CHIEF COMPLAINT: Transfer from outside hospital after iv tPA for Left Hemiplegia

PRESENT ILLNESS: Ms. [**Known lastname **] is a 34yo F with stage IIIa NSCLC discharged from
[**Hospital1 18**] yesterday with admitting complaint of N/V who now presents
with suddent onset left sided weakness. Pt does not remember
events which occurred earlier today. Per report of OSH records,
pt was at home today and had sudden onset left sided weakness.
Taken to OSH where NIHSS 20. She was given 5mg IVtPA at 7:20pm
followed by 45mg infusion over 60minutes and med-flighted to
[**Hospital1 18**] for further management. On arrival pt was alert and
oriented to person, place, "today is super bowl Sunday," +
dysarthric, unable to elucidate details of what happened to her
earlier. NIHSS her was 19 for R conjugate eye deviation, dense
left upper and lower extremity hemiplegia with hemibody sensory
loss. She was taken to the CT scan which did not reveal
intracranial hemorrhage, but confirmed near total R MCA
territory occlusion. Given risk for reperfusion injury the
patient was not
taken to the interventional suite for angiography or clot
retrieval. While in the ED, the pt's L arm and leg was noted to
have tremor. Given IV ativan 2mg for possible seizure.

MEDICAL HISTORY: Stage IIIA nonsmall cell lung cancer
Infected cavitary lesion in the right upper lobe
Heavy tob use
.
TREATMENT:
1) Started radiation therapy [**2125-12-10**]
2) Status post 1 cycle of cisplatin 50 mg/m2 day 1,8 and
etoposide 50 mg/m2 days [**12-22**]
3) Tentatively to start cycle 2 on [**2126-1-14**] (now postponed)

MEDICATION ON ADMISSION: 1. Docusate Sodium 100 mg PO BID
2. Senna 8.6 mg Tablet PO BID
3. Metronidazole 500 mg PO TID
4. Fluconazole 200 mg (2) Tablet PO once a day
5. Pantoprazole 40 mg PO Q24H
6. Levofloxacin 500 mg PO DAILY
8. Combivent
9. Nystatin 100,000 unit/mL (5) mL PO QID for thrush
10. Ativan 0.5 mg PO every (8) PRN nausea.
11. Compazine 10 mg Tablet PO q6-8 PRN nausea.
12. Oxycodone 5 mg 1-2 Tablets PO Q6H PRN pain
13. Zofran 4 mg Q8hrs PRN nausea

ALLERGIES: Penicillins

PHYSICAL EXAM: Gen- acutely ill appearing
HEENT: R gaze dev, + bleeding mucosal lesions
NECK: no carotid bruits bilaterally
CV: RRR, no MRG
PULM: scattered rhonci throughout
Abd: soft, NT, ND
Extrem: no CCE, no rash

FAMILY HISTORY: NC

SOCIAL HISTORY: The patient started smoking cigarettes at age 11 or 12. She
smoked until age 34 with an average of two pack per day that
accounts for a 44-pack-year history of smoking. She has a steady
boyfriend with whom she has been actively trying to conceive up
until diagnosis. Been seen at IVF [**Location (un) 86**] for possibility
freezing embryos prior to chemo.
Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Other cerebral degeneration
Crbl art ocl NOS w infrc,Pneumonia, organism NOS,Mal neo bronch/lung NEC,Cereb degeneration NEC
Admission Date:  [**2126-1-21**]              Discharge Date:   [**2126-1-22**]

Date of Birth:  [**2091-8-29**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
Transfer from outside hospital after iv tPA for Left Hemiplegia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname **] is a 34yo F with stage IIIa NSCLC discharged from
[**Hospital1 18**] yesterday with admitting complaint of N/V who now presents
with suddent onset left sided weakness. Pt does not remember
events which occurred earlier today. Per report of OSH records,
pt was at home today and had sudden onset left sided weakness.
Taken to OSH where NIHSS 20. She was given 5mg IVtPA at 7:20pm
followed by 45mg infusion over 60minutes and med-flighted to
[**Hospital1 18**] for further management. On arrival pt was alert and
oriented to person, place, "today is super bowl Sunday," +
dysarthric, unable to elucidate details of what happened to her
earlier. NIHSS her was 19 for R conjugate eye deviation, dense
left upper and lower extremity hemiplegia with hemibody sensory
loss. She was taken to the CT scan which did not reveal
intracranial hemorrhage, but confirmed near total R MCA
territory occlusion. Given risk for reperfusion injury the
patient was not
taken to the interventional suite for angiography or clot
retrieval. While in the ED, the pt's L arm and leg was noted to
have tremor. Given IV ativan 2mg for possible seizure.

ROS: + severe headache. unable to elicit a full ROS.


Past Medical History:
Stage IIIA nonsmall cell lung cancer
Infected cavitary lesion in the right upper lobe
Heavy tob use
.
TREATMENT:
1) Started radiation therapy [**2125-12-10**]
2) Status post 1 cycle of cisplatin 50 mg/m2 day 1,8 and
etoposide 50 mg/m2 days [**12-22**]
3) Tentatively to start cycle 2 on [**2126-1-14**] (now postponed)


Social History:
The patient started smoking cigarettes at age 11 or 12. She
smoked until age 34 with an average of two pack per day that
accounts for a 44-pack-year history of smoking. She has a steady
boyfriend with whom she has been actively trying to conceive up
until diagnosis. Been seen at IVF [**Location (un) 86**] for possibility
freezing embryos prior to chemo.


Family History:
NC

Physical Exam:
Gen- acutely ill appearing
HEENT: R gaze dev, + bleeding mucosal lesions
NECK: no carotid bruits bilaterally
CV: RRR, no MRG
PULM: scattered rhonci throughout
Abd: soft, NT, ND
Extrem: no CCE, no rash

NEUROLOGIC EXAM:
MS: alert, oriented to place, "super bowl sunday," +
inattention, falls asleep frequently during exam, + dysarthria,
unable to test naming.

CN: PERRL 3-->2mm bilaterally, R gaze deviation, R head turn,
able to cross the midline, no nystagmus, ? R sided field cut but
this is difficult to verify, left UMN facial droop, tongue at
midline.

Motor: Dense flaccid left hemiplegia. right hemibody is full
strength.

Sensory: absent on left hemibody to light touch, pinprick or
noxious.

Plantar Response: no response on left, downgoing on R.

Reflexes: 3+ on the left, 2 on the right.

Coordination: not tested

Gait: not tested as pt critically ill.


Pertinent Results:
[**2126-1-22**] 03:01AM BLOOD WBC-6.3 RBC-2.70* Hgb-8.6* Hct-25.8*
MCV-96 MCH-31.9 MCHC-33.3 RDW-16.6* Plt Ct-342
[**2126-1-20**] 09:31PM BLOOD Neuts-88.1* Lymphs-9.4* Monos-0.5*
Eos-2.0 Baso-0.1
[**2126-1-20**] 09:31PM BLOOD PT-11.5 PTT-22.9 INR(PT)-1.0
[**2126-1-20**] 09:31PM BLOOD Glucose-93 UreaN-18 Creat-0.7 Na-134
K-3.5 Cl-96 HCO3-28 AnGap-14
[**2126-1-21**] 04:13AM BLOOD Glucose-86 UreaN-12 Creat-0.8 Na-141
K-3.8 Cl-103 HCO3-28 AnGap-14
[**2126-1-22**] 03:01AM BLOOD Glucose-184* UreaN-8 Creat-0.6 Na-143
K-3.6 Cl-107 HCO3-28 AnGap-12
[**2126-1-21**] 12:02PM BLOOD CK(CPK)-51
[**2126-1-21**] 12:02PM BLOOD cTropnT-<0.01
[**2126-1-22**] 03:01AM BLOOD Calcium-8.8 Phos-4.6* Mg-1.7
[**2126-1-21**] 12:02PM BLOOD Iron-158 Cholest-149
[**2126-1-21**] 12:02PM BLOOD calTIBC-195* Ferritn-396* TRF-150*
[**2126-1-21**] 12:02PM BLOOD Triglyc-157* HDL-40 CHOL/HD-3.7
LDLcalc-78

CXR:
1. Endotracheal tube tip 2.5 cm from the carina.
2. Cavitary lesion in the right lung apex, consistent with
diagnosis of lung cancer.

HCT [**1-20**]:
Limited study. Loss of [**Doctor Last Name 352**] white matter differentiation in the
right parietal and occipital lobe raises concern for acute right
MCA and PCA territory infarction. No hemorrhage

HCT [**1-21**]:
Since [**2126-1-20**], evolution of large infarct involving the majority
of the right cerebrum with sparing of the right ACA territory.
This finding suggests that there is likely a fetal right
posterior cerebral artery. The sparing of the right thalamus
suggests that it may be supplied by an artery of Percheron
arising from the left.


Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the ICU for closer monitoring. A long
discussion with her family took place to clarify the goals of
care. Her likely course including significant intracerebral
edema and herniation were explained. Her family clearly stated
that they did not want a craniotomy. She was therefore continued
on mannitol. The following morning, she was able to follow
simple commands on the R side, however later that day, she
pupils became unresponsive and she did not follow commands. The
repeat CT showed worsening edema and beginnings of herniation.
These findings were discussed with her family and they
re-iterated their desire not to take her to the OR. Her mannitol
was increased. Over the night she developed increasingly dilated
pupils. On exam in the morning, her pupils were fixed and
dilated and she had no corneal or gag reflex. These findings and
the fact that she was herniating was discussed with her family
again. They decided to make her CMO that afternoon. She died
shortly after extubation.

Medications on Admission:
1. Docusate Sodium 100 mg PO BID
2. Senna 8.6 mg Tablet PO BID
3. Metronidazole 500 mg PO TID
4. Fluconazole 200 mg (2) Tablet PO once a day
5. Pantoprazole 40 mg PO Q24H
6. Levofloxacin 500 mg PO DAILY
8. Combivent
9. Nystatin 100,000 unit/mL (5) mL PO QID for thrush
10. Ativan 0.5 mg PO every (8) PRN nausea.
11. Compazine 10 mg Tablet PO q6-8 PRN nausea.
12. Oxycodone 5 mg 1-2 Tablets PO Q6H PRN pain
13. Zofran 4 mg Q8hrs PRN nausea


Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
Stroke, Cerebral herniation, lung cancer, PNA

Discharge Condition:
Expired

Discharge Instructions:
NA

Followup Instructions:
NA

                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Other cerebral degeneration'}


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: Transfer from outside hospital after iv tPA for Left Hemiplegia

PRESENT ILLNESS: Ms. [**Known lastname **] is a 34yo F with stage IIIa NSCLC discharged from
[**Hospital1 18**] yesterday with admitting complaint of N/V who now presents
with suddent onset left sided weakness. Pt does not remember
events which occurred earlier today. Per report of OSH records,
pt was at home today and had sudden onset left sided weakness.
Taken to OSH where NIHSS 20. She was given 5mg IVtPA at 7:20pm
followed by 45mg infusion over 60minutes and med-flighted to
[**Hospital1 18**] for further management. On arrival pt was alert and
oriented to person, place, "today is super bowl Sunday," +
dysarthric, unable to elucidate details of what happened to her
earlier. NIHSS her was 19 for R conjugate eye deviation, dense
left upper and lower extremity hemiplegia with hemibody sensory
loss. She was taken to the CT scan which did not reveal
intracranial hemorrhage, but confirmed near total R MCA
territory occlusion. Given risk for reperfusion injury the
patient was not
taken to the interventional suite for angiography or clot
retrieval. While in the ED, the pt's L arm and leg was noted to
have tremor. Given IV ativan 2mg for possible seizure.

MEDICAL HISTORY: Stage IIIA nonsmall cell lung cancer
Infected cavitary lesion in the right upper lobe
Heavy tob use
.
TREATMENT:
1) Started radiation therapy [**2125-12-10**]
2) Status post 1 cycle of cisplatin 50 mg/m2 day 1,8 and
etoposide 50 mg/m2 days [**12-22**]
3) Tentatively to start cycle 2 on [**2126-1-14**] (now postponed)

MEDICATION ON ADMISSION: 1. Docusate Sodium 100 mg PO BID
2. Senna 8.6 mg Tablet PO BID
3. Metronidazole 500 mg PO TID
4. Fluconazole 200 mg (2) Tablet PO once a day
5. Pantoprazole 40 mg PO Q24H
6. Levofloxacin 500 mg PO DAILY
8. Combivent
9. Nystatin 100,000 unit/mL (5) mL PO QID for thrush
10. Ativan 0.5 mg PO every (8) PRN nausea.
11. Compazine 10 mg Tablet PO q6-8 PRN nausea.
12. Oxycodone 5 mg 1-2 Tablets PO Q6H PRN pain
13. Zofran 4 mg Q8hrs PRN nausea

ALLERGIES: Penicillins

PHYSICAL EXAM: Gen- acutely ill appearing
HEENT: R gaze dev, + bleeding mucosal lesions
NECK: no carotid bruits bilaterally
CV: RRR, no MRG
PULM: scattered rhonci throughout
Abd: soft, NT, ND
Extrem: no CCE, no rash

FAMILY HISTORY: NC

SOCIAL HISTORY: The patient started smoking cigarettes at age 11 or 12. She
smoked until age 34 with an average of two pack per day that
accounts for a 44-pack-year history of smoking. She has a steady
boyfriend with whom she has been actively trying to conceive up
until diagnosis. Been seen at IVF [**Location (un) 86**] for possibility
freezing embryos prior to chemo. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Pneumonia, organism unspecified,Malignant neoplasm of other parts of bronchus or lung,Other cerebral degeneration'}
