CHIEF COMPLAINT: CC:[**CC Contact Info 18245**]

PRESENT ILLNESS: 79 year old right-handed woman (currently using left hand-only
because of R hemiparesis due to MS), with secondary progressive
MS (R hemiparesis from MS for 25 years), DM who presented with L
visual field cut, dysarthria at 10:30am,
followed by L neglect, L hemiparesis s/p IV tPA at 12:25pm at
OSH; transferred to [**Hospital1 18**]; family opted for trial of IA tPA.
   Patient reports that at 10:30am she was [**Location (un) 1131**] and she
noticed that there was a white are in her visual field ("I
thought it was on the right eye"); she was also dysarthric. Her
husband called EMS. The husband did not notice any new weakness
at that time (baseline pt has R hemiparesis from MS for 25
years; she walks with a walker for limited distance; she uses
wheelchair when she leaves the house). At OSH she was noticed to
have a L hemiparesis as well and a L sided neglect at 11am. Her
vitals were: T 97.3 BP 151/85  HR 63. She had a CT head which
showed no ICH. [**Last Name (un) **] 27. She had no contraindications of tPA and
IV tPA bolus was given at 12:15pm and the infusion was completed
at 13:29pm. She was then transferred here. Her exam was
unchanged  with L hemiparesis
(besides baseline R hemiparesis), R gaze deviation, L neglect
and L visual field cut. [**Last Name (un) 18246**] 27. A CTA head and neck showed an
extensive R MCA territory stroke and occlusion of R carotid
artery. After discussion with family of risks and benefits of
further procedures, family opted for IA tPA.

MEDICAL HISTORY: -DM
-secondary progressive MS (R hemiparesis from MS for 25 years).
She was diagnosed in her 40's. She has been off treatment for
decades.

MEDICATION ON ADMISSION: -metformin 1000mg
-glipizide 2 tabs [**Hospital1 **]
-lantus
-medroxyprogesterone 5-10mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T-98 BP-182/58 HR-62 RR-16 100O2Sat
Gen: Lying in bed, [**Name (NI) 18247**]
[**Name (NI) 4459**]: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Her father died of [**Name (NI) 2481**] diseas and he mother had a
heart attack

SOCIAL HISTORY: pt lives with her husband, she uses a walker at home and
wheelcheer to leave home, she quit smoking 40 years ago
Occlusion and stenosis of carotid artery with cerebral infarction,Cerebral edema,Diplegia of upper limbs,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Encounter for palliative care,Multiple sclerosis,Unspecified essential hypertension,Personal history of tobacco use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysarthria,Long-term (current) use of insulin
Ocl crtd art w infrct,Cerebral edema,Diplegia of upper limbs,TPA adm status 24 hr pta,Encountr palliative care,Multiple sclerosis,Hypertension NOS,History of tobacco use,DMII wo cmp nt st uncntr,Dysarthria,Long-term use of insulin
Admission Date:  [**2193-5-10**]              Discharge Date:   [**2193-5-11**]

Date of Birth:  [**2113-9-9**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
CC:[**CC Contact Info 18245**]

Major Surgical or Invasive Procedure:
IV TPA, IA TPA, [**Hospital1 **] and Penumbra capture devices, all
unsuccessful

History of Present Illness:
79 year old right-handed woman (currently using left hand-only
because of R hemiparesis due to MS), with secondary progressive
MS (R hemiparesis from MS for 25 years), DM who presented with L
visual field cut, dysarthria at 10:30am,
followed by L neglect, L hemiparesis s/p IV tPA at 12:25pm at
OSH; transferred to [**Hospital1 18**]; family opted for trial of IA tPA.
   Patient reports that at 10:30am she was [**Location (un) 1131**] and she
noticed that there was a white are in her visual field ("I
thought it was on the right eye"); she was also dysarthric. Her
husband called EMS. The husband did not notice any new weakness
at that time (baseline pt has R hemiparesis from MS for 25
years; she walks with a walker for limited distance; she uses
wheelchair when she leaves the house). At OSH she was noticed to
have a L hemiparesis as well and a L sided neglect at 11am. Her
vitals were: T 97.3 BP 151/85  HR 63. She had a CT head which
showed no ICH. [**Last Name (un) **] 27. She had no contraindications of tPA and
IV tPA bolus was given at 12:15pm and the infusion was completed
at 13:29pm. She was then transferred here. Her exam was
unchanged  with L hemiparesis
(besides baseline R hemiparesis), R gaze deviation, L neglect
and L visual field cut. [**Last Name (un) 18246**] 27. A CTA head and neck showed an
extensive R MCA territory stroke and occlusion of R carotid
artery. After discussion with family of risks and benefits of
further procedures, family opted for IA tPA.

ROS:
The patient denied hearing changes, difficulty speaking,
language problems, memory difficulty, , vertigo, unsteady gait,
paresthesias.

The patient denied fever, wt loss, appetite changes, cp,
palpitations, DOE, sob, cough, wheeze, nausea, vomiting,
diarrhea, constipation, abd pain, fecal incont, dysuria,
nocturia, urinary incontinence, muscle or joint pain, hot/cold
intolerance, polyuria, polydipsia, easy bruising, depression,
anxiety, stress, or psychotic sx.


Past Medical History:
-DM
-secondary progressive MS (R hemiparesis from MS for 25 years).
She was diagnosed in her 40's. She has been off treatment for
decades.

Social History:
pt lives with her husband, she uses a walker at home and
wheelcheer to leave home, she quit smoking 40 years ago

Family History:
Her father died of [**Name (NI) 2481**] diseas and he mother had a
heart attack


Physical Exam:
T-98 BP-182/58 HR-62 RR-16 100O2Sat
Gen: Lying in bed, [**Name (NI) 18247**]
[**Name (NI) 4459**]: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: [**Name (NI) 18247**], [**Name2 (NI) 18248**] to voice, R gaze preference,
L sided neglect, dysarthric, she could say [**Doctor Last Name 1841**] backwards, she is
fluent and her comprehension is intact, normal naming.

Cranial Nerves:
Pupils equally round and reactive to light, 4 to 2mm
bilaterally. L visual field cut. R gaze preference; she can
cross midline to the left side.  Sensation intact V1-V3.  L
Facial weakness.  Palate elevation symmetrical.
Sternocleidomastoid and trapezius normal bilaterally. Tongue
midline, movements intact

Motor: Spasticity of R arm and R leg. Patient had no movement on
any
extremity, even against gravity.

Sensation: Patient reports that she could feel pinprick and
temperature BL and symmetrically

Reflexes: B T Br Pa Pl
Right     0 0 0  0  0
Left      0 0 0  0  0

Toes were UPgoing bilaterally.

Coordination: unable to perform

Gait: unable to perform

Romberg: Negative

Pertinent Results:
Labs:
Trop-T: <0.01
Comments: cTropnT: Ctropnt > 0.10 Ng/Ml Suggests Acute Mi

137  103  21  170   AGap=12
------------<
4.9  27  0.7
Comments: Glucose: If Fasting, 70-100 Normal, >125 Provisional
Diabetes

estGFR: >75 (click for details)
Ca: 10.0 Mg: 1.6 P: 4.8

WBC14.5  Hb12.4  plat198 Ht39.0
 N:80.1 L:14.0 M:4.0 E:1.4 Bas:0.4

PT: 13.6  PTT: 28.6  INR: 1.2


Imaging: A CTA head and neck showed an extensive R MCA territory
stroke and occlusion of R carotid artery

Brief Hospital Course:
ADMISSION ASSESSMENT/PLAN:
A/P: 79 year old right-handed woman (currently using left
hand-only because of R paralysis due to MS), with secondary
progressive MS (R hemiparesis from MS for 25 years), DM who
presented with L visual field cut, dysarthria at 10:30am,
followed by L neglect, L hemiparesis; s/p IV tPA at 12:25pm at
OSH; transferred to [**Hospital1 18**] where she was found to have a L
neglect, R gaze preference (she can cross midline on L gaze)
dysarthria, L facial weakness, L visual field cut, and L
hemiparesis besides baseline R hemiparesis from MS. [**Last Name (Titles) 18246**] 27. A
CTA head and neck showed an extensive R MCA territory stroke and
occlusion of R carotid artery. After discussion with family of
further procedures, family opted for IA tPA.

HOSPITAL COURSE:
NEURO: The patient was transferred to the angiogram suite with
the IR team where she underwent IA TPA.  She was admitted to the
neurology ICU under Attending Physician [**Name9 (PRE) 18249**] [**Name9 (PRE) **].
Follow-up head CT the next morning revealed extensive edema nad
midline shift with possible contrast extravasation versus
hemorrhagic conversion.  In conversation with the family, they
brought the [**Hospital 228**] health care proxy documentation to the
attention of the medical team who requested that the patient be
made comfort measures only given her poor prognosis.  She was
therefore transferred to the floor on a morphine drip and
expired at 21:16.

In accordance with the patient's wishes, the MS tissue bank was
[**Hospital 653**] prior to her death regarding brain donation.
Unfortunately given funding constraints donation was no longer
possible out-of-state.  Alternative tissue banks in [**State 4565**],
[**State 18250**], [**State 12000**], and [**State 350**] were [**Name (NI) 653**], however
given her medical issues of stroke and multiple sclerosis her
brain was not appropriate for donation.  Therefore, in
accordance with her healthcare proxy documentation, her brain
was designated to undergo autopsy for donation to research and
education purposes at the request of her family.  Pathology was
[**Name (NI) 653**].

Medications on Admission:
-metformin 1000mg
-glipizide 2 tabs [**Hospital1 **]
-lantus
-medroxyprogesterone 5-10mg


Discharge Medications:
None.

Discharge Disposition:
Expired

Discharge Diagnosis:
Stroke

Discharge Condition:
Expired

Discharge Instructions:
Not applicable.

Followup Instructions:
Not applicable.

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

Completed by:[**2193-5-12**]
{'Occlusion and stenosis of carotid artery with cerebral infarction,Cerebral edema,Diplegia of upper limbs,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Encounter for palliative care,Multiple sclerosis,Unspecified essential hypertension,Personal history of tobacco use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysarthria,Long-term (current) use of insulin'}


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: CC:[**CC Contact Info 18245**]

PRESENT ILLNESS: 79 year old right-handed woman (currently using left hand-only
because of R hemiparesis due to MS), with secondary progressive
MS (R hemiparesis from MS for 25 years), DM who presented with L
visual field cut, dysarthria at 10:30am,
followed by L neglect, L hemiparesis s/p IV tPA at 12:25pm at
OSH; transferred to [**Hospital1 18**]; family opted for trial of IA tPA.
   Patient reports that at 10:30am she was [**Location (un) 1131**] and she
noticed that there was a white are in her visual field ("I
thought it was on the right eye"); she was also dysarthric. Her
husband called EMS. The husband did not notice any new weakness
at that time (baseline pt has R hemiparesis from MS for 25
years; she walks with a walker for limited distance; she uses
wheelchair when she leaves the house). At OSH she was noticed to
have a L hemiparesis as well and a L sided neglect at 11am. Her
vitals were: T 97.3 BP 151/85  HR 63. She had a CT head which
showed no ICH. [**Last Name (un) **] 27. She had no contraindications of tPA and
IV tPA bolus was given at 12:15pm and the infusion was completed
at 13:29pm. She was then transferred here. Her exam was
unchanged  with L hemiparesis
(besides baseline R hemiparesis), R gaze deviation, L neglect
and L visual field cut. [**Last Name (un) 18246**] 27. A CTA head and neck showed an
extensive R MCA territory stroke and occlusion of R carotid
artery. After discussion with family of risks and benefits of
further procedures, family opted for IA tPA.

MEDICAL HISTORY: -DM
-secondary progressive MS (R hemiparesis from MS for 25 years).
She was diagnosed in her 40's. She has been off treatment for
decades.

MEDICATION ON ADMISSION: -metformin 1000mg
-glipizide 2 tabs [**Hospital1 **]
-lantus
-medroxyprogesterone 5-10mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T-98 BP-182/58 HR-62 RR-16 100O2Sat
Gen: Lying in bed, [**Name (NI) 18247**]
[**Name (NI) 4459**]: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Her father died of [**Name (NI) 2481**] diseas and he mother had a
heart attack

SOCIAL HISTORY: pt lives with her husband, she uses a walker at home and
wheelcheer to leave home, she quit smoking 40 years ago 

### Response:
{'Occlusion and stenosis of carotid artery with cerebral infarction,Cerebral edema,Diplegia of upper limbs,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Encounter for palliative care,Multiple sclerosis,Unspecified essential hypertension,Personal history of tobacco use,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Dysarthria,Long-term (current) use of insulin'}
