CHIEF COMPLAINT: change in behavior and left sided neglect

PRESENT ILLNESS: 83y/o female p/w above symptoms to [**Hospital 8**] [**Hospital 1263**] Hospital.
She is a resident of Nursing home ([**First Name5 (NamePattern1) 18404**] [**Last Name (NamePattern1) 69170**] Nrs Home,
[**Telephone/Fax (1) 69171**]) with baseline function of verbal with good sense
of humor, wheel chair but can eat by herself. Caregiver noticed
that she has been odd in the way of response in
conversation over the 3days. Today, they noticed that patient
did not pay attendtion to the person who stood left side of her,
and also she did not responded when she was touched her left
side of the body. She was brought into [**Hospital 1263**] Hospital, where
she was found to have Rt thalamic hemorrhage (3.2 x 2.6cm) and a
focus of hyperdensity at left frontal lobe. The lateral
ventricles were prominent, possible hydrocephalus. She was
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: HTN
hyperlipidemia
Pacemaker
schizophrenia
dementia
hypothyroidism

MEDICATION ON ADMISSION: Atenolol 25mg po daily
Lipitor 41mg po daily
Levothyroxine 100mcg po daily
Omeprazol 20mg po daily
Enulose syrup 30ml [**Hospital1 **]
Ferrous sulfate 325mg po bid
Remeron 15mg po QHS
Ativan 0.5mg QHS
Hydrocodone/APAP 5/500mg 1 Tab po q8h prn pain
Senna, Bisacodyl, Docusate, Milk of magnesia 30ml po daily prn
Actonel 35mg po weekly on empty stomach

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission exam:
T-97.0 BP-141/52 HR-58, reg RR- 23 SaO2 97%, r/a
Gen: Awake, no distress
HEENT: clear ears, conjunctivas, oral membrane, no neck bruit,
no goiter
Neck: no rigidity
Chest: vesicular sound, symmetrical, symmetrical chest
Heart: S1, S2 nl, no murmur
Abd: soft but slightly distended w/o tenderness, no mass, had
sagittal scar (umbilicus removed) with one puncture scarring
(most likely drainage wound). Hepatosplenomegaly not appreciated
but difficult to exam due to sl distention.
Skin: no lesions, skin stigmata, moist, turgor nl
Exts: cotracture at bilateral knee.

FAMILY HISTORY: NC

SOCIAL HISTORY: From [**Hospital3 **]. HCP is sister who lives in the area.
Intracerebral hemorrhage,Urinary tract infection, site not specified,Other persistent mental disorders due to conditions classified elsewhere,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension
Intracerebral hemorrhage,Urin tract infection NOS,Mental disor NEC oth dis,Pure hypercholesterolem,Hypothyroidism NOS,Hypertension NOS
Admission Date:  [**2104-8-17**]              Discharge Date:   [**2104-8-20**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
change in behavior and left sided neglect

Major Surgical or Invasive Procedure:
none

History of Present Illness:
83y/o female p/w above symptoms to [**Hospital 8**] [**Hospital 1263**] Hospital.
She is a resident of Nursing home ([**First Name5 (NamePattern1) 18404**] [**Last Name (NamePattern1) 69170**] Nrs Home,
[**Telephone/Fax (1) 69171**]) with baseline function of verbal with good sense
of humor, wheel chair but can eat by herself. Caregiver noticed
that she has been odd in the way of response in
conversation over the 3days. Today, they noticed that patient
did not pay attendtion to the person who stood left side of her,
and also she did not responded when she was touched her left
side of the body. She was brought into [**Hospital 1263**] Hospital, where
she was found to have Rt thalamic hemorrhage (3.2 x 2.6cm) and a
focus of hyperdensity at left frontal lobe. The lateral
ventricles were prominent, possible hydrocephalus. She was
transferred to [**Hospital1 18**] for further management.

ROS: No fever, vomiting, diarrhea, pain, headache.

Past Medical History:
HTN
hyperlipidemia
Pacemaker
schizophrenia
dementia
hypothyroidism


Social History:
From [**Hospital3 **]. HCP is sister who lives in the area.

Family History:
NC

Physical Exam:
Admission exam:
T-97.0 BP-141/52 HR-58, reg RR- 23 SaO2 97%, r/a
Gen: Awake, no distress
HEENT: clear ears, conjunctivas, oral membrane, no neck bruit,
no goiter
Neck: no rigidity
Chest: vesicular sound, symmetrical, symmetrical chest
Heart: S1, S2 nl, no murmur
Abd: soft but slightly distended w/o tenderness, no mass, had
sagittal scar (umbilicus removed) with one puncture scarring
(most likely drainage wound). Hepatosplenomegaly not appreciated
but difficult to exam due to sl distention.
Skin: no lesions, skin stigmata, moist, turgor nl
Exts: cotracture at bilateral knee.

NEURO
MS Awake w/o any stimuli, did not respond to the question (name,
place, how are you feeling), did not follow any simple command
(lift your leg, squeeze your hand). Respond to the voice said
muffling sound and one word able to pick was "help".

CN: Fundus normal disc margin. Eyes deviated to the right, no
nystagmus, oculocephalic reflex could not break deviation.
Symmetrical NLF, mouth angle, normal gag reflexes, uvula at
midline. Smacking movement at mouth. SCM seemed to be normal
bulk, strength

Motor: Spontaneous anti gravity movement at rt arm, grasped
examiner's fingers (unrelated to the command). Rt toe wiggling
(unrelated to the command), left arm, leg showed no spontaneous
movement). Cog-wheel like rigidity at LUE and LLE (knees had
contracture)

Reflex:
   [**Hospital1 **] Tri BR Pat [**Doctor First Name **]
Rt 2  2   2  2   2
Lt 3  3   3  3   3   no foot clonus. Bil planters going down.

Sensory: No withdrawal to all extremities. Grimace on facial
anoxic stimuli.

Pertinent Results:
CBC: 8.4  >11.0/31.6<  146
Diff N:76 Band:6 L:10 M:5 E:2 Bas:0 Metas: 1

140  105  22  215    AGap=18
------------------
4.0  21  1.1
CK: 28  MB: 2  Trop-*T*: <0.01

PT: 13.4  PTT: 29.1  INR: 1.2

NCHCT: FINDINGS: There is a large 4cm hemorrhagic focus lying
within the right thalamus tracking into the ventricles with
moderate amount of blood layering within the occipital horns
(right greater than left). There is brain atrophy as indicated
by enlarged sulci and cisterns, but the marked enlargement of
the ventricles and appearance of the third ventricle indicates
superimposed hydrocephalus. Fourth ventricle is within normal
limits. Small amount of adjacent subarachnoid hemorrhage is
present within the right parietal lobe. More chronic changes are
also present including periventricular white matter
hypodensities representing the sequela of chronic small vessel
infarction, a previous left frontal infarct, and prior lacunar
infarcts bilaterally in the basal ganglia.

A second tiny 5 mm high density, likely hemorrhagic focus is
also identified within the convexity of the left frontoparietal
cortex. Underlying neoplasm and ischemia cannot be excluded for
the above findings.

IMPRESSION:
1. Large 4 cm hemorrhage centered in the right thalamus tracking
into the occipital horns bilaterally with hydrocephalus.
2. 5-mm left frontoparietal convexity high density, (likely
hemorrhagic)
Underlying neoplasm and ischemia cannot be excluded. When
patient's condition stabilizes, evaulation with MR would provide
further clarification.


Brief Hospital Course:
83y/o woman with dementia who presented with right thalamic
hemorrhage and left frontoparietal convexity focus (unclear if
neoplasm, ischemia, or bleed). Considering her etiology, and
current and BP at OSH (SBP 140's) differential diagnosis
included hypertensive versus amyloid bleed. MRI/MRA was the
preferrable evaluation but could not be done due to hx of Pacer.
PMH of HTN, hyperlipidemia suggested possibility of ischemia at
left frontal lobe, but considering large bleeding, aspirin was
held. Patient was admitted to the ICU for blood pressure
management. She was treated for a urinary tract infection with
Ciprofloxacin. Cardiac enzymes were negative x3. Patient was
doing when when on morning of [**8-19**] patient had increased
difficulty breathing. Concern was for aortic dissection given
unusual pattern of calcification of the aortic arch on CXR.
Also, resolving LLL infiltrate suggested possible pneumonia.
Patient's next of [**Doctor First Name **] was contact[**Name (NI) **] regarding code status and
stated that patient would not have wanted extraordinary measures
including intubation or resuscitation. Furthermore, patient's
sister expressed that the patient would have wanted to be made
comfortable in this situation. Patient was subsequently made CMO
code status and transferred to the floor. She expired from
respiratory failure on [**2104-8-20**].


Medications on Admission:
Atenolol 25mg po daily
Lipitor 41mg po daily
Levothyroxine 100mcg po daily
Omeprazol 20mg po daily
Enulose syrup 30ml [**Hospital1 **]
Ferrous sulfate 325mg po bid
Remeron 15mg po QHS
Ativan 0.5mg QHS
Hydrocodone/APAP 5/500mg 1 Tab po q8h prn pain
Senna, Bisacodyl, Docusate, Milk of magnesia 30ml po daily prn
Actonel 35mg po weekly on empty stomach


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Primary cause of death: Respiratory failure
Secondary cause of death: Right thalamic hemorrhage

Discharge Condition:
Expired

Discharge Instructions:
N/A

Followup Instructions:
N/A

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

Completed by:[**2104-9-7**]
{'Intracerebral hemorrhage,Urinary tract infection, site not specified,Other persistent mental disorders due to conditions classified elsewhere,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}


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: change in behavior and left sided neglect

PRESENT ILLNESS: 83y/o female p/w above symptoms to [**Hospital 8**] [**Hospital 1263**] Hospital.
She is a resident of Nursing home ([**First Name5 (NamePattern1) 18404**] [**Last Name (NamePattern1) 69170**] Nrs Home,
[**Telephone/Fax (1) 69171**]) with baseline function of verbal with good sense
of humor, wheel chair but can eat by herself. Caregiver noticed
that she has been odd in the way of response in
conversation over the 3days. Today, they noticed that patient
did not pay attendtion to the person who stood left side of her,
and also she did not responded when she was touched her left
side of the body. She was brought into [**Hospital 1263**] Hospital, where
she was found to have Rt thalamic hemorrhage (3.2 x 2.6cm) and a
focus of hyperdensity at left frontal lobe. The lateral
ventricles were prominent, possible hydrocephalus. She was
transferred to [**Hospital1 18**] for further management.

MEDICAL HISTORY: HTN
hyperlipidemia
Pacemaker
schizophrenia
dementia
hypothyroidism

MEDICATION ON ADMISSION: Atenolol 25mg po daily
Lipitor 41mg po daily
Levothyroxine 100mcg po daily
Omeprazol 20mg po daily
Enulose syrup 30ml [**Hospital1 **]
Ferrous sulfate 325mg po bid
Remeron 15mg po QHS
Ativan 0.5mg QHS
Hydrocodone/APAP 5/500mg 1 Tab po q8h prn pain
Senna, Bisacodyl, Docusate, Milk of magnesia 30ml po daily prn
Actonel 35mg po weekly on empty stomach

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Admission exam:
T-97.0 BP-141/52 HR-58, reg RR- 23 SaO2 97%, r/a
Gen: Awake, no distress
HEENT: clear ears, conjunctivas, oral membrane, no neck bruit,
no goiter
Neck: no rigidity
Chest: vesicular sound, symmetrical, symmetrical chest
Heart: S1, S2 nl, no murmur
Abd: soft but slightly distended w/o tenderness, no mass, had
sagittal scar (umbilicus removed) with one puncture scarring
(most likely drainage wound). Hepatosplenomegaly not appreciated
but difficult to exam due to sl distention.
Skin: no lesions, skin stigmata, moist, turgor nl
Exts: cotracture at bilateral knee.

FAMILY HISTORY: NC

SOCIAL HISTORY: From [**Hospital3 **]. HCP is sister who lives in the area. 

### Response:
{'Intracerebral hemorrhage,Urinary tract infection, site not specified,Other persistent mental disorders due to conditions classified elsewhere,Pure hypercholesterolemia,Unspecified acquired hypothyroidism,Unspecified essential hypertension'}
