CHIEF COMPLAINT: Left sided weakness

PRESENT ILLNESS: This 83 y/o woman with recent diagnosis of lung cancer after
dyspnea/hemoptysis 2wk ago in setting of LE DVT and recurrent
contralateral DVT w/ PE in spite of warfarin presents with left
sided weakness.

MEDICAL HISTORY: recent LLL PNA; NSC Lung CA in left lower lobe; b/l LE DVT;
PE s/p IVC filter; HTN; lipids; RA; depression; GERD

MEDICATION ON ADMISSION: -Lovenox
-Acetaminophen 325-650mg q6h prn pain, fever
-Atenolol 25mg qd
-Fluoxetine
-Folic acid 1mg qd
-HCTZ 25mg qd
-Lisinopril 10mg qd
-Methotrexate 12.5mg qMon
-Timolol 0.5% 1 drop OU [**Hospital1 **]

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Temp: 97.6; BP:  145/75; HR: 70; RR: 20; SaO2: 100%
Gen: Somnolent but rousable w/ voice. Sclerae anicteric. MMM.
No meningismus.
No carotid bruits auscultated.
Diminshed breath sounds on left.
Heart regular in rate.
Abd soft, nontender, nondistended.  Bowel sounds heard
throughout.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with daughter long term.  No alcohol or drug use.  Smoked
up to at least 1 ppd but tapered off over the years and none for
the last month.
Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Hemiplegia, unspecified, affecting unspecified side,Thrombophlebitis migrans,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Personal history of venous thrombosis and embolism,Other and unspecified hyperlipidemia,Rheumatoid arthritis,Personal history of tobacco use
Crbl art ocl NOS w infrc,Pneumonia, organism NOS,Mal neo lower lobe lung,Unsp hemiplga unspf side,Thrombophlebitis migrans,Crnry athrscl natve vssl,Chr airway obstruct NEC,Hypertension NOS,Esophageal reflux,Hx-ven thrombosis/embols,Hyperlipidemia NEC/NOS,Rheumatoid arthritis,History of tobacco use
Admission Date:  [**2168-6-12**]              Discharge Date:   [**2168-6-15**]

Date of Birth:  [**2084-12-4**]             Sex:   F

Service: NEUROLOGY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Left sided weakness

Major Surgical or Invasive Procedure:
None

History of Present Illness:
This 83 y/o woman with recent diagnosis of lung cancer after
dyspnea/hemoptysis 2wk ago in setting of LE DVT and recurrent
contralateral DVT w/ PE in spite of warfarin presents with left
sided weakness.

As per the patient's daughter with whom the patient lives (and
who provided English/[**First Name3 (LF) 595**] translation) the patient was in
USOH [**6-11**].  At midnight, her daughter came in her bedroom to
check on her and found her dosing and leaning to the left.  This
seemed unusual to her so she woke her mother and checked both
her grip strength which was equal.  Her mother only indicated
that she
felt tired and thus retired to bed.  At 0430h, her daughter had
awoken so again went to check on her mother, this time finding
her awake but collapsed on the floor with left sided weakness.
She called EMS whence the patient was brought to [**Hospital1 18**].

In the ER, FSBS 133, SBP 140s.  Over the initial 45 minutes of
evaluation, her left sided weakness progressed from significant
drift to hemiplegia.  Her gaze progressed from mild to forced
right gaze deviation and her speech progressed from mild to
unintelligible dysarthria.  She was nonetheless hemodynamically
stable and able to protect her airway.


Past Medical History:
recent LLL PNA; NSC Lung CA in left lower lobe; b/l LE DVT;
PE s/p IVC filter; HTN; lipids; RA; depression; GERD


Social History:
Lives with daughter long term.  No alcohol or drug use.  Smoked
up to at least 1 ppd but tapered off over the years and none for
the last month.


Family History:
Non-contributory

Physical Exam:
Temp: 97.6; BP:  145/75; HR: 70; RR: 20; SaO2: 100%
Gen: Somnolent but rousable w/ voice. Sclerae anicteric. MMM.
No meningismus.
No carotid bruits auscultated.
Diminshed breath sounds on left.
Heart regular in rate.
Abd soft, nontender, nondistended.  Bowel sounds heard
throughout.

Neuro:

>>MS??????Somnolent but rousable to voice.  Speech (w/ daughter
translating from English to [**Name (NI) 595**]) hypophonic and severely
labially/lingually dysarthric but fluent.  Able to follow
commands on right side.  Does not read or name.

>>CN??????Fundi w/ sharp discs. PERRL. VFIC.   Forced right gaze
deviation but able to get slightly to left of midline
volitionally. Moderate left facial weakness. Palate elevates
midline.  Tongue protrudes midline.

>>Motor??????Right UE/LE power intact.  Left UE 0/5 proximally and
distally with low tone.  Left LE 0/5 proximally and [**3-17**] distally
with normal tone.

>>Sensory??????Grimaces to nox stim applied throughout albeit less
robustly on left.

>>DTRs??????L/R: bic [**3-14**], br [**2-11**], tri 0/1; pat [**2-11**], Ach 0/0. Left
plantar extensor.

>>Coord/Gait??????No dysmetria on right.



1a LOC =1

1b Orientation =0

1c Commands =0

2 Gaze =2

3 Visual Fields =0

4 Facial Paresis =2

5a Motor Function R UE =0

5b Motor Function L UE=4

6a Motor Function R LE=0

6b Motor Function L LE=4

7 Limb Ataxia =0

8 Sensory perception =1

9 Language =0

10 Dysarthria = 2

11 Extinction/Inattention =2

                    TOTAL = 18


Pertinent Results:
[**Known lastname 33232**],[**Known firstname **] [**Medical Record Number 33233**] F  83  [**2084-12-4**]

Radiology Report CTA HEAD W&W/O C & RECONS Study Date of
[**2168-6-12**] 5:38 AM

PRELIMINARY REPORT: Provided by Dr. [**First Name (STitle) 805**], who indicated
"cutoff" in right middle cerebral artery (M1 segment); increased
mean transit time, decreased flow, equal volume compatible with
penumbra. Discussed with Dr. [**First Name (STitle) **] at 7:05 a.m.

FINDINGS: I concur with Dr. [**Last Name (STitle) 18991**] observations. There is
obstruction of the right middle cerebral artery M1 segment
shortly after its origin. The discrepancy between blood volume
and mean transit times raises the question of an ischemic
penumbra. There was no sign for the presence of an intracranial
hemorrhage. Corresponding to the area of early ischemia is the
presence of a right-sided insular ribbon sign on the
conventional head CT images.

There is re-demonstration of the prominent left-sided cavernous
carotid and supraclinoid aneurysm, which has substantial
calcific components.

With regard to the angiography of the neck, neither common
carotid bifurcation exhibits hemodynamically significant
stenosis, although there was a markedly tortuous proximal right
internal carotid artery demonstrated. The vertebral arteries
appear to be non-stenotic.

CONCLUSION: Findings consistent with large area of prolonged
mean transit
time, but with a blood volume "mismatch" within virtually the
entire right middle cerebral artery territory. Obstruction of
the right middle cerebral artery at its M1 segment.


Radiology Report CHEST (PORTABLE AP) Study Date of [**2168-6-13**]
10:06 AM
Provisional Findings Impression: EAGg MON [**2168-6-13**] 12:46 PM
Complete left lung collapse, leftward mediastinal shift and
obliteration of the left bronchial lumen.

[**2168-6-12**] 01:11PM   GLUCOSE-111* UREA N-15 CREAT-0.7 SODIUM-136
POTASSIUM-3.0* CHLORIDE-98 TOTAL CO2-28 ANION GAP-13
[**2168-6-12**] 01:11PM   CALCIUM-9.0 PHOSPHATE-3.0 MAGNESIUM-1.8
[**2168-6-12**] 06:26AM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2168-6-12**] 06:26AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2168-6-12**] 05:37AM   GLUCOSE-136* UREA N-18 CREAT-0.9 SODIUM-136
POTASSIUM-3.3 CHLORIDE-98 TOTAL CO2-26 ANION GAP-15
[**2168-6-12**] 05:37AM   ALT(SGPT)-12 AST(SGOT)-18 CK(CPK)-23* ALK
PHOS-113 TOT BILI-0.4
[**2168-6-12**] 05:37AM   TRIGLYCER-99 HDL CHOL-45 CHOL/HDL-3.1
LDL(CALC)-73
[**2168-6-12**] 05:37AM   ALBUMIN-3.2* CHOLEST-138
[**2168-6-12**] 05:37AM   WBC-17.1* RBC-3.90* HGB-10.3* HCT-31.2*
MCV-80* MCH-26.5* MCHC-33.1 RDW-16.8*
[**2168-6-12**] 05:37AM   NEUTS-92.3* LYMPHS-4.3* MONOS-2.8 EOS-0.5
BASOS-0.1
[**2168-6-12**] 05:37AM   PT-12.9 PTT-28.8 INR(PT)-1.1

Brief Hospital Course:
83y [**Year/Month/Day 595**] speaking woman with a new diagnosis lung cancer,
HTN, HL, long h/o smoking, bilateral DVTs and recent PE while on
Coumadin, now on therapeutic Lovenox and s/p IVC filter p/w
right MCA occlusion and stroke.  Etiology most likely her
diffuse hypercoagulability related to her lung cancer.  She is
not a candidate for tPA as she currently on therapeutic Lovenox,
had recent hemoptysis due to lung cancer.  She is not a
candidate for MERCI clot retrieval because there is decreased
flow to the right anterior temporal lobe seen on perfusion
imaging.  Her diffuse
hypercoagulability with both Coumadin and more recently, Lovenox
represents a Trousseau-like syndrome. She was started on a
heparin drip with her goal PTTs between 50-70.

In rounds with Dr [**Last Name (STitle) **] on [**2168-6-13**], there was a discussion with
the patient's grand-daughter ([**Name (NI) **] [**Name (NI) 28334**]) regarding prognosis.
Dr [**Last Name (STitle) **] explained that the prognosis was very poor due to her
multiple medical co morbidities. Dr [**Last Name (STitle) 28334**] mentioned that she
wanted to have a discussion with her family. Dr [**Last Name (STitle) 28334**]
mentioned that the DNI would be addressed once her family had
convened. Later that afternoon, they discussed palliative care
options with [**First Name8 (NamePattern2) 2270**] [**Last Name (NamePattern1) 33234**].

On [**2168-6-15**] a morphine drip was started for comfort, and the
patient expired at 20:25h.


Medications on Admission:
-Lovenox
-Acetaminophen 325-650mg q6h prn pain, fever
-Atenolol 25mg qd
-Fluoxetine
-Folic acid 1mg qd
-HCTZ 25mg qd
-Lisinopril 10mg qd
-Methotrexate 12.5mg qMon
-Timolol 0.5% 1 drop OU [**Hospital1 **]


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Respiratory arrest
Right middle cerebral artery stroke
Lung cancer


Discharge Condition:
expired


Discharge Instructions:
None

Followup Instructions:
not applicable


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

Completed by:[**2168-6-15**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Hemiplegia, unspecified, affecting unspecified side,Thrombophlebitis migrans,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Personal history of venous thrombosis and embolism,Other and unspecified hyperlipidemia,Rheumatoid arthritis,Personal history of tobacco use'}


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: Left sided weakness

PRESENT ILLNESS: This 83 y/o woman with recent diagnosis of lung cancer after
dyspnea/hemoptysis 2wk ago in setting of LE DVT and recurrent
contralateral DVT w/ PE in spite of warfarin presents with left
sided weakness.

MEDICAL HISTORY: recent LLL PNA; NSC Lung CA in left lower lobe; b/l LE DVT;
PE s/p IVC filter; HTN; lipids; RA; depression; GERD

MEDICATION ON ADMISSION: -Lovenox
-Acetaminophen 325-650mg q6h prn pain, fever
-Atenolol 25mg qd
-Fluoxetine
-Folic acid 1mg qd
-HCTZ 25mg qd
-Lisinopril 10mg qd
-Methotrexate 12.5mg qMon
-Timolol 0.5% 1 drop OU [**Hospital1 **]

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: Temp: 97.6; BP:  145/75; HR: 70; RR: 20; SaO2: 100%
Gen: Somnolent but rousable w/ voice. Sclerae anicteric. MMM.
No meningismus.
No carotid bruits auscultated.
Diminshed breath sounds on left.
Heart regular in rate.
Abd soft, nontender, nondistended.  Bowel sounds heard
throughout.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives with daughter long term.  No alcohol or drug use.  Smoked
up to at least 1 ppd but tapered off over the years and none for
the last month. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Malignant neoplasm of lower lobe, bronchus or lung,Hemiplegia, unspecified, affecting unspecified side,Thrombophlebitis migrans,Coronary atherosclerosis of native coronary artery,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Personal history of venous thrombosis and embolism,Other and unspecified hyperlipidemia,Rheumatoid arthritis,Personal history of tobacco use'}
