CHIEF COMPLAINT: Left sided weakness

PRESENT ILLNESS: 68 yo man h/o DM2, [**Hospital **] transferred from OSH after presenting
with sudden onset of headache, left sided weakness and decreased
verbal output.

MEDICAL HISTORY: DM2
HTN
gout
[**Hospital1 3390**] [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7568**], [**Location (un) 5503**], MA

MEDICATION ON ADMISSION: Valsartan 40mg QD
Simvastatin 80mg QD
Glipizide 5mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T- 97.5  BP- 157/79  HR- 74  RR- 16  100 O2Sat RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: supple, no carotid or vertebral bruit
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with wife [**Name (NI) 47532**] [**Telephone/Fax (1) 78608**] (home), [**Telephone/Fax (1) 78609**]
(cell), two daughters also nearby.  No tob, ~2 drinks/wk, no
drugs.  Retired delivery truck driver.
Thrombocytopenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified intracranial hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Iatrogenic cerebrovascular infarction or hemorrhage,Other and unspecified infection due to central venous catheter,Sepsis,Unspecified septicemia,Urinary tract infection, site not specified
Thrombocytopenia NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Intracranial hemorr NOS,Crbl art ocl NOS w infrc,Iatrogen CV infarc/hmrhg,Oth/uns inf-cen ven cath,Sepsis,Septicemia NOS,Urin tract infection NOS
Admission Date:  [**2167-6-8**]              Discharge Date:   [**2167-6-25**]

Date of Birth:  [**2098-12-22**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Left sided weakness


Major Surgical or Invasive Procedure:
[**6-10**] craniotomy with evacuation of hematoma
[**6-17**] bilateral cerebral angiogram
[**6-18**] PEG placement


History of Present Illness:
68 yo man h/o DM2, [**Hospital **] transferred from OSH after presenting
with sudden onset of headache, left sided weakness and decreased
verbal output.

History obtained from family and OSH records.  Patient went to
his usual volunteer work at an animal shelter and returned home
around 9am where he reported not feeling well and having a
sudden
onset of a headache.

He proceeded to become nonverbal and develop left sided weakness
around 10am which prompted his family to call 911.  Upon arrival
to OSH ED, BP 156/102 HR 69.  NCHCT showed ICH, "centrally in
the
frontal region, there is an acute 6 x 4 cm intraparenchymal
bleed.  On the posterior margin, there is a somewhat enhancing
rim which raises the question as to whether there is a
meningioma
in this area which has bled.  There is mild anterior midline
shift to the left and the ventricles are normal size."

At OSH, rec'd reglan, zofran and 1g dilantin IV.  Transferred to
[**Hospital1 18**] ED for further management.  Noted to by dry heaving en
route.

ROS: Denies head trauma, weight loss, prior h/o cancer, blood
clotting disorder.


Past Medical History:
DM2
HTN
gout
[**Hospital1 3390**] [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7568**], [**Location (un) 5503**], MA


Social History:
Lives with wife [**Name (NI) 47532**] [**Telephone/Fax (1) 78608**] (home), [**Telephone/Fax (1) 78609**]
(cell), two daughters also nearby.  No tob, ~2 drinks/wk, no
drugs.  Retired delivery truck driver.


Family History:
NC

Physical Exam:
T- 97.5  BP- 157/79  HR- 74  RR- 16  100 O2Sat RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: supple, no carotid or vertebral bruit
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
MS: asleep requiring constant stimulus to stay awake.  does not
answer questions but then says "ouch" with noxious stim.
follows
commands with right hand, squeeze hand, shows two fingers and
wiggles thumb.

CN:
I: not tested
II,III:  blinks to threat bilaterally, PERRL 3mm to 2mm
III,IV,V:
EOMI with OCM, no ptosis
V:  unable
VII:  left facial droop
VIII:  unable
IX,X:  palate elevates symmetrically, uvula midline
[**Doctor First Name 81**]:  SCM/trapezeii [**6-1**] bilaterally
XII:  tongue protrudes midline, no dysarthria

Motor: Normal bulk.  Decr'd tone on left side; no tremor,
asterixis or myoclonus.  Right arm full [**6-1**] to resistance and
purposeful.  Left arm flaccid no movement to noxious stim.  Legs
w/d to noxious stim only R>L.

Reflex: No clonus, 2+ brisker on the left arm>leg and 2+ on the
right.  Right toe downgoing, left upgoing.

Coordination/Gait/Romberg: Negative


Pertinent Results:
[**6-8**] MRI OF THE BRAIN: There is a large mixed-density hematoma
centered within the corpus callosum and extending superiorly
into the right interhemispheric cistern and along the right
medial frontal lobe. There is inferior displacement of the
septum pellucidum and mass effect on the ventricles which are
mildly dilated and increased compared to prior CT. Hemorrhage
has also increased within the ventricles. There is no definite
underlying mass or arteriovenous malformation. Restricted
diffusion within the hematoma is expected. There are additional
areas of restricted diffusion to suggest infarction.

MRA OF THE CIRCLE OF [**Location (un) **]: The MRA is somewhat suboptimal due
to motion. The right A1 is hypoplastic and the right A2 arises
from the anterior communicating artery. There is a right-sided
fetal PCA. No flow-limiting stenosis, aneurysm or AV
malformation is identified.

IMPRESSION:
1. Large corpus callosal and right intraparenchymal hematoma
with mixed- density blood products and no definite underlying
mass or arteriovenous malformation. A repeat MRI could be
performed in six weeks to better assess for an underlying
abnormality such as a mass, aneurysm or undetected small AVM.
2. Increased size of hemorrhage and intraventricular extension,
with increased hydrocephalus.

CT/CTA [**6-9**] NON-CONTRAST HEAD CT: There has been interval
expansion of the large intraparenchymal hemorrhage located in
the right medial frontal lobe and corpus callosum. The hematoma
in greatest dimension measures 6.8 x 4.8 cm, previously 6.3 x 4
cm. The component in the corpus callosum is also expanded, and
there is inferior displacement of the septum pellucidum. The
hematoma is of mixed density with clotted blood centrally. There
is markedly increased intraventricular extension, which layers
in the occipital horns, as well as interval increase in
ventricular size and prominence of the temporal horns. There are
also new foci of subarachnoid hemorrhage within the bilateral
parietal sulci and interpeduncular cistern. No evidence of acute
infarct.

CTA OF THE CIRCLE OF [**Location (un) **]: As noted on recent MRA, there are
hypoplastic right A1 and the right A2 derived from the anterior
communicating artery. There is a fetal right PCA, a normal
variant. No flow-limiting stenosis or aneurysm is seen within
the circle of [**Location (un) 431**].

IMPRESSION: Interval increase in right frontal/corpus callosal
hemorrhage with increasing intraventricular extension of
hemorrhage and hydrocephalus. No definite underlying mass,
aneurysm, or AVM is detected, though followup imaging is
recommended to evaluate for underlying abnormality. There are
also new foci of subarachnoid hemorrhage.

POST-OP CT [**6-10**] Patient is status post right frontal craniotomy
and right frontal intraparenchymal hemorrhage evacuation. There
is a small amount of residual blood within the right frontal
lobe. There is no appreciable extra-axial collection. There is
hyperdensity seen along the left medial frontal lobe, probably
related to artifact rather than new hemorrhage. Bilateral
parietal subarachnoid hemorrhages are again noted with of more
apparent frontal subarachnoid involvement, which was previously
present, overall of similar extent. The intraventricular blood
layering within the occipital horns is similar. There is no
hydrocephalus, and the ventricles are similar in size.

IMPRESSION: Expected postoperative changes following right
frontal intraparenchymal hemorrhage evacuation.

MRI [**6-13**] (done for persistent fever, to r/o post-surgical
abscess) The patient is status post right frontal craniotomy and
evacuation of right frontal intra-axial hemorrhage. In
comparison with the prior MRI, there is evidence of residual
blood products and vasogenic edema at the level of the corpus
callosum and interhemispheric cistern as well as along the right
medial frontal lobes. There is persistent inferior displacement
of the septum pellucidum and narrowing of the right frontal
ventricular [**Doctor Last Name 534**]. The amount of intraventricular hemorrhage has
decreased in the interim. Restricted diffusion is again
visualized surrounding the surgical cavity and extending to the
convexity and also involving partially the left medial cerebral
hemisphere, which are also hyperintense on the T1 pre-contrast
sequence, likely related with blood products, contiguous
followup is recommended to rule out ischemic changes in these
areas. Diffuse hyperintensity signal is noted in the convexity
sulci, likely consistent with post-surgical subarachnoid
hemorrhage. After the administration of gadolinium contrast, no
significant enhancement is visualized to suggest abscess
formation. Soft tissue swelling is identified in the right
frontal region and related with the recent surgical procedure.
The orbits, the paranasal sinuses appear within normal limits.
Minimal patchy opacities are noted in the mastoid air cells.

IMPRESSION:
1. Status post right frontal craniotomy and evacuation of right
frontal hemorrhage. Persistent areas of restricted diffusion,
surrounding the surgical bed, worrisome for ischemic changes,
new areas of hyperintensity signal are demonstrated on the
T1-weighted sequence, likely consistent with blood products,
contiguous followup is recommended to rule out new ischemic
changes. Residual diffuse subarachnoid hemorrhage likely
post-surgical in nature. Decrease in the amount of the
intraventricular hemorrhage as described above. No significant
enhancement is visualized or evidence of abscess.

ANGIOGRAM [**6-17**] Written informed consent was obtained after
explaining the risks, indications, and alternative management of
the procedure. Risks explained included stroke, loss of vision
and speech whether temporary or permanent, with possible
treatment with stent and coils if needed.

After obtaining informed consent, the patient was brought to the
interventional neuroradiology suite and placed on the biplane
table in the supine position. Both groins were prepped and
draped in the usual sterile fashion. Access to the right common
femoral artery was obtained using a 19- gauge single wall needle
under local anesthesia with 1% lidocaine. Through the needle, a
0.035 [**Last Name (un) 7648**] wire was introduced and the needle was taken out.
Over the wire, a 5 French vascular sheath was placed and
connected to a saline infusion (mixed with heparin 500 units in
500 cc of saline) with a continuous drip. Through the sheath, a
4 French Berenstein catheter was introduced and connected to a
continuous saline infusion (with heparin mixture: 1000 units of
heparin in 1000 cc of saline). The following vessels were
selectively catheterized and arteriograms were performed from
these locations:

1. Left internal carotid artery.
2. Left common carotid artery.
3. Left vertebral artery.
4. Right common carotid artery.
5. Right external carotid artery.
6. Right internal carotid artery.
7. Right vertebral artery.

After review of the film, it was determined that there was mild
vasospasm of the right distal MCA branches and nonvisualization
of the right anterior cerebral artery. At this point, 5 mg of
Verapamil were administered through the right internal carotid
artery. The films were reviewed and at this point the sheath and
catheter were withdrawn and pressure was applied on the groin
until hemostasis was obtained. The procedure was uneventful and
the patient tolerated the procedure well.

FINDINGS: Upon arteriogram of the right internal carotid artery,
there is decreased perfusion over the right anterior cerebral
artery territory without visualization of the right anterior
cerebral artery. The finding could be due to severe vasospasm or
perhaps due to the obstruction due to the hemorrhage in this
region or an infarct. However, there is normal appearance of the
right M1 and M2 segments but there is mild vasospasm in the
distal right in M3 branches. The visualized distal right
internal carotid artery is unremarkable.

The right and left vertebral arteries demonstrated no high-grade
stenosis or occlusion. The posterior and anterior inferior
cerebellar arteries are within normal limits. The basilar artery
shows no high-grade stenosis or occlusion. There is normal flow
into the posterior cerebral arteries. Evaluation of the right
and left external carotid artery demonstrate normal course in
the appearance of the external carotid artery and its major
branches.

Arteriogram of the left internal carotid artery demonstrate
normal flow into the anterior and middle cerebral arteries on
the left. There is only mild cross filling into the branches of
the right ACA.

IMPRESSION: Cerebral angiogram demonstrated decreased perfusion
along the right anterior cerebral artery territory.
Nonvisualization of the right anterior cerebral artery. There is
mild vasospasm of the distal branches of the right middle
cerebral artery. 5 mg of Verapamil were administered into the
right internal carotid artery.

PATH [**6-10**] clot: SPECIMEN SUBMITTED:  Subdural clot, dura,
superficial clot ?mass, deep ? clot?mass, deep margins.

Procedure date     Tissue received     Report Date    Diagnosed
by
[**2167-6-9**] [**2167-6-10**] [**2167-6-22**] DR. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]/lo??????

DIAGNOSIS:



I.  Subdural clot, removal (A):



     A.  Organizing hemorrhage.



     B.  No malignancy identified (Cytokeratin cocktail, LCA and
HMB45 reviewed).





II.  Dura (B-C):

Fragments of dura and unremarkable bone.



III.  Superficial clot of mass (D):



     A.  Numerous vessels with thickened walls and mural
deposition of eosinophilic material (See part V for further
description).



     B.  Organizing hemorrhage.





IV.  Deep clot mass (E):



     A.  Numerous vessels with thickened walls and mural
deposition of eosinophilic material (See part V for further
description).



     B.  Organizing hemorrhage.





V.  Deep margin (F-J):



     A.  Amyloid angiopathy (see note).



     B.  Organizing hemorrhage.



     C.  Cortical [**Doctor Last Name 352**] matter with amyloid plaques (early
Alzhiemer's type neurodegenerative change)



     D.  Iron stain shows iron deposition within brain tissue
suggestive of remote hemorrhage (see slide I).



Note:  Several arteries show evidence of chronic injury
including mural thickening, adventitial fibrosis, and
reduplication of the internal elastic lamina (trichrome and
elastic stain evaluated).  There is marked deposition of
beta-amyloid (immunohistochemistry) within several
leptomeningeal and penetrating vessels and as plaques within the
[**Doctor Last Name 352**] matter brain tissue confirming the diagnosis of amyloid
angiopathy and indicating some early neurodegenerative changes
often found in Alzhiemer's disease.  GFAP immunohistochemistry
was also performed and showed a mild gliosis.


Brief Hospital Course:
68 yo man h/o DM2, [**Hospital **] transferred from OSH after presenting
with sudden onset of headaches which progressed to left-sided
weakness and decreased verbal output. Initial exam: blinks to
threat, PERRL, EOMs intact, mild left facial droop, keeps his
eyes closed; brisk reflexes on the left, left toe upgoing; does
not follow any commands; L hemiparesis; akinetic mutism. CT at
OSH showed 6.4 cm intraparenchymal bleed with compression of
lateral ventricles, blood seems to cross in the corpus callosum.
The differential diagnosis of this hemorrhagic lesion includes
an underlying mass such as a glioblastoma multiforme that
suddenly bled. Alternatively, there could be a vascular
malformation (e.g., aneurysm of the pericallosal artery, AVM,
cavernoma). An amyloid hemorrhage is less likely and a
hemorrhagic metastasis is also less likely considering the
location. Less typical for hypertensive bleed; family denies
preceding trauma.

NEURO:
-intial CTA did not show evidence of vasc malformation
-deterioration in neurological status on [**6-9**], started on
Mannitol and Decadron, required intubation, and emergency
craniotomy for evacuation of the IPH [**6-10**] and biopsy.
-Post-op course complicated by MRI/MRA brain w/ and w/o contrast
repeated [**6-14**] acute R ACA infarct, likely due to sacrificing of
vessel intraop.
-Prelim path did not show evidence of tumor, possibly vascular
malformation (ectatic veins, beta-amyloid staining pending)
-Thus he underwent a conventional [**Hospital1 **]-hemispheric cerebral angio
[**6-17**], which did not show evidence of vascular malformation,
though if there had been one it could have been removed during
surgery given that there was no longer a R ACA present.
-He was on dilantin which was discontinued [**6-15**] after EEG showed
mild encephalopathy: diffuse slowing 7 Hz esp bifrontal R > L,
no epileptiform discharges.
-He developed a fluid collection under his craniotomy site which
neurosurg evaluated and thought was just CSF leak, not requiring
intervention.
-Exam improved: much more alert, still non-verbal,
intermittently shows 2 fingers with R hand on command, dense
L-plegia, LLE ext rotated, bilat upgoing plantars
-Full code status

CVS:
-HTN was somewhat difficult to control (goal was MAP < 130, SBP
<160), though some discrepancy between art line and cuff BPs,
meds increased as follows: Valsartan 80 daily, Metoprolol 75 TID
and Amlodipine 10 daily.
-on one occasion he was switched to Labetalol and had a
hypotensive episode [**6-19**] requiring a few hours on Neosyneph

RESP:
extubated [**6-11**], he slowly weaned off shovel mask O2

FLUIDS/METABOLICS:
-ALT/AST normal on admission and then repeated on [**6-16**] to look
for evidence of acalculous cholecystitis given fever NOS, and
found to be trending upwards with ALT 123 & AST 53
-His Simvastatin 80 daily was held; he was receiving regular
Acetaminophen due to fever and so this was discontinued in favor
of Ibuprofen.
-Liver U/S [**6-17**] showed mild liver echogenicity c/w non-specific
fatty liver.
-He underwent PEG tube insertion [**6-18**]
-His insulin was held on multiple occasions due to being NPO for
PEG tube so his glycemic control has been poor.
-hypernatremia resolved with free H20, also persistently
elevated BUN around 30

HEME:
Hct stable post-PEG

ID:
persistent leucocytosis since admission, recurrent fevers for
many days with negative cultures, LP was considered but then
found to have E.Coli UTI [**6-15**] so started on Cipro until [**6-23**] and
CoNS grew at 48 hrs from CVL tip removed [**6-15**] so started on
Vanco. He subsequently defervesced.

BRIEF FLOOR COURSE [**6-20**] - [**6-25**]
Elevated LFTs as above, maximum values ALT 539 AST 251.
Hepatology was consulted. Extensive hepatitis A, B, C panel,
NH3, CMV, EBV, [**Doctor First Name **] and anti-SMA, Fe, Ferritin, TIBC all
negative, although the latter revealed some anemia of chronic
illness. U/S (including Doppler) of RUQ on [**6-17**] and repeat on
[**6-23**] negative. D/C'd acetaminophen, phenytoin, vancomycin,
statin, motrin, cefazolin, started to trend down spontaneously.
Last values on [**6-25**] were ALT 249 AST 53, consistently trending
down for four days. Most likely Dx is medication induced
transaminitis.

There we no further issues on the floor. His exam remained very
poor, opening eyes to voice, not regarding, fixing or following,
not following commands. Dense plegia on the L, no response to
noxious stimulation. Grasping reflex on R, likely representing a
frontal release sign.

Medications on Admission:
Valsartan 40mg QD
Simvastatin 80mg QD
Glipizide 5mg [**Hospital1 **]

ALL: NKDA


Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) 10 mL PO BID
(2 times a day).
2. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constip.
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) 5000
units Injection TID (3 times a day).
5. Albuterol Sulfate 2.5 mg/3 mL Solution for Nebulization Sig:
One (1)  Inhalation Q6H (every 6 hours) as needed.
6. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Insulin
Insulin schedule: NPH 40 Q12 hrs, plus SLIDING SCALE.
8. Labetalol 100 mg Tablet Sig: 0.5 Tablet PO TID (3 times a
day).
9. Valsartan 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for thrush.
11. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
TID (3 times a day) as needed for skin irritation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Hospital of [**Location (un) **] & Islands - [**Location (un) 6251**]

Discharge Diagnosis:
1 Large R frontal intracranial hemorrhage
2 R anterior  cerebral artery infarction
3 Medication induced transaminitis
4 E Coli urinary tract infection
5 PEG placement [**6-18**]
6 CNS Line sepsis


Discharge Condition:
Stable. For details please see [**Hospital **] hospital course' inthe D/C
summary. Monitor LFTs.


Discharge Instructions:
You have been admitted with a R frontal bleed, which eventually
needed urgent evacuation. The surgery was complicated by a
stroke.

Please take all your medications excactly as directed and please
attend all your follow-up appointments.

Please report to the nearest ER or call 911 or your [**Hospital 3390**]
immediately when you experience recurrence of weakness,
numbness, tingling, problems with vision, speech, language,
walking, thinking, headache, or difficulties arousing, or any
other signs or symptoms of concern.

Followup Instructions:
Please call [**Telephone/Fax (1) 78610**] for a follow-up appointment with Stroke
Service if the rehabilitation doctors [**Name5 (PTitle) **] your [**Name5 (PTitle) 3390**] find it
indicated as well as feasible.


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

Completed by:[**2167-6-25**]
{'Thrombocytopenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified intracranial hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Iatrogenic cerebrovascular infarction or hemorrhage,Other and unspecified infection due to central venous catheter,Sepsis,Unspecified septicemia,Urinary tract infection, site not specified'}


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 sided weakness

PRESENT ILLNESS: 68 yo man h/o DM2, [**Hospital **] transferred from OSH after presenting
with sudden onset of headache, left sided weakness and decreased
verbal output.

MEDICAL HISTORY: DM2
HTN
gout
[**Hospital1 3390**] [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7568**], [**Location (un) 5503**], MA

MEDICATION ON ADMISSION: Valsartan 40mg QD
Simvastatin 80mg QD
Glipizide 5mg [**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T- 97.5  BP- 157/79  HR- 74  RR- 16  100 O2Sat RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: supple, no carotid or vertebral bruit
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with wife [**Name (NI) 47532**] [**Telephone/Fax (1) 78608**] (home), [**Telephone/Fax (1) 78609**]
(cell), two daughters also nearby.  No tob, ~2 drinks/wk, no
drugs.  Retired delivery truck driver. 

### Response:
{'Thrombocytopenia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified intracranial hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Iatrogenic cerebrovascular infarction or hemorrhage,Other and unspecified infection due to central venous catheter,Sepsis,Unspecified septicemia,Urinary tract infection, site not specified'}
