CHIEF COMPLAINT: aphasia, right-sided weakness

PRESENT ILLNESS: 73 year old woman with multiple medical problems
including ESRD (On HD qMWF), CAD, CHF, HIV (CD4 198), DM2,
Hyperlipidemia, and Hep C who presents to the ED this morning
with speech difficulty and right facial weakness.  The patient
herself is unable to provide a history at this time.  According
to family, the patient woke up this morning around 5:30AM.  She
was last seen well yesterday evening.  upon awakening this
morning, she apparently tried to call another relative to report
that something was wrong.  During that phone call, however, her
speech was unintelligible.  The family went to the house to
check
on her and found her ambulating with non fluent, nonsensical
speech.  She followed occasional commands, but appeared
"confused".  Her daughter noted a right facial droop.  EMS was
called and she was brought to the ED.  Neurology consult was
called at 8:30 AM and I was present at the bedside within at
8:35AM.

MEDICAL HISTORY: PMH:
1. ESRD on HD MWF
2. CAD -s/p MI [**6-6**] s/p stent [**2154**].
3. CHF-last echo [**2157-3-9**] EF 40%, depressed LVSF, global hypo,
moderate AR
4. Hx of pulmonary edema requiring intubation [**5-6**]
5. HIV on [**Month/Year (2) 2775**], most recent CD4 198, started on Bactrim [**3-9**]
6. DM2, diet controlled
7. HTN
8. Hyperlipidemia
9. Spinal TB
10.  Gout
11. Anemia
12. Hep C
13. ? hx of stroke in past.  Fell yrs ago and was told that she
suffered a "minor stroke".  Symptoms unknown.  No residual.

MEDICATION ON ADMISSION: ASA 325
Plavix 75
Sevelamer 800 TID
Lipitor 80
Zetia 10
Lamivudine 100 qd
Zidovudine 100 TID
Metoprolol SR 100 qd
Nevirapine 200mg [**Hospital1 **]
Captopril 50 [**Hospital1 **]
Vit B Cmplx
Bactrim DS TIW

ALLERGIES: Allopurinol / Ethambutol / Colchicine / Efavirenz

PHYSICAL EXAM: Right homonymous hemianopia
Fluent aphasia
Right-sided weakness

FAMILY HISTORY: She has a son with DM and CAD

SOCIAL HISTORY: Pt lives alone and gets around with a walker. She cooks for
herself. Her daughter comes over daily to help her take her
meds.  She denies tobacco, EtOH, IVDA, herbals/vitamins.  She
has 6 kids.
Human immunodeficiency virus [HIV] disease,Cerebral embolism with cerebral infarction,Unspecified viral hepatitis C without hepatic coma,Aortic valve disorders,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction
Human immuno virus dis,Crbl emblsm w infrct,Hpt C w/o hepat coma NOS,Aortic valve disorder,CHF NOS,Hyp kid NOS w cr kid V,End stage renal disease,Nephritis NOS,DMII wo cmp nt st uncntr,Gout NOS,Ocl crtd art wo infrct
Admission Date:  [**2157-4-2**]              Discharge Date:   [**2157-4-8**]

Date of Birth:  [**2083-8-18**]             Sex:   F

Service: NEUROLOGY

Allergies:
Allopurinol / Ethambutol / Colchicine / Efavirenz

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
aphasia, right-sided weakness

Major Surgical or Invasive Procedure:
None


History of Present Illness:
73 year old woman with multiple medical problems
including ESRD (On HD qMWF), CAD, CHF, HIV (CD4 198), DM2,
Hyperlipidemia, and Hep C who presents to the ED this morning
with speech difficulty and right facial weakness.  The patient
herself is unable to provide a history at this time.  According
to family, the patient woke up this morning around 5:30AM.  She
was last seen well yesterday evening.  upon awakening this
morning, she apparently tried to call another relative to report
that something was wrong.  During that phone call, however, her
speech was unintelligible.  The family went to the house to
check
on her and found her ambulating with non fluent, nonsensical
speech.  She followed occasional commands, but appeared
"confused".  Her daughter noted a right facial droop.  EMS was
called and she was brought to the ED.  Neurology consult was
called at 8:30 AM and I was present at the bedside within at
8:35AM.

According to the family, she has had occasional diarrhea over
the
last week.  Otherwise, she has been healthy.  She had her
regularly scheduled dialysis yesterday. She was recently
admitted
to the medicine service [**Date range (1) 12431**] for fever.  She was felt to
have
a viral infection, all cultures were negative.


Past Medical History:
PMH:
1. ESRD on HD MWF
2. CAD -s/p MI [**6-6**] s/p stent [**2154**].
3. CHF-last echo [**2157-3-9**] EF 40%, depressed LVSF, global hypo,
moderate AR
4. Hx of pulmonary edema requiring intubation [**5-6**]
5. HIV on [**Month/Year (2) 2775**], most recent CD4 198, started on Bactrim [**3-9**]
6. DM2, diet controlled
7. HTN
8. Hyperlipidemia
9. Spinal TB
10.  Gout
11. Anemia
12. Hep C
13. ? hx of stroke in past.  Fell yrs ago and was told that she
suffered a "minor stroke".  Symptoms unknown.  No residual.


Social History:
Pt lives alone and gets around with a walker. She cooks for
herself. Her daughter comes over daily to help her take her
meds.  She denies tobacco, EtOH, IVDA, herbals/vitamins.  She
has 6 kids.


Family History:
She has a son with DM and CAD

Physical Exam:
Right homonymous hemianopia
Fluent aphasia
Right-sided weakness


Pertinent Results:
[**2157-4-2**] 08:30AM BLOOD Triglyc-157* HDL-68 CHOL/HD-5.4
LDLcalc-266* LDLmeas-241*
[**2157-4-7**] 09:35AM BLOOD %HbA1c-5.7 [Hgb]-DONE [A1c]-DONE

Brief Hospital Course:
The patient was admitted to the neurology ICU given her
hypotension and position-dependent exam, with fluctuating
right-sided weakness. She stabilized her pressures on pressor
support for the first few days and was then transferred to the
floor on HD #3 off pressors. At this point, her global aphasia
had resolved to a fluent aphasia and her right side had
recovered its strength.

Her vascular risk factors include hyperlipidemia, for which she
will continue on lipitor and zetia. HbA1c was 5.7. TTE was
unremarkable for cardioembolic source. MRA neck showed no
stenoses.

The patient was started on aggrenox, as she had a drug-eluding
stent in [**2154-6-4**] and no history of angina. Cardiology agreed
with this plan and discontinuation of plavix.

She was followed by renal for hemodialysis and suffered no
complications.

She will be seen in stroke clinic for follow-up.

Her NG tube should be continued until she is fully able to eat
enough to meet her nutritional needs. On video swallow, she had
no esophageal difficulty but was slow to swallow. For this
reason, the NG tube was continued, even as her diet was advanced
to nectar/puree, until she is able to eat enough on her own.

Medications on Admission:
ASA 325
Plavix 75
Sevelamer 800 TID
Lipitor 80
Zetia 10
Lamivudine 100 qd
Zidovudine 100 TID
Metoprolol SR 100 qd
Nevirapine 200mg [**Hospital1 **]
Captopril 50 [**Hospital1 **]
Vit B Cmplx
Bactrim DS TIW


Discharge Medications:
1. Atorvastatin 80 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
2. Ezetimibe 10 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY (Daily).

3. Lamivudine 100 mg Tablet [**Hospital1 **]: One (1) Tablet PO DAILY
(Daily).
4. Zidovudine 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO TID (3
times a day).
5. Sevelamer 800 mg Tablet [**Hospital1 **]: One (1) Tablet PO TID (3 times a
day): Hold while patient not taking po.
6. B Complex-Vitamin C-Folic Acid 1 mg Capsule [**Hospital1 **]: One (1) Cap
PO DAILY (Daily).
7. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet [**Hospital1 **]: One (1)
Tablet PO TIW () as needed.
8. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
Injection TID (3 times a day).
9. Insulin Regular Human 100 unit/mL Solution [**Hospital1 **]: One (1)
Injection ASDIR (AS DIRECTED): sliding scale.
10. Nevirapine 200 mg Tablet [**Hospital1 **]: One (1) Tablet PO BID (2 times
a day).
11. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
12. Dipyridamole-Aspirin 200-25 mg Cap, Multiphasic Release 12
hr [**Last Name (STitle) **]: One (1) Cap PO BID (2 times a day).
13. Heparin Lock Flush (Porcine) 100 unit/mL Syringe [**Last Name (STitle) **]: as
below ML Intravenous DAILY (Daily) as needed: 10ml NS followed
by 1ml of 100 units/ml heparin (100 units heparin) each lumen QD
and PRN. Inspect site every shift .
14. Aluminum Hydroxide Gel 320 mg/5 mL Suspension [**Last Name (STitle) **]: Ten (10)
cc PO three times a day as needed for for serum phosphate >6.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Left middle cerebral artery infarct


Discharge Condition:
Fluent aphasia. Mild right-sided weakness. Right facial droop.
Right homonymous hemianopia.


Discharge Instructions:
You were admitted to the neurology service after suffering a
left middle cerebral artery stroke, which has affected your
language and made your right side weak. Your speech should
improve over the course of the next 6 months and your strength
has already begun to improve. Your plavix was discontinued and
you were started on aggrenox; should you experience headache
with this medication, it should be taken with tylenol for a
couple of weeks as your body adjusts to it. You should also
continue to take lipitor and zetia for your high cholesterol.
Please keep all appointments and take your medications as
prescribed.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10134**], MD Phone:[**Telephone/Fax (1) 7976**]
Date/Time:[**2157-5-3**] 12:15

Provider: [**Name10 (NameIs) 4267**] [**Last Name (NamePattern4) 4268**], MD, PHD[**MD Number(3) 708**]:[**Telephone/Fax (1) 657**]
Date/Time:[**2157-6-8**] 1:00


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

Completed by:[**2157-4-8**]
{'Human immunodeficiency virus [HIV] disease,Cerebral embolism with cerebral infarction,Unspecified viral hepatitis C without hepatic coma,Aortic valve disorders,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}


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: aphasia, right-sided weakness

PRESENT ILLNESS: 73 year old woman with multiple medical problems
including ESRD (On HD qMWF), CAD, CHF, HIV (CD4 198), DM2,
Hyperlipidemia, and Hep C who presents to the ED this morning
with speech difficulty and right facial weakness.  The patient
herself is unable to provide a history at this time.  According
to family, the patient woke up this morning around 5:30AM.  She
was last seen well yesterday evening.  upon awakening this
morning, she apparently tried to call another relative to report
that something was wrong.  During that phone call, however, her
speech was unintelligible.  The family went to the house to
check
on her and found her ambulating with non fluent, nonsensical
speech.  She followed occasional commands, but appeared
"confused".  Her daughter noted a right facial droop.  EMS was
called and she was brought to the ED.  Neurology consult was
called at 8:30 AM and I was present at the bedside within at
8:35AM.

MEDICAL HISTORY: PMH:
1. ESRD on HD MWF
2. CAD -s/p MI [**6-6**] s/p stent [**2154**].
3. CHF-last echo [**2157-3-9**] EF 40%, depressed LVSF, global hypo,
moderate AR
4. Hx of pulmonary edema requiring intubation [**5-6**]
5. HIV on [**Month/Year (2) 2775**], most recent CD4 198, started on Bactrim [**3-9**]
6. DM2, diet controlled
7. HTN
8. Hyperlipidemia
9. Spinal TB
10.  Gout
11. Anemia
12. Hep C
13. ? hx of stroke in past.  Fell yrs ago and was told that she
suffered a "minor stroke".  Symptoms unknown.  No residual.

MEDICATION ON ADMISSION: ASA 325
Plavix 75
Sevelamer 800 TID
Lipitor 80
Zetia 10
Lamivudine 100 qd
Zidovudine 100 TID
Metoprolol SR 100 qd
Nevirapine 200mg [**Hospital1 **]
Captopril 50 [**Hospital1 **]
Vit B Cmplx
Bactrim DS TIW

ALLERGIES: Allopurinol / Ethambutol / Colchicine / Efavirenz

PHYSICAL EXAM: Right homonymous hemianopia
Fluent aphasia
Right-sided weakness

FAMILY HISTORY: She has a son with DM and CAD

SOCIAL HISTORY: Pt lives alone and gets around with a walker. She cooks for
herself. Her daughter comes over daily to help her take her
meds.  She denies tobacco, EtOH, IVDA, herbals/vitamins.  She
has 6 kids. 

### Response:
{'Human immunodeficiency virus [HIV] disease,Cerebral embolism with cerebral infarction,Unspecified viral hepatitis C without hepatic coma,Aortic valve disorders,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Nephritis and nephropathy, not specified as acute or chronic, with unspecified pathological lesion in kidney,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Gout, unspecified,Occlusion and stenosis of carotid artery without mention of cerebral infarction'}
