CHIEF COMPLAINT: Headache, nausea, vomiting, and dizziness.

PRESENT ILLNESS: This is a 69-year-old right-
handed man with multiple vascular risk factors who presents
with the acute onset of dizziness followed by nausea,
vomiting, and a headache.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No strokes.

SOCIAL HISTORY: He is a retired carpenter who lives with his
wife.  [**Name (NI) **] quit smoking in [**2078**].  He drinks occasional
alcohol, but he uses no drugs.
Cerebral embolism with cerebral infarction,Occlusion and stenosis of vertebral artery without mention of cerebral infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified disorder of kidney and ureter,Unspecified acquired hypothyroidism,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Crbl emblsm w infrct,Ocl vrtb art wo infrct,Hypertension NOS,DMII wo cmp nt st uncntr,Pure hypercholesterolem,Renal & ureteral dis NOS,Hypothyroidism NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date: [**2118-6-13**]        Discharge Date: [**2118-6-17**]

Date of Birth:  [**2049-8-11**]        Sex:  M

Service:  NME


CHIEF COMPLAINT:  Headache, nausea, vomiting, and dizziness.

HISTORY OF PRESENT ILLNESS:  This is a 69-year-old right-
handed man with multiple vascular risk factors who presents
with the acute onset of dizziness followed by nausea,
vomiting, and a headache.

Two days prior to admission, he was having lunch with his
wife when he suddenly felt dizzy - like things were moving
around here.  He got up and tried to walk 10 feet, and he
then fell to the right against a wall.  He then walked to his
care but was veering to the right.  When he got to the car,
he noticed that dizziness was worse with head movement.  911
was called, and he was taken to [**Hospital3 **].

At the outside hospital, he had a noncontrast head computer
tomography that was negative.  He was then admitted for rule
out for myocardial infarction.  On Sunday morning he noticed
that his right arm was clumsy and that his speech was clumsy.
He denied any language difficulties such as comprehension or
thinking of words to say.  He then became nauseous with a
headache and vomited.  A repeat noncontrast head computer
tomography showed a right 4-cm X 3-cm cerebellar infarction.
The patient was then put on intravenous heparin without bolus
and transferred to the Intensive Care Unit on a nitroglycerin
drip due to a blood pressure of 220/80.

REVIEW OF SYSTEMS:  The patient denies any fevers, chills,
weakness, numbness, visual changes, hearing changes, chest
pain, shortness of breath, abdominal pain, dysuria,
hematuria, dysphagia, diarrhea, bright red blood per rectum,
or bowel or bladder problems.

PAST MEDICAL HISTORY:  Coronary artery disease.

Hypertension.

Diabetes.

Hypercholesterolemia.

Chronic renal insufficiency.

Hypothyroidism.

MEDICATIONS AT HOME:
1. Aspirin 81 mg by mouth once per day.
2. Atenolol 50 mg by mouth once per day.
3. Lisinopril 40 mg by mouth once per day.
4. Synthroid 150 mcg by mouth every day.
5. Glucophage 500 mg by mouth twice per day.
6. Glucotrol-XL 10 mg by mouth once per day.


ALLERGIES:  No known drug allergies.

FAMILY HISTORY:  No strokes.

SOCIAL HISTORY:  He is a retired carpenter who lives with his
wife.  [**Name (NI) **] quit smoking in [**2078**].  He drinks occasional
alcohol, but he uses no drugs.

PHYSICAL EXAMINATION ON PRESENTATION:  Temperature was 99.3
degrees Fahrenheit, his blood pressure was 166/63, his pulse
was 51, his respiratory rate was 20, and oxygen saturation
was  96 percent on room air.  Generally, a pleasant male in
no acute distress.  There were no carotid bruits.  His heart
had a regular rate and rhythm.  The lungs were clear to
auscultation bilaterally.  Extremities had no clubbing,
cyanosis, or edema.  On neurologic examination, he was awake
and alert.  He was cooperative with examination.  He was
oriented to person, place, and date.  He was able to do
months of the year backwards.  His recall was [**3-9**] at five
minutes.  He was fluent with good comprehension and
repetition.  His naming was intact.  There was no dysarthria
or paraphasic errors.  There was apraxia or neglect.  On
cranial nerve examination, the pupils were equal, round, and
reactive to light at 4 mm to 3 mm bilaterally.  The visual
fields were full to confrontation.  The extraocular movements
were intact and without nystagmus.  There was limited
abduction of the eyes bilaterally.  His facial strength and
sensation were intact and symmetric.  Hearing was intact to
finger rub bilaterally.  Palatal elevation was symmetric.
Sternocleidomastoid and trapezius were normal bilaterally.
The tongue was midline and without fasciculations.  On motor
examination, he had normal bulk and tone bilaterally.  There
was no tremor.  He had full power at 5/5 throughout.  There
was no pronator drift.  On sensory examination, he was intact
to light touch, pinprick, and proprioception.  On reflex
testing, he was [**3-10**] in the upper extremities and [**2-9**] in the
lower extremities.  The toes were downgoing bilaterally.  On
coordination examination, he had dysmetria on the right
finger-to-nose and heel-to-shin test.  On gait testing, he
could not perform examination due to dizziness.

OUTSIDE LABORATORY VALUES ON PRESENTATION:  White blood cell
count was 6.2, his hematocrit was 40.5, and his platelets
were 235.  Sodium was 140, potassium was 5.5, chloride was
105, bicarbonate was 24, blood urea nitrogen was 47,
creatinine was 1, and blood glucose was 333.  His creatine
kinase was 134.  His MB was 3.5.  Troponin was less than
0.15.

PERTINENT RADIOLOGY-IMAGING:  A magnetic resonance imaging of
the head with magnetic resonance angiography of the head and
neck at the outside hospital showed a right PICA and SCA
infarction of the right cerebellum. Scans reviewed with Dr [**Last Name (STitle) 1693**]
who felt it appeared embolic. There was little flow in the
right vertebral artery in the neck.  Both intracranial/vertebral
arteries were difficult to visualize. The left intracranial
vertebral seemed to have no flow at the junction with the
basilar, and there was some flow in the right intracranial
vertebral artery.

SUMMARY OF HOSPITAL COURSE:  The patient was admitted to the
Intensive Care Unit given that he was on nitroglycerin and
heparin drips.  His goal blood pressures were 150s to 170s,
and he was able to be weaned off of the nitroglycerin drip.
Once his blood pressure was manageable off any drips, he was
transferred to the floor.

He was kept on heparin with a goal partial thromboplastin
time of 50 to 60 until a transthoracic
echocardiogram/transesophageal echocardiogram were performed.
Information from these echocardiograms revealed that he had a
small patent foramen ovale and nonmobile atheroma in his
aortic arch.  Given the amount of right vertebral occlusion
in the neck, he was kept on heparin and Coumadin was started.
The heparin can be discontinued once he reaches an INR level
between 2 and 3.  He will be anticoagulated for three to six
months, and then that will be discontinued.

He was ruled out for a myocardial infarction.  He was
continued on his statin and his lipid panel was checked.  His
cholesterol was normal at 186, his triglycerides were 155,
his high-density lipoprotein was 60, and his low-density
lipoprotein was 95.  His homocystine was checked and found to
be normal at 11.7.

A noncontrast head computer tomography was performed and
showed no interval change in the right cerebellar infarction.
One day prior to discharge, a magnetic resonance
imaging/magnetic resonance angiography of the head was
repeated and found to show no changes except for some small
susceptibility signaling in the right cerebellum.  Given that
the amount of blood was quite small in the cerebellum, it was
felt that it was safe to continue his anticoagulation.

DISCHARGE DIAGNOSES:  Right cerebellar infarction.

Right vertebral occlusion.

Hypercholesterolemia.

MEDICATIONS ON DISCHARGE:
1. Coumadin 5 mg by mouth once per day.
2. Heparin drip.
3. Protonix 40 mg by mouth once per day.
4. Colace.
5. Synthroid 150 mcg by mouth every day.
6. Pravastatin 40 mg by mouth once per day.


CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To rehabilitation.

DISCHARGE FOLLOW UP:  The patient was instructed to follow up
with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in the [**Hospital 878**] Clinic within two to
four weeks of being discharged from the rehabilitation
center.  The patient was instructed to call for an
appointment at telephone number [**Telephone/Fax (1) 29128**].

The patient was instructed to follow up with his primary care
doctor within one week of discharge from the rehabilitation
center.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6600**], [**MD Number(1) 6601**]

Dictated By:[**Last Name (NamePattern1) 11265**]
MEDQUIST36
D:  [**2118-6-16**] 18:01:02
T:  [**2118-6-16**] 18:47:52
Job#:  [**Job Number **]
{'Cerebral embolism with cerebral infarction,Occlusion and stenosis of vertebral artery without mention of cerebral infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified disorder of kidney and ureter,Unspecified acquired hypothyroidism,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}


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: Headache, nausea, vomiting, and dizziness.

PRESENT ILLNESS: This is a 69-year-old right-
handed man with multiple vascular risk factors who presents
with the acute onset of dizziness followed by nausea,
vomiting, and a headache.

MEDICAL HISTORY: Coronary artery disease.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No strokes.

SOCIAL HISTORY: He is a retired carpenter who lives with his
wife.  [**Name (NI) **] quit smoking in [**2078**].  He drinks occasional
alcohol, but he uses no drugs. 

### Response:
{'Cerebral embolism with cerebral infarction,Occlusion and stenosis of vertebral artery without mention of cerebral infarction,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Pure hypercholesterolemia,Unspecified disorder of kidney and ureter,Unspecified acquired hypothyroidism,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
