CHIEF COMPLAINT: left sidedweakness, confusion

PRESENT ILLNESS: HPI:89 yo RHF with ho of uncontrolled HTN and severe peripheral
neuropathy who presents with confusion, dysarthia and left
face/arm weakness and CT findings showing right thalamic
hemorrhage with ventricular extension. Patient was in her usual
state of health until appx 7:30 pm last night when she was noted
to be calling a well known dinner guest by her daughter's name.
The patient persistently made this error and it was later noted
she was clumsy with the left hand. She required more assistance
with transfers from her wheelchair later in the evening and then
left arm noted to have weakness. She was taken to OSH where VSS
showed SBP 200-230s. She had CT head which showed 2.6 cm
hemorrhage in right thalmus with intraventricular hemorrhage, no
hydrocephalus. The patient was transferred to [**Hospital1 18**] for further
care.

MEDICAL HISTORY: PMHx:
-HTN-uncontrolled for at least 5 years
-idiopathic peripheral neuropathy-wheelchair bound
-hyponatremia/hypokalemia
-h/o left breast cancer dx [**2177**] (s/p lumpectomy and XRT)
-Lumbar fractures after MVC at age 40 y
-Pelvic fracture after fall in [**2180**]
-h/o of seizures while in 40s thought to be secondary to benzene
exposure
-cataract surgery bilat

MEDICATION ON ADMISSION: Medications prior to admission:
1.demeclocycline 300mg [**Hospital1 **]
2. hydralazine 25 qam/ 50mg qpm;
3. sertraline 25mg qam
4. synthroid 175mcg qam
5. toprol XL 50mg qam
6. PRNs: colace #1 tid; tylenol 325mg tid.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: AF BP:107-157/39-69    HR: 60-66   R [**12-18**]    O2Sats
96-100% 2L
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: irreg, reactive to light 4 mm-> 3mm
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.Murmur present
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect, talkative.
Orientation: Oriented to person and date.
Recall: [**1-7**] objects at 5 minutes.
Language: Speech dysarthic with good comprehension and
repetition.
Naming intact [**2-7**] lo freqhency objects.
Cranial Nerves:
I: Not tested
II: Pupils equally irreg and reactive to light, 4 to 3
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: left facial droop
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

FAMILY HISTORY: Family Hx:Mother died of stroke at age 70y, no bleeding
dyscrasias in family. 2 younger sisters with peripheral
neuropathy

SOCIAL HISTORY: Social Hx: lives with daughter; nonsmoker/nondrinker.
Intracerebral hemorrhage,Malignant essential hypertension,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Personal history of malignant neoplasm of breast,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified
Intracerebral hemorrhage,Malignant hypertension,Urin tract infection NOS,Hyposmolality,Hx of breast malignancy,Idio periph neurpthy NOS,Anemia NOS
Admission Date:  [**2195-5-17**]              Discharge Date:   [**2195-5-24**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
left sidedweakness, confusion

Major Surgical or Invasive Procedure:
none

History of Present Illness:
HPI:89 yo RHF with ho of uncontrolled HTN and severe peripheral
neuropathy who presents with confusion, dysarthia and left
face/arm weakness and CT findings showing right thalamic
hemorrhage with ventricular extension. Patient was in her usual
state of health until appx 7:30 pm last night when she was noted
to be calling a well known dinner guest by her daughter's name.
The patient persistently made this error and it was later noted
she was clumsy with the left hand. She required more assistance
with transfers from her wheelchair later in the evening and then
left arm noted to have weakness. She was taken to OSH where VSS
showed SBP 200-230s. She had CT head which showed 2.6 cm
hemorrhage in right thalmus with intraventricular hemorrhage, no
hydrocephalus. The patient was transferred to [**Hospital1 18**] for further
care.


Past Medical History:
PMHx:
-HTN-uncontrolled for at least 5 years
-idiopathic peripheral neuropathy-wheelchair bound
-hyponatremia/hypokalemia
-h/o left breast cancer dx [**2177**] (s/p lumpectomy and XRT)
-Lumbar fractures after MVC at age 40 y
-Pelvic fracture after fall in [**2180**]
-h/o of seizures while in 40s thought to be secondary to benzene
exposure
-cataract surgery bilat


Social History:
Social Hx: lives with daughter; nonsmoker/nondrinker.


Family History:
Family Hx:Mother died of stroke at age 70y, no bleeding
dyscrasias in family. 2 younger sisters with peripheral
neuropathy


Physical Exam:
PHYSICAL EXAM:
O: T: AF BP:107-157/39-69    HR: 60-66   R [**12-18**]    O2Sats
96-100% 2L
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: irreg, reactive to light 4 mm-> 3mm
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.Murmur present
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect, talkative.
Orientation: Oriented to person and date.
Recall: [**1-7**] objects at 5 minutes.
Language: Speech dysarthic with good comprehension and
repetition.
Naming intact [**2-7**] lo freqhency objects.
Cranial Nerves:
I: Not tested
II: Pupils equally irreg and reactive to light, 4 to 3
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: left facial droop
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors.
    D  B   T   WE WF FF  FE

R   5  5   5   5   5  5   5
L   4  5   4   4-  5- 4+  3+

    IP  Q  H   DF  PF  [**Last Name (un) 938**]
R   5-  5- 5-   5    5   5
L   5-  5- 5-   5-    5   5

Sensation: Intact to light touch. Decreased vibration in toes
bilat.
Reflexes: B T Br Pa Ac
Right     1 1  1  1  0
Left      1 1  1  1  0

Toes upgoing bilaterally.

Coordination: slightly dysmetric FNF bilat.


Pertinent Results:
[**2195-5-22**] 06:30AM BLOOD WBC-9.6 RBC-2.82* Hgb-8.7* Hct-26.0*
MCV-92 MCH-30.9 MCHC-33.5 RDW-19.9* Plt Ct-378
[**2195-5-17**] 08:04AM BLOOD Neuts-66.2 Lymphs-23.4 Monos-7.0 Eos-3.0
Baso-0.5
[**2195-5-22**] 06:30AM BLOOD Glucose-104 UreaN-19 Creat-0.5 Na-134
K-3.8 Cl-100 HCO3-27 AnGap-11
[**2195-5-22**] 06:30AM BLOOD Calcium-8.4 Phos-3.3 Mg-2.2

CT head [**2195-5-17**]:
No significant change in the appearance of the right thalamic
intraparenchymal hemorrhage with 6 mm right to left midline
shift, obliteration of the left ventricle and dissection into
the left lateral ventricle. No change in the amount of blood in
the occipital [**Doctor Last Name 534**] of the left lateral ventricle, cerebral
aqueduct and fourth ventricle.

CT head [**2195-5-19**]:

Since the prior examination of [**2195-5-17**], there has been no
change in the right thalamic hemorrhage. There are unchanged
amounts of intraventricular blood present. The size of the
ventricular system is enlarged consistent with worsening
communicating hydrocephalus. The mass effect and minimal
leftward midline shift are also unchanged. No new intracranial
hemorrhage is noted. On today's exam, the blood in the fourth
ventricle is no longer apparent.

Unchanged amounts of chronic microvascular ischemic change are
again identified. There is no evidence of herniation.


Brief Hospital Course:
Neurology: Patient admitted to ICU under Neurology for
hypertensive associated intracranial hemorrhage of the left
thalamus. Patient received Neurosurgical consultation but no
surgical intervention needed as she had no evidence of clinical
decline of neurological status. In ICU, blood pressures were
controlled with metaprolol. She was transferred to the floor and
monitored in the step down unit for 24 hours because of CT scan
on [**2195-5-19**] showing increased non-communicating hydrocephalus.
Patient continued to show no evidence of decline in neurological
status and remained stable on floor. She had episodes of HTN
noted with SBP 170-180s so Metaprolol increased to 37.5 mg po
tid and Lisinopril 20 mg po qday added. This improved SBP to
goal of SBP > 90 and less than 160. Her discharge exam shows Ax
0 x 2 (forgets month and date), alert, occassional paraphasic
errors, mild dysarthia, left facial weakness, left wrist
extensors [**4-9**] and left finger extensor [**4-9**] and triceps 5-/5. She
passed a swallow study and tolerated regular diet. She was
treated for 3 days with for UTI found on admission
(ENTEROBACTERIACEAE species sensitive to Ciprofloxacin). She
refused to urinate in bedside commode and foley had to be
replaced.  Was recommended for STR to which she agreed.  Was
transferred [**5-24**] t SKRH.
Prior to d/c she was restarted on cipro for recurrent UTI.
Please repeat UA at rehab, and adjust treatment if indicated.

Medications on Admission:
Medications prior to admission:
1.demeclocycline 300mg [**Hospital1 **]
2. hydralazine 25 qam/ 50mg qpm;
3. sertraline 25mg qam
4. synthroid 175mcg qam
5. toprol XL 50mg qam
6. PRNs: colace #1 tid; tylenol 325mg tid.


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
2. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Demeclocycline 300 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO TID (3
times a day).
9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
10. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily): hold for SBP <120.
11. Ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 3 days: starting date was [**5-24**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Medical Center - [**Hospital1 3597**]

Discharge Diagnosis:
left thalamic hemorrhage
UTI


Discharge Condition:
left lower facial weakness, mild dysarthia, left wrist ext
weakness 4/5 and finger ext weakness 4/5 and triceps 5-/5.


Discharge Instructions:
Follow-up as instructed

Followup Instructions:
Stroke Neurology: [**Hospital1 18**] [**Hospital Ward Name 23**] bldng [**Location (un) **]. Provider:
[**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2195-6-22**] 3:00 pm


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

Completed by:[**2195-5-24**]
{'Intracerebral hemorrhage,Malignant essential hypertension,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Personal history of malignant neoplasm of breast,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified'}


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 sidedweakness, confusion

PRESENT ILLNESS: HPI:89 yo RHF with ho of uncontrolled HTN and severe peripheral
neuropathy who presents with confusion, dysarthia and left
face/arm weakness and CT findings showing right thalamic
hemorrhage with ventricular extension. Patient was in her usual
state of health until appx 7:30 pm last night when she was noted
to be calling a well known dinner guest by her daughter's name.
The patient persistently made this error and it was later noted
she was clumsy with the left hand. She required more assistance
with transfers from her wheelchair later in the evening and then
left arm noted to have weakness. She was taken to OSH where VSS
showed SBP 200-230s. She had CT head which showed 2.6 cm
hemorrhage in right thalmus with intraventricular hemorrhage, no
hydrocephalus. The patient was transferred to [**Hospital1 18**] for further
care.

MEDICAL HISTORY: PMHx:
-HTN-uncontrolled for at least 5 years
-idiopathic peripheral neuropathy-wheelchair bound
-hyponatremia/hypokalemia
-h/o left breast cancer dx [**2177**] (s/p lumpectomy and XRT)
-Lumbar fractures after MVC at age 40 y
-Pelvic fracture after fall in [**2180**]
-h/o of seizures while in 40s thought to be secondary to benzene
exposure
-cataract surgery bilat

MEDICATION ON ADMISSION: Medications prior to admission:
1.demeclocycline 300mg [**Hospital1 **]
2. hydralazine 25 qam/ 50mg qpm;
3. sertraline 25mg qam
4. synthroid 175mcg qam
5. toprol XL 50mg qam
6. PRNs: colace #1 tid; tylenol 325mg tid.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: AF BP:107-157/39-69    HR: 60-66   R [**12-18**]    O2Sats
96-100% 2L
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: irreg, reactive to light 4 mm-> 3mm
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.Murmur present
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect, talkative.
Orientation: Oriented to person and date.
Recall: [**1-7**] objects at 5 minutes.
Language: Speech dysarthic with good comprehension and
repetition.
Naming intact [**2-7**] lo freqhency objects.
Cranial Nerves:
I: Not tested
II: Pupils equally irreg and reactive to light, 4 to 3
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: left facial droop
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

FAMILY HISTORY: Family Hx:Mother died of stroke at age 70y, no bleeding
dyscrasias in family. 2 younger sisters with peripheral
neuropathy

SOCIAL HISTORY: Social Hx: lives with daughter; nonsmoker/nondrinker. 

### Response:
{'Intracerebral hemorrhage,Malignant essential hypertension,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Personal history of malignant neoplasm of breast,Unspecified hereditary and idiopathic peripheral neuropathy,Anemia, unspecified'}
