures Only
(CMO). She was extubated and given prn morphine for comfort. She
was transferred to the floor and passed away shortly thereafter.
Cause of death was cerebral herniation due to intracerebral
hemorrhage, likely precipitated by amyloid angiopathy. Time of
death was 8:47 pm on [**2114-4-12**]. Autopsy was offered and declined
by the family.


Medications on Admission:
Zocor 10 mg QD
Triamcinolone 0.025% cream [**Hospital1 **]
Glucovance 5-500 mg [**Hospital1 **]
Synthroid 0.112 mg QD
Lisinopril 2.5 mg QD
Metoprolol 25 mg [**Hospital1 **]
Folic acid 1 mg QD
Provigil 100 mg QD
Plavix 75 mg QD
Miacalcin 200 IU QD

ALL: ASA (rash), Bactrim (rash)


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Intracerebral hemorrhage
Amyloid Angiopathy

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A

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

Completed by:[**2114-4-13**]
{'Intracerebral hemorrhage,Compression of brain,Transient retinal arterial occlusion,Osteoporosis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hip joint replacement,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}


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: slurred speech, L sided weakness

PRESENT ILLNESS: Mrs. [**Known lastname 103135**] is an 89 y/o with HTN, hyperlipidemia, type II
DM, hx Amarosis, who presents as Code Stroke for acute onset
slurred speech and L sided weakness today.  She reports that she
was at the dentist's office today from 1:00-1:30, and was in her
USOH before the appointment.  Around the time the
appointment ended (1:30-2:00) she started noticing that her
speech was slurred.  Shortly thereafter (around 2:00 - 2:30) she
started noticing that her left side was weak.  She called Dr.
[**First Name (STitle) 1313**], her PCP, [**Name10 (NameIs) **] his office and he directed her to come
directly to the ED.

MEDICAL HISTORY: OA in hips and knees
R hip replacement
HTN
Hyperlipidemia
Type II DM
Amarosis fugax, on Coumadin for awhile but this was stopped
after
a fall and shoulder fracture many years ago
Hashimoto's Thyroiditis
MI s/p angioplasty to LAD
Diverticulosis
Osteoporosis

MEDICATION ON ADMISSION: Zocor 10 mg QD
Triamcinolone 0.025% cream [**Hospital1 **]
Glucovance 5-500 mg [**Hospital1 **]
Synthroid 0.112 mg QD
Lisinopril 2.5 mg QD
Metoprolol 25 mg [**Hospital1 **]
Folic acid 1 mg QD
Provigil 100 mg QD
Plavix 75 mg QD
Miacalcin 200 IU QD

ALLERGIES: Aspirin / Bactrim

PHYSICAL EXAM: T- BP- 170/100 HR- 92 RR- 17 O2Sat- 98% on RA
Gen: Lying in bed, NAD, thin, frail
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: coarse transmitted upper airway sounds throughout
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: unknown

SOCIAL HISTORY: [**Doctor Last Name 6165**] in [**State **], widowed, remote tobacco (quit > 30 yrs ago) 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Transient retinal arterial occlusion,Osteoporosis, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hip joint replacement,Other and unspecified hyperlipidemia,Unspecified essential hypertension'}
