CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
woman with past history of hypertension, diabetes, heart
block status post pacemaker in [**10/2129**], mild congestive heart
failure, depression, with recent admission on [**2130-9-30**] to
[**Hospital1 69**] status post fall.  At
that time, she was found by a home aid on the floor in the
bathroom and did not remember who she fell and did not recall
any symptoms prior to falling.  On admission now, she was
found by a home aid at approximately 10:30 p.m. sitting up in
bed, awake, but not responding to any commands, nonverbal
with the right arm noted to be flaccid.  Emergency medical
services were called.  By emergency medical services report,
the patient vomited two times.

MEDICAL HISTORY: Her past medical history is
significant for hypertension, heart block status post
pacemaker in [**10/2129**], diabetes, depression, and left tibial
fracture.

MEDICATION ON ADMISSION: 

ALLERGIES: She is allergic to penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone in elder housing.  She is a
former concert pianist.  She was mostly independent in her
activities of daily living.
Cerebral embolism with cerebral infarction,Other convulsions,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Umbilical hernia without mention of obstruction or gangrene,Cardiac pacemaker in situ
Crbl emblsm w infrct,Convulsions NEC,Urin tract infection NOS,CHF NOS,DMII wo cmp nt st uncntr,Adv eff medicinal NOS,Umbilical hernia,Status cardiac pacemaker
Admission Date:  [**2130-10-30**]       Discharge Date:


Service:  Neurology

HISTORY OF PRESENT ILLNESS:  The patient is a [**Age over 90 **]-year-old
woman with past history of hypertension, diabetes, heart
block status post pacemaker in [**10/2129**], mild congestive heart
failure, depression, with recent admission on [**2130-9-30**] to
[**Hospital1 69**] status post fall.  At
that time, she was found by a home aid on the floor in the
bathroom and did not remember who she fell and did not recall
any symptoms prior to falling.  On admission now, she was
found by a home aid at approximately 10:30 p.m. sitting up in
bed, awake, but not responding to any commands, nonverbal
with the right arm noted to be flaccid.  Emergency medical
services were called.  By emergency medical services report,
the patient vomited two times.

In the Emergency Department, the patient was afebrile.  Blood
pressure was 222/75, initial pulse oximetry 85 percent in
room air.  She was found to be completely nonverbal and not
following commands.  She was seen by the stroke fellow and
was taken CT/CTA as she could not have an MRI secondary to
her pacemaker.  While at CT, she had a witnessed focal motor
seizure with deviation of the eyes to the right and jerking
of right arm and leg.  The seizure lasted approximately one
minute and stopped spontaneously.  The patient became more
somnolent after the seizure.  The CT/CT angiogram was normal
without evidence of bleed or early infarct.

PAST MEDICAL HISTORY:  Her past medical history is
significant for hypertension, heart block status post
pacemaker in [**10/2129**], diabetes, depression, and left tibial
fracture.

MEDICATIONS:  Her medications prior to admission were Lasix
40 mg q.day, Glipizide 5 mg q.day, Toprol XL 100 mg q.day,
Captopril 6.25 mg t.i.d., Celexa 20 mg q.day, Trazodone 25 mg
p.r.n. q.h.s., enteric coated aspirin 325 mg q.day.

ALLERGIES:  She is allergic to penicillin.

SOCIAL HISTORY:  She lives alone in elder housing.  She is a
former concert pianist.  She was mostly independent in her
activities of daily living.

PHYSICAL EXAMINATION:  On admission, her blood pressure was
222/75, pulse 90, respirations 20, oxygen saturation 96
percent on six liters.  General exam revealed lungs with
rhonchi bilaterally, heart regular rate and rhythm, abdomen
soft and nontender.  Neurological exam revealed she was
awake, alert with her eyes open and no verbal output, not
following any commands.  Pupils:  Right 3 mm, left 2 mm,
minimally reactive bilaterally.  The anasecoria was noted in
prior notes.  She did not track with her eyes.  There was
positive blink to threat bilaterally, positive corneals
bilaterally.  Her face was symmetric.  There was decreased
gag reflex.  On motor exam, her right arm was flaccid.  She
had purposeful withdrawal of her right leg to pain.  She
withdrew the left arm and left leg to pain.  She was
hyporeflexive throughout bilateral upper and lower
extremities.  Her right toe was upgoing.

LABORATORY DATA:  On admission, complete blood count was
unremarkable.  CK and troponin were negative.  Electrolytes
were negative.  BUN and creatinine was 29/1.6.  Glucose 189.
Chest x-ray showed mild congestive heart failure.

HOSPITAL COURSE:  After the witnessed seizure while at CT in
the Emergency Department, the patient was loaded on Dilantin
with 1500 mg intravenously.  She was admitted to the
Intensive Care Unit for observation.  She was continued on
aspirin 325 mg q.day.  She was placed on regular insulin
sliding scale for diabetes, and she was started on Levaquin
and clindamycin for possible infiltrate on chest x-ray.

While in the Intensive Care Unit, her right-sided weakness
resolved, and she was moving all extremities equally
including the right upper extremity.  Her blood pressure
ranged 150s.  Her blood pressure was controlled with
Hydralazine and Lopressor.  She became agitated and required
sedation with Ativan.  She continued to be aphasic but now
had incoherent mumbling.  She was noted at one point to have
some abdominal distension with possible tenderness on exam
and had further two episodes of bilious vomiting.  She was
seen by a general surgery consultant and found to have a
reducible umbilical hernia.  There was no sign of obstruction
on KUB.  The recommendation was for elective hernia repair
when her further medical issues resolve.

Electroencephalogram was done on [**2130-10-31**] which showed slow
background without epileptiform activity consistent with
encephalopathy.  The electroencephalogram did show some focal
slowing in the right anterior quadrant and the loss of
cortical rhythms broadly on the left, both suggesting
additional focal abnormalities beyond the encephalopathy.

Repeat head CT was done on [**2130-11-2**] to evaluate for any
sign of infarct.  The head CT showed a possible sign of left
middle cerebral artery region infarct with subtle sulcal loss
of definition.  The patient remained on a maintenance dose of
Dilantin.  She continued to be confused and agitated and was
treated with Haldol for acute agitation.

Through her hospital course, her agitation resolved.  She was
weaned off of the Haldol and continued to move all
extremities equally; however, she remained largely nonverbal,
only sometimes speaking, sometimes in Polish and sometimes in
English.

Surface echocardiogram was done for embolic workup for the
possible stroke.  Echocardiogram showed mildly dilated left
atrium, borderline to mildly hypertrophied left ventricle,
overall preserved left ventricular systolic function.  Right
ventricular function could not be adequately assessed.  There
was a mildly dilated ascending aorta, mildly thickened aortic
leaflets, mild aortic regurgitation, mildly thickened mitral
leaflets, moderate mitral regurgitation, and moderate
pulmonary hypertension.  There was no evidence of cardiac
embolic source.

The patient remained on Dilantin as above, and there were no
further seizure events.  As above, she continued to move all
extremities equally.  On discharge, there does not appear to
be any right-sided motor deficit.

In addition, the patient is DNR/DNI as per her attorney and
health care proxy, Mr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 100977**].

DISCHARGE DIAGNOSIS:
Possible embolic stroke with subsequent seizure and
subsequent encephalopathy likely postictal and medication
induced.

DISCHARGE MEDICATIONS:
1.  Enteric coated aspirin 325 mg q.day.
2.  Nystatin powder.
3.  Regular insulin sliding scale.
4.  Subcutaneous heparin 5000 units b.i.d.
5.  Dilantin 300 mg p.o. q.day.
6.  Lasix 10 mg intravenously q.day.

FOLLOW-UP:  The patient will follow-up in [**Hospital 878**] Clinic
with Dr. [**First Name (STitle) 6817**].  She will follow-up with her primary care
physician.  [**Name10 (NameIs) **] blood pressure medications are currently
being held with blood pressure running 150s-160s.  Her prior
blood pressure medications should be restarted by her primary
care physician on [**Name9 (PRE) 702**].  She will continue on aspirin
and on the Dilantin.  She is stable for discharge to
rehabilitation.




                       DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 13-140




Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36

D:  [**2130-11-9**]  13:58
T:  [**2130-11-9**]  14:05
JOB#:  [**Job Number 100978**]
{'Cerebral embolism with cerebral infarction,Other convulsions,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Umbilical hernia without mention of obstruction or gangrene,Cardiac pacemaker in situ'}


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: 

PRESENT ILLNESS: The patient is a [**Age over 90 **]-year-old
woman with past history of hypertension, diabetes, heart
block status post pacemaker in [**10/2129**], mild congestive heart
failure, depression, with recent admission on [**2130-9-30**] to
[**Hospital1 69**] status post fall.  At
that time, she was found by a home aid on the floor in the
bathroom and did not remember who she fell and did not recall
any symptoms prior to falling.  On admission now, she was
found by a home aid at approximately 10:30 p.m. sitting up in
bed, awake, but not responding to any commands, nonverbal
with the right arm noted to be flaccid.  Emergency medical
services were called.  By emergency medical services report,
the patient vomited two times.

MEDICAL HISTORY: Her past medical history is
significant for hypertension, heart block status post
pacemaker in [**10/2129**], diabetes, depression, and left tibial
fracture.

MEDICATION ON ADMISSION: 

ALLERGIES: She is allergic to penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: She lives alone in elder housing.  She is a
former concert pianist.  She was mostly independent in her
activities of daily living. 

### Response:
{'Cerebral embolism with cerebral infarction,Other convulsions,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified drug or medicinal substance causing adverse effects in therapeutic use,Umbilical hernia without mention of obstruction or gangrene,Cardiac pacemaker in situ'}
