CHIEF COMPLAINT: Slurred speech and right sided numbness

PRESENT ILLNESS: The pt is a 71 year-old right-handed man with no significant
PMH who presented to as OSH with dysarthria and R arm tingling.
There is some discrepancy between the patients report and that
of
the records. Earlier today, he noted R arm tingling and then
developed dysarthria. Neither the patient nor his wife can give
an exact time course, however it does not appear that there was
a
clear [**Month (only) **] associated with the onset of his symptoms. Per the
OSH records, he also had R leg tingling, however he denied this.
They went to the OSH where his symptoms resolved. He had a CT
scan which showed a large L temporal chemerage with mild edema
but no shift. He was also noted to be hypertensive while there
with a SBP up to 190. He was therefore started on a Nipride drip
and transferred for further evaluation.

MEDICAL HISTORY: - appy (remote)
- borderline HTN

MEDICATION ON ADMISSION: ASA 325
MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:97  BP: 145/85   HR: 75    R 18      O2Sats 99%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Skin: no rashes or lesions noted.

FAMILY HISTORY: -Father w/ [**Name2 (NI) 499**] CA

SOCIAL HISTORY: -married, retired and worked for [**University/College **]
-remote tobacco > 15 yrs ago, rare EtOH, no drugs
Unspecified intracranial hemorrhage,Other amyloidosis,Unspecified essential hypertension
Intracranial hemorr NOS,Amyloidosis NEC,Hypertension NOS
Admission Date:  [**2152-10-22**]              Discharge Date:   [**2152-10-24**]

Date of Birth:  [**2081-6-16**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Slurred speech and right sided numbness


Major Surgical or Invasive Procedure:
None

History of Present Illness:
The pt is a 71 year-old right-handed man with no significant
PMH who presented to as OSH with dysarthria and R arm tingling.
There is some discrepancy between the patients report and that
of
the records. Earlier today, he noted R arm tingling and then
developed dysarthria. Neither the patient nor his wife can give
an exact time course, however it does not appear that there was
a
clear [**Month (only) **] associated with the onset of his symptoms. Per the
OSH records, he also had R leg tingling, however he denied this.
They went to the OSH where his symptoms resolved. He had a CT
scan which showed a large L temporal chemerage with mild edema
but no shift. He was also noted to be hypertensive while there
with a SBP up to 190. He was therefore started on a Nipride drip
and transferred for further evaluation.

The pt denied headache, loss of vision, blurred vision,
diplopia,
dysphagia, lightheadedness, vertigo, tinnitus or hearing
difficulty. Denied difficulties producing or comprehending
speech
despite clearly having difficulties with this during the exam.
Denied focal weakness. No bowel or bladder incontinence or
retention. Denied difficulty with gait.

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.  Denied nausea, vomiting, diarrhea, constipation
or
abdominal pain.  No recent change in bowel or bladder habits.
No
dysuria.  Denied arthralgias or myalgias. Denied rash.

Of note, he has never had any age appropriate cancer screening.


Past Medical History:
- appy (remote)
- borderline HTN


Social History:
-married, retired and worked for [**University/College **]
-remote tobacco > 15 yrs ago, rare EtOH, no drugs


Family History:
-Father w/ [**Name2 (NI) 499**] CA


Physical Exam:
Vitals: T:97  BP: 145/85   HR: 75    R 18      O2Sats 99%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: Alert, oriented x 3. Has difficulty relating
history secondary to intermittent paraphasic errors, such as
ballpoint pencil as well as some dysarthria. His speech
fluctuates from periods of fluency to periods with aphasia.
[**Location (un) **] is intact however repetition is somewhat impaired for
complex phrases. Comprehension appears intact. Naming is largely
intact with a few small errors as above. Normal prosody. Able to
follow both midline and appendicular commands. There was no
evidence of apraxia or neglect.


-Cranial Nerves: Olfaction not tested.  PERRL 4 to 3mm and
brisk.
VFF to confrontation.  There is no ptosis bilaterally.
Funduscopic exam revealed no papilledema, exudates, or
hemorrhages. EOMI without nystagmus.  Normal saccades. Facial
sensation intact to light touch. 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 pronator drift
bilaterally.
No adventitious movements noted. No asterixis noted.

  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, cold sensation, vibratory
sense or 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  1------->    0   0
R  1------->    0   0

Plantar response was flexor bilaterally.

-Gait: deferred due to patient request, awaiting opportunity to
use bathroom


Pertinent Results:
CT-Head without contrast [**2152-10-22**]
IMPRESSION: Large intraparenchymal hemorrhage in the left
temporal lobe in the region of the left sylvian fissure with
mild surrounding edema, but no significant mass effect or
midline shift. Given its location within the sylvian fissure, a
dedicated CTA or MRA examination is recommended to rule out
underlying vascular etiology such as aneurysm.

EEG: This is an abnormal portable EEG in the waking and drowsy
states due to persistent mixed theta and delta frequency focal
slowing
in the left anterior temporal region. There were no associated
epileptiform features. The findings suggest an area of
subcortical
dysfunction in that region.

MRI:
1) Recent intraparenchymal hemorrhage in the left temporal lobe
without evidence for an associated enhancing mass.
2) Numerous punctate susceptibility artifacts consistent with
prior tiny hemorrhages in the cerebral hemispheres. Most of
these are located peripherally. The appearance is overall highly
suggestive of amyloid.
3) Moderate to severe extent of T2-hyperintense areas in the
cerebral white matter and pons, most suggestive of chronic small
vessel ischemic disease.

Echo: EF > 55%
Mild symmetric left ventricular hypertrophy with preserved
global and regional biventricular systolic function. No definite
structural cardiac source of embolism identified.

[**2152-10-22**] 03:45PM BLOOD WBC-9.8 RBC-4.04* Hgb-14.1 Hct-40.3
MCV-100* MCH-35.0* MCHC-35.1* RDW-13.2 Plt Ct-267
[**2152-10-23**] 04:11AM BLOOD WBC-9.8 RBC-3.95* Hgb-14.0 Hct-40.2
MCV-102* MCH-35.5* MCHC-34.9 RDW-12.7 Plt Ct-293
[**2152-10-24**] 11:25AM BLOOD WBC-8.7 RBC-4.04* Hgb-14.3 Hct-39.6*
MCV-98 MCH-35.5* MCHC-36.2* RDW-13.3 Plt Ct-269
[**2152-10-22**] 03:45PM BLOOD PT-13.1 PTT-26.2 INR(PT)-1.1
[**2152-10-24**] 11:20AM BLOOD PT-12.9 PTT-23.9 INR(PT)-1.1
[**2152-10-24**] 11:25AM BLOOD PT-12.6 PTT-24.0 INR(PT)-1.1
[**2152-10-22**] 03:45PM BLOOD ESR-15
[**2152-10-22**] 03:45PM BLOOD Glucose-94 UreaN-14 Creat-1.0 Na-139
K-3.9 Cl-104 HCO3-25 AnGap-14
[**2152-10-24**] 09:15AM BLOOD Glucose-213* UreaN-10 Creat-1.1 Na-137
K-4.3 Cl-100 HCO3-25 AnGap-16
[**2152-10-24**] 11:25AM BLOOD Glucose-121* UreaN-11 Creat-1.1 Na-136
K-4.7 Cl-103 HCO3-25 AnGap-13
[**2152-10-22**] 03:45PM BLOOD CK-MB-3 cTropnT-<0.01
[**2152-10-22**] 10:27PM BLOOD CK-MB-4 cTropnT-<0.01
[**2152-10-23**] 04:11AM BLOOD CK-MB-4 cTropnT-<0.01

[**2152-10-23**] 04:11AM BLOOD Albumin-4.1 Calcium-9.0 Phos-2.6* Mg-2.4
Cholest-231*
[**2152-10-24**] 11:20AM BLOOD Calcium-9.6 Phos-2.9 Mg-2.6
[**2152-10-24**] 11:25AM BLOOD Calcium-9.3 Phos-2.6* Mg-2.5
[**2152-10-23**] 04:11AM BLOOD %HbA1c-5.5
[**2152-10-23**] 04:11AM BLOOD Triglyc-74 HDL-56 CHOL/HD-4.1
LDLcalc-160*
[**2152-10-23**] 04:11AM BLOOD TSH-1.1
[**2152-10-22**] 03:45PM BLOOD CRP-1.7
[**2152-10-23**] 04:11AM BLOOD Phenyto-8.3*

Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the Neurology Service for further
evaluation. He was monitored on tele and ruled out for an MI. He
was maintained normothermic and euglycemic. His Aspirin was held
and he was given pneumoboots for DVT prophylaxis.  His blood
pressure was controlled to systolic 120-160 and MAP <130. His
A1c and FLP were checked and she was noted to have an elevated
LDL, therefore he was started on Simvastatin 40.

He had an MR which showed multitude of punctate hemorrhages
suggestive of amyloid angiopathy. A CTA did not reveal an AVM.
He was started on Dilantin for seizure prophylaxis and EEG was
obtained that demonstrated focal slowing in the left anterior
temporal region but no epileptiform discharged.

He was discharged on dilantin for a total of 10 days and will
have outpatient neurology follow-up.

Medications on Admission:
ASA 325
MVI

Discharge Medications:
1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day) for 7 days.
Disp:*21 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Intracerebral hemorrhage
Amyloid


Discharge Condition:
Stable: no focal deficts, mild paraphasic errors


Discharge Instructions:
1. DO NOT TAKE ASPIRIN OR OTHER NSAIDS UNLESS INSTRUCTED BY YOUR
DOCTOR
2. Please call your doctor or come to the closed ED if you
develop new symptoms

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2152-12-19**] 11:00


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{'Unspecified intracranial hemorrhage,Other amyloidosis,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 and right sided numbness

PRESENT ILLNESS: The pt is a 71 year-old right-handed man with no significant
PMH who presented to as OSH with dysarthria and R arm tingling.
There is some discrepancy between the patients report and that
of
the records. Earlier today, he noted R arm tingling and then
developed dysarthria. Neither the patient nor his wife can give
an exact time course, however it does not appear that there was
a
clear [**Month (only) **] associated with the onset of his symptoms. Per the
OSH records, he also had R leg tingling, however he denied this.
They went to the OSH where his symptoms resolved. He had a CT
scan which showed a large L temporal chemerage with mild edema
but no shift. He was also noted to be hypertensive while there
with a SBP up to 190. He was therefore started on a Nipride drip
and transferred for further evaluation.

MEDICAL HISTORY: - appy (remote)
- borderline HTN

MEDICATION ON ADMISSION: ASA 325
MVI

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:97  BP: 145/85   HR: 75    R 18      O2Sats 99%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Skin: no rashes or lesions noted.

FAMILY HISTORY: -Father w/ [**Name2 (NI) 499**] CA

SOCIAL HISTORY: -married, retired and worked for [**University/College **]
-remote tobacco > 15 yrs ago, rare EtOH, no drugs 

### Response:
{'Unspecified intracranial hemorrhage,Other amyloidosis,Unspecified essential hypertension'}
