CHIEF COMPLAINT: right sided weakness

PRESENT ILLNESS: This is a 78 yo Cantonese speaking right handed man with a
history of vascular dementia, stroke with left sided weakness,
HTN, h/o right SDH s/p evacuation who was in his usual state of
health until this morning.  He walked to the bathroom and did
not come out for 20 minutes.  His wife got worried and walked in
to find him curled up on the bathroom floor.  He said,"I'm fine"
and denied any pain, headache.  She and a friend tried to sit
him up but were unable.  [**Name (NI) **] son (who lives downstairs)
came up and sat him up.  Over the course of several hours the
wife noticed he became more quiet, and it wasn't clear if he was
understanding her.  Then, he was unable to lift his right arm
although still could wiggle his right fingers.  This is odd
because his right side is usually his stronger side given his
old stroke and resultant left sided weakness.  This weakness
prompted the call to EMS.  In the ED, CT scan was performed, 5mg
IV hydral was given for elevated BP, followed by labetolol drip.

MEDICAL HISTORY: 1.  Dementia, presumed vascular per notes
2.  HTN
3.  Stroke with left sided weakness in [**2130**] - etiology?
4.  right subdural hematoma s/p evacuation by Dr. [**Last Name (STitle) 1327**] after a
    fall in [**2147**].
5.  Cervical spondylosis, neurology admission [**2148**]
6.  Gout, last flare was [**2148**]
7.  left hip fracture [**2138**] s/p ORIF

MEDICATION ON ADMISSION: arricept 10mg daily, toprol XL 50mg daily, EC ASA 325 mg daily,
vitamin E, ditropan - dose?, lisinopril 20mg daily - may not be
taking this medication

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: 98.0, 78, 170/75, 20, 100% on 2LNC
GEN:  elderly man laying flat on a stretcher, drool on the right
side of mouth, awake but yawning.
SKIN:  no rash
HEENT:  NC/AT, anicteric sclera, mmm, + thick secretions
NECK: supple, no carotid bruits
CHEST:  normal respiratory pattern, CTA bilat
CV:  regular rate and rhythm with systolic murmur at USB
ABD:  soft, nontender, nondistended, +BS
EXTREM:  no edema

FAMILY HISTORY: orphaned, but has 6 healthy children.

SOCIAL HISTORY: former chef, has lived in [**Location **] for 20+ years, cantonese
speaking, former smoker but quit 30 years ago, no etoh, no
drugs.  Per discussion with patient's daughter and wife, they
are leaning towards DNR/DNI, but this is not yet official.
Daughter:  Soyan [**Telephone/Fax (1) 6828**].
Intracerebral hemorrhage,Urinary tract infection, site not specified,Unspecified essential hypertension,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Cervical spondylosis without myelopathy
Intracerebral hemorrhage,Urin tract infection NOS,Hypertension NOS,Vascular dementia,uncomp,Cerebral atherosclerosis,Cervical spondylosis
Admission Date:  [**2149-12-10**]              Discharge Date:   [**2149-12-15**]

Date of Birth:  [**2071-7-22**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
right sided weakness

Major Surgical or Invasive Procedure:
CTs
Swallow evaluation

History of Present Illness:
This is a 78 yo Cantonese speaking right handed man with a
history of vascular dementia, stroke with left sided weakness,
HTN, h/o right SDH s/p evacuation who was in his usual state of
health until this morning.  He walked to the bathroom and did
not come out for 20 minutes.  His wife got worried and walked in
to find him curled up on the bathroom floor.  He said,"I'm fine"
and denied any pain, headache.  She and a friend tried to sit
him up but were unable.  [**Name (NI) **] son (who lives downstairs)
came up and sat him up.  Over the course of several hours the
wife noticed he became more quiet, and it wasn't clear if he was
understanding her.  Then, he was unable to lift his right arm
although still could wiggle his right fingers.  This is odd
because his right side is usually his stronger side given his
old stroke and resultant left sided weakness.  This weakness
prompted the call to EMS.  In the ED, CT scan was performed, 5mg
IV hydral was given for elevated BP, followed by labetolol drip.

Upon review of systems, no new meds, no alternative meds, he
takes a daily aspirin, no fevers, chills, illnesses, chest pain,
SOB, abdominal pain.  He has baseline urgency of urine and stool
for the past year or so, and has to run to the bathroom quickly.

At baseline, he no longer reads or writes, paucity of speech -
talks in one or two word sentences when spoken to, ambulates
with a walker, wife is the sole care giver and he requires
assistance with all ADLS (grooming, bathing, dressing, feeding).
 Has very poor short term memory.

Past Medical History:
1.  Dementia, presumed vascular per notes
2.  HTN
3.  Stroke with left sided weakness in [**2130**] - etiology?
4.  right subdural hematoma s/p evacuation by Dr. [**Last Name (STitle) 1327**] after a
    fall in [**2147**].
5.  Cervical spondylosis, neurology admission [**2148**]
6.  Gout, last flare was [**2148**]
7.  left hip fracture [**2138**] s/p ORIF


Social History:
former chef, has lived in [**Location **] for 20+ years, cantonese
speaking, former smoker but quit 30 years ago, no etoh, no
drugs.  Per discussion with patient's daughter and wife, they
are leaning towards DNR/DNI, but this is not yet official.
Daughter:  Soyan [**Telephone/Fax (1) 6828**].


Family History:
orphaned, but has 6 healthy children.


Physical Exam:
VITALS: 98.0, 78, 170/75, 20, 100% on 2LNC
GEN:  elderly man laying flat on a stretcher, drool on the right
side of mouth, awake but yawning.
SKIN:  no rash
HEENT:  NC/AT, anicteric sclera, mmm, + thick secretions
NECK: supple, no carotid bruits
CHEST:  normal respiratory pattern, CTA bilat
CV:  regular rate and rhythm with systolic murmur at USB
ABD:  soft, nontender, nondistended, +BS
EXTREM:  no edema

NEURO:
Mental status: Patient is awake but yawns frequently and must be
awakened as he
dozes off . He follows some commands such as "show me two
fingers" but does not speak.  He tries to wisper.  He is unable
to read or write at baseline.  Appears to pay more attention to
the left and does not blink to threat on the right, however,
when daughter speaks to him on the right side, he will turn his
head and orient her way.

Cranial Nerves: Visual acuity:  counts 5 fingers on my hand.
Visual fields: difficult to assess but does not blink to threat
on the right. Fundoscopic exam: unable to visualize, very small
pupils. Pupils: 1.5->1 mm, consenual constriction to light.
Moves eyes to the left and right but will not move
up and down, gaze conjugate. No nystagmus or ptosis. Unable to
assess sensation. Right face droop with drool (lower face) Turns
head to daughters voice on both sides Gag reflex present but
delayed. Symmetric elevation of
palate. Will not shrug shoulders for me. Tongue midline without
atrophy or fasciulations.

Sensory: unable to assess formally, but withdraws vigorously on
the left arm, moves right arm proximally to pain, triple flexes
right leg to pain, withdrawls to pain left leg.

Motor: Normal bulk, very high tone in the legs bilaterally.  No
fasciculations. No adventitious movements.
Strength:
     Delt Tri [**Hospital1 **] WE WF FE FF
RT:   0    4- 3  3  3  3  3
LEFT: 5    5  5  5  5  5  5
- both legs: unable to lift or hold to gravity, some minimal
proximal movement when asked to bend knees, not wiggling toes or
ankles.

Reflexes:  No grasp, glabellar, snout, palmomental.  Mild Jaw
jerk.  Reflexes brisk throughout with crossed adductors,
sustained left ankle clonus. Bilateral upgoing toes.

Unable to assess coordination and gait.

Pertinent Results:
GLUCOSE-112* UREA N-12 CREAT-0.9 SODIUM-142 POTASSIUM-3.6
CHLORIDE-100 TOTAL CO2-35* ANION GAP-11
WBC-8.0 (77N, 15L, 3M, 3E, 1B) HGB-15.7 HCT-44.2 PLT COUNT-209
PT-12.5 PTT-25.0 INR(PT)-1.0

CT c-spine:  1. No evidence of fracture or malalignment. 2.
Degenerative changes. 3. Ossifications of portions of the
anterior and posterior longitudinal ligaments, with similar
calcifications in the posterior neck.

CT head:  Left thalamic and left intraventricular hemorrhage as
described above. Small focus of increased attenuation in the
right thalamus. This could represent a calcification or a focus
of hemorrhage as well.

MRI c/t spine:  Limited by the image quality. Disc bulge at C2-3
does not cause significant spinal stenosis. Moderate spinal
stenosis is noted at the C3-4, [**2-24**], and [**3-27**] levels secondary to
posterior concentric disc bulging and corresponding posterior
osteophytes seen on CT scan. Posterior disc protrusion is also
noted at T1 to 2 but does not cause significant compression. The
remainder of the thoracic spine is unremarkable.

Brief Hospital Course:
Mr. [**Known lastname **] was admitted to the Neuro ICU as he was on a labetolol
drip for BP control following left thalamic (and possible right
thalamic) bleeds.  He was weaned off the drip and transferred to
the floor the next day.  The bleeds remained stable upon repeat
head CT.  He passed a swallow evaluation and was able to take in
PO antihypertensives.  On day of discharge he was restarted on
aspirin at a lower dose (81mg). Blood pressure has remained
elevated, and we are currently titrating his medications for
goal SBP<120.

Clinically he improved.  He became less sleepy and more
interactive.  With a cantonese translator he was able to say, "I
am a man," when asked if he was a woman.  He followed directions
like sticking out his tongue.  He remains with right arm
weakness proximally> distally.  His legs are very hypertonic,
and the left is especially hyperreflexic.

For his paraparesis, MRI c and t spines were obtained and were
not significantly different from those one year ago.  He still
has spondylosis of the cervival and thoracic spine but no
impingement upon the cord.

During hospitalization, spiked fever. Workup revealed urinary
tract infection, cultures are still pending. Is now on
levofloxacin for 7 day course, and is afebrile.

Regarding code status, his wife was clear in that he had lived a
long life, and the past year has been very difficult for him
with his dementia and other medical problems.  She said she did
not want CPR or intubation.  However, the PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 1603**],
stopped by to see the family and thought the code status
decision was not quite as clear cut.  We are currently still in
the process of coming to a conclusion.  Remains FULL CODE for
now.

Medications on Admission:
arricept 10mg daily, toprol XL 50mg daily, EC ASA 325 mg daily,
vitamin E, ditropan - dose?, lisinopril 20mg daily - may not be
taking this medication

Discharge Medications:
1. Heparin Sodium (Porcine) 5,000 unit/mL Solution Sig: One (1)
ml Injection TID (3 times a day) as needed for dvt prophylaxis.

2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for fever, pain.
3. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 5 days.
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
5. Captopril 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
6. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 2670**] - [**Location (un) **]

Discharge Diagnosis:
Left thalamic bleed
Urinary tract infection
Hypertension
Cervical and thoracic spondylosis
Dementia


Discharge Condition:
Improved, though still with new right-sided hemiparesis face and
arm>leg, and with baseline lower extremity spastic paraparesis

Discharge Instructions:
Take all medicines as prescribed.

Keep all follow-up appointments.

Call your doctor or return to the ED for new or worsening
weakness, difficulty speaking or swallowing, trouble seeing or
hearing.

Followup Instructions:
Needs continued blood pressure management for goal SBP<120. Will
need titration of captopril and metoprolol in the short term.
Once stable doses have been achieved, he can be converted to
toprol XL and lisinopril for once daily dosing.

Follow-up with your PCP [**Last Name (NamePattern4) **] [**12-26**] weeks for continued blood
pressure management.

Follow-up in [**Hospital 4038**] Clinic with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] or Dr.
[**First Name (STitle) **] [**Name (STitle) **] in [**11-23**] months. Call [**Telephone/Fax (1) 1694**] to schedule
an appointment.

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Intracerebral hemorrhage,Urinary tract infection, site not specified,Unspecified essential hypertension,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Cervical spondylosis without myelopathy'}


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: right sided weakness

PRESENT ILLNESS: This is a 78 yo Cantonese speaking right handed man with a
history of vascular dementia, stroke with left sided weakness,
HTN, h/o right SDH s/p evacuation who was in his usual state of
health until this morning.  He walked to the bathroom and did
not come out for 20 minutes.  His wife got worried and walked in
to find him curled up on the bathroom floor.  He said,"I'm fine"
and denied any pain, headache.  She and a friend tried to sit
him up but were unable.  [**Name (NI) **] son (who lives downstairs)
came up and sat him up.  Over the course of several hours the
wife noticed he became more quiet, and it wasn't clear if he was
understanding her.  Then, he was unable to lift his right arm
although still could wiggle his right fingers.  This is odd
because his right side is usually his stronger side given his
old stroke and resultant left sided weakness.  This weakness
prompted the call to EMS.  In the ED, CT scan was performed, 5mg
IV hydral was given for elevated BP, followed by labetolol drip.

MEDICAL HISTORY: 1.  Dementia, presumed vascular per notes
2.  HTN
3.  Stroke with left sided weakness in [**2130**] - etiology?
4.  right subdural hematoma s/p evacuation by Dr. [**Last Name (STitle) 1327**] after a
    fall in [**2147**].
5.  Cervical spondylosis, neurology admission [**2148**]
6.  Gout, last flare was [**2148**]
7.  left hip fracture [**2138**] s/p ORIF

MEDICATION ON ADMISSION: arricept 10mg daily, toprol XL 50mg daily, EC ASA 325 mg daily,
vitamin E, ditropan - dose?, lisinopril 20mg daily - may not be
taking this medication

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VITALS: 98.0, 78, 170/75, 20, 100% on 2LNC
GEN:  elderly man laying flat on a stretcher, drool on the right
side of mouth, awake but yawning.
SKIN:  no rash
HEENT:  NC/AT, anicteric sclera, mmm, + thick secretions
NECK: supple, no carotid bruits
CHEST:  normal respiratory pattern, CTA bilat
CV:  regular rate and rhythm with systolic murmur at USB
ABD:  soft, nontender, nondistended, +BS
EXTREM:  no edema

FAMILY HISTORY: orphaned, but has 6 healthy children.

SOCIAL HISTORY: former chef, has lived in [**Location **] for 20+ years, cantonese
speaking, former smoker but quit 30 years ago, no etoh, no
drugs.  Per discussion with patient's daughter and wife, they
are leaning towards DNR/DNI, but this is not yet official.
Daughter:  Soyan [**Telephone/Fax (1) 6828**]. 

### Response:
{'Intracerebral hemorrhage,Urinary tract infection, site not specified,Unspecified essential hypertension,Vascular dementia, uncomplicated,Cerebral atherosclerosis,Cervical spondylosis without myelopathy'}
