CHIEF COMPLAINT: Bilateral leg weakness

PRESENT ILLNESS: Patient is a 66 year-old right-handed man with past medical
history of back injury 36years ago, coronary artery disease
status post CABG four years ago who presented to [**Hospital1 18**] ED on
[**2104-11-1**] with bilateral leg weakness and backache, with onset ten
days prior to admission and worsening over the three days
leading up to admission. He was in his usual state of health
until ten days prior to admission, when patient twisted his
lower back when he was standing in the bus, when it turned. He
noticed sharp shooting pain thru his legs bilaterally. Paint was
transient at that time and was followed by numbness. The
symptoms got worse three days prior to admission with bilateral
leg numbness, pain, weakness, and difficulty with ambulation.
Patient stayed in the bed. Noted difficulty with urination two
days prior to admission and no bowel movement for three days.

MEDICAL HISTORY: Inflammatory disease of the spinal cord
Right frontal lobe lesion
Abnormal visual evoked potentials
Status post brain biopsy of right frontal lobe lesion
Pulmonary embolus
Status post IVC filter placement
Asthma
Coronary artery disease
Status post liver surgery for liver laceration following stab
wound
Chronic back pain
Vitiligo

MEDICATION ON ADMISSION: 1. Oxycodone/APAP 5/325mg po prn
2. Lisinopril 10 mg QD
3. Singulair 10 mg QD
4. Toprol XL 50 mg QD
5. Omeprazole 20 mg QD
6. Lipitor 20mg QD
7. Advair diskus 500/50 QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T-98.9 BP-120/85 HR-106, reg RR-20 SaO2 97% on room air
Gen: Awake, alert, no distress.
HEENT: Clear ears, conjunctivas, oral membrane, no neck bruit,
no goiter.
Chest: Vesicular sound, symmetrical, symmetrical chest.
Heart: S1, S2 nl, no murmur.
Abd: Soft nt/nd, no hepatosplenomegaly.
Skin: No lesions, skin stigmata.
Exts: No clubbing, cyanosis, or edema.

FAMILY HISTORY: No stroke, aneurysm, no seizure, no AAA.

SOCIAL HISTORY: Patient lives alone and is divorced. Has 3 healthy children.
Retired due to back pain, used to work as [**Doctor Last Name 9808**] driver.
Unspecified causes of encephalitis, myelitis, and encephalomyelitis,Multiple sclerosis,Other pulmonary embolism and infarction,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Paraplegia,Constipation, unspecified,Abdominal pain, generalized,Acute (transverse) myelitis NOS,Prostatitis, unspecified,Vitiligo,Aortocoronary bypass status,Asthma, unspecified type, unspecified,Long-term (current) use of steroids
Encephalitis NOS,Multiple sclerosis,Pulm embol/infarct NEC,React-indwell urin cath,Urin tract infection NOS,Paraplegia NOS,Constipation NOS,Abdmnal pain generalized,Acute myelitis NOS,Prostatitis NOS,Vitiligo,Aortocoronary bypass,Asthma NOS,Long-term use steroids
Admission Date:  [**2104-11-1**]              Discharge Date:   [**2104-12-4**]

Date of Birth:  [**2038-4-1**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4583**]
Chief Complaint:
Bilateral leg weakness


Major Surgical or Invasive Procedure:
Lumbar puncture
IVC filter placement
Open right frontal brain biopsy


History of Present Illness:
Patient is a 66 year-old right-handed man with past medical
history of back injury 36years ago, coronary artery disease
status post CABG four years ago who presented to [**Hospital1 18**] ED on
[**2104-11-1**] with bilateral leg weakness and backache, with onset ten
days prior to admission and worsening over the three days
leading up to admission. He was in his usual state of health
until ten days prior to admission, when patient twisted his
lower back when he was standing in the bus, when it turned. He
noticed sharp shooting pain thru his legs bilaterally. Paint was
transient at that time and was followed by numbness. The
symptoms got worse three days prior to admission with bilateral
leg numbness, pain, weakness, and difficulty with ambulation.
Patient stayed in the bed. Noted difficulty with urination two
days prior to admission and no bowel movement for three days.

Patient has had chronic backaches and occasional/transient
numbness at legs for past 36 years since he injured his lower
back by slipping and falling when he carried bananas back in
[**Country 3594**]. Approximately twenty years ago, patient was diagnosed
with "spine compression" while in [**Country 3594**]. He was later
followed at [**Hospital1 112**] since about 10 years ago for his back pain and
occasional numbness.

On review of systems, reports no fever, headache, neckache,
diarrhea, vomiting, recent travel, tick bites, other traumatic
episodes.

Past Medical History:
Inflammatory disease of the spinal cord
Right frontal lobe lesion
Abnormal visual evoked potentials
Status post brain biopsy of right frontal lobe lesion
Pulmonary embolus
Status post IVC filter placement
Asthma
Coronary artery disease
Status post liver surgery for liver laceration following stab
wound
Chronic back pain
Vitiligo


Social History:
Patient lives alone and is divorced. Has 3 healthy children.
Retired due to back pain, used to work as [**Doctor Last Name 9808**] driver.


Family History:
No stroke, aneurysm, no seizure, no AAA.

Physical Exam:
Vitals: T-98.9 BP-120/85 HR-106, reg RR-20 SaO2 97% on room air
Gen: Awake, alert, no distress.
HEENT: Clear ears, conjunctivas, oral membrane, no neck bruit,
no goiter.
Chest: Vesicular sound, symmetrical, symmetrical chest.
Heart: S1, S2 nl, no murmur.
Abd: Soft nt/nd, no hepatosplenomegaly.
Skin: No lesions, skin stigmata.
Exts: No clubbing, cyanosis, or edema.

NEURO:
Mental status: Awake and alert, cooperative with exam, normal
affect. Oriented to person, place, and date. Attentive; able to
name of the days of week backwards smoothly. Speech is fluent
with normal comprehension and repetition. No dysarthria. [**Location (un) **]
intact. Registers [**4-11**], recalls [**3-14**] in 10 minutes.  No right-left
confusion. No evidence of apraxia or neglect.

Cranial nerves: Visual acuity 20/200 w/o glasses, 20/25 w/
glasses bilaterally. Fundi with clear margins with normal color
of disc. No red desaturation. Visual fields full, both at mono-,
binocular testings).Pupils round, equal, and reactive to light,
4mm to 3mm. Symmetrical facial sensation and appearance. Palate
and uvula midline. Tongue full strength.

Motor: Upper extremity strength is full throughout with normal
tone. In the lower extremities, there is a flaccid paralysis.

Reflexes: Absent at patella and achilles bilaterally. Planters
mute. Upper extremity reflexes are present and symmetric.

Sensory: Sensory level to pin to ~T8 anteriorly. No vibratory,
position sense, or ability to appreciate light touch from pelvis
down.

Coordination: Normal on finger-nose-finger with no
dysdiadochokinesia. Heel shin unable to perform.

Gait: Unable to assess.

Pertinent Results:
Labs on admission:
-WBC-8.4 RBC-5.57# HGB-18.4*# HCT-51.1# MCV-92 MCH-33.1*
MCHC-36.1* RDW-14.2 PLT COUNT-167 with diff NEUTS-76.8*
LYMPHS-14.5* MONOS-6.6 EOS-1.9 BASOS-0.1.
-GLUCOSE-101 UREA N-16 CREAT-1.0 SODIUM-144 POTASSIUM-4.2
CHLORIDE-108 TOTAL CO2-21* ANION GAP-19
-CRP-11.0*  TSH-0.73
-CHOLEST-147 TRIGLYCER-101 HDL CHOL-41 CHOL/HDL-3.6 LDL(CALC)-86
-IRON-79 calTIBC-316 VIT B12-668 FOLATE-13.2 FERRITIN-118
TRF-243
ALBUMIN-4.1
-----
Lumbar puncture with 32 wbc with 89% lymphocytes and 12%
monocytes, protein of 82 and glucose of 75. CSF culture
negative.
-----
Flow cytometry CSF [**11-3**]: No monotypic B-cell population
identified; most lymphocytes in the specimen are represent by
CD4 positive T-cells.
-----
Cytology CSF [**11-3**]: NEGATIVE FOR MALIGNANT CELLS.  Lymphocytes
with reactive changes and monocytes.

-----
IMAGING:
[**11-1**] MRI T spine: Increased signal in the distal spinal cord
indicating cord edema. Subtle irregularity suspicious for flow
voids on the surface of the cord and this finding could indicate
arteriovenous fistula or AVM. No intrinsic hemorrhage is seen
within the spinal cord. Further evaluation with gadolinium
enhanced MRI of the thoracic spine is recommended. Findings were
conveyed to the neurology resident taking care of the patient at
the time of interpretation of this study.

[**11-1**] MRI L spine: Mild multilevel degenerative changes without
spinal stenosis or disc herniation. There are no MRI findings to
explain patient's lower extremity paralysis. Please also see the
thoracic spine MRI of the same day for further evaluation.

[**11-1**] Abd US: No evidence of abdominal aortic aneurysm.

[**11-1**] MRI T spine w/contrast: The increased signal in the distal
spinal cord is confirmed on T2 axial images. However, no
evidence of abnormal vascular enhancement seen along the surface
of the cord or to suggest arteriovenous malformation. MRA of the
spine or spinal angiogram would help for further assessment as
clinically indicated.

[**11-2**] CXR: no cardiopulmonary process

[**11-2**] MRI Head w/&w/o contrast: Multiple T2 signal white matter
abnormalities, some of which enhance. These findings may be the
same process that is occurring within the distal thoracic spinal
cord described on the [**2104-11-1**] examination. The differential
includes an inflammatory versus an infectious process. This
could include a demyelinating process such as multiple
sclerosis, or an infectious process such as Lyme disease.
Vasculitis is also a consideration.

[**11-4**] ECHO: The left atrium is elongated. No atrial septal defect
or patent foramen ovale is seen by 2D, color Doppler or saline
contrast with maneuvers. There is mild symmetric left
ventricular hypertrophy. There is moderate to severe global left
ventricular hypokinesis (ejection fraction 30 percent). No
masses or thrombi are seen in the left ventricle. There is no
ventricular septal defect.  Right ventricular chamber size and
free wall motion are normal. The aortic root is moderately
dilated. The ascending aorta is mildly dilated. The aortic arch
is mildly dilated. There are focal calcifications in the aortic
arch. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is no
mitral valve prolapse. Trivial mitral regurgitation is seen.
There is mild pulmonary artery systolic hypertension. There is
no pericardial effusion.

[**11-4**] Chest CT w/contrast:
1.  No evidence of sarcoidosis.
2.  Incidental finding of pulmonary embolus involving the left
lower branch of the pulmonary artery and left lower lobe
segmental branches.  There is Also thrombus in the right upper
lobe branch of the pulmonary artery.
3.  Calcification of the aortic valve as described above.
4.  Gallstone.

[**11-4**] C spine w/contrast: Extensive changes of cervical
spondylosis seen, most significantly at C4-C5, C5-C6 and C6-C7
levels resulting in exit neural foraminal stenosis.
Superimposed left paracentral and foraminal herniation is
identified at C6-C7 level encroaching over the left exiting C7
nerve root.  No cord compression is seen.

[**11-5**] Bilateral LENIs: 1.  Acute to subacute deep venous
thrombosis from the proximal left superficial femoral vein
extending into the left popliteal vein.
2.  Acute thrombus within the right peroneal vein.

[**11-12**] MRA T spine: FINDINGS:  The study reveals the distal
aspect of the anterior spinal artery extending from
approximately the mid thoracic region to the level of the conus
tip.  The fact that the vessel is visible is not necessarily of
pathologic consequence.  Nevertheless, if there remains clinical
suspicion for a spinal vascular malformation, this test is not
to be construed as the optimum examination to exclude this type
of pathology.  For this purpose, conventional catheter spinal
angiography is the definitive diagnostic modality.  There are no
other vascular abnormalities identified.
CONCLUSION:  Visibility of the distal aspect of the anterior
spinal artery, a finding of dubious pathological significance.
See above report.

[**11-17**] MRI Head w/&w/o contrast: Resolution of the previously
seen areas of enhancement along the cerebral white matter since
the previous exam of [**2104-11-2**].  The findings raise the
suggestion of an inflammatory condition such as demyelinating
disease.  Other infectious etiologies cannot be totally excluded
and were discussed on the prior MRI report.  No
abnormal-enhancing lesions are seen on the current exam.  There
are several scattered T2-hyperintense lesions within the
cerebral white matter in a similar distribution to the previous
exam.  Further followup is suggested based on clinical grounds.

[**12-2**] Visual evoked potentials: After stimulation of either eye
there
were evoked potential peaks recorded. The peak after left eye
stimulation was 113 ms, near the upper limit of normal for this
laboratory (114 ms). The peak after right eye stimulation
occurred at
118 ms and was a very broad peak. Though the difference is
relatively
small, the peak after rightsided stimulation is delayed and
suggests a
defect in the optic conducting system anterior to the chiasm on
the
right.


Brief Hospital Course:
Briefly, patient is a 66 year-old male with remote history of
back injury, coronary artery disease, asthma who presented to
[**Hospital1 18**] ED with bilateral leg weakness and backache. Exam
progressed over day of admission to point of flaccid paraplegia
with ~T8 sensory level. Initial differential diagnosis included
infectious versus inflammatory disease like multiple sclerosis
versus post infectious process like acute disseminated
encephalomyelisits versus vascular cause like dural
arteriovenous malformation.

1. Neurology:  Patient had MRI spine with gadolinium which
showed evidence of spinal cord edema in the nlower thoracic
cord. There was no inflammation in the cervical cord.
Additionally, MRI of the brain showed multiple T2 signal
abnormalities in the subcortical white matter as well as within
the right frontal lobe. Three of these areas enhanced with the
administration of gadolinium, specifically within the right
pons, within the right frontal lobe adjacent to the anterior
[**Doctor Last Name 534**] of the lateral ventricle, and within the left frontal lobe
within the corona radiata. Lumbar puncture showed pleocytosis
with 32 WBC (differential 89L 12M), elevated protein 82 and
glucose 75.  Patient initially recieved 2 days of Decadron which
was then discontinued given WBCs in CSF until cultures were
negative. He was then placed on IV Solumedrol 1g QD. Please see
below for infectious workup. In terms of the inflammatory work
up, serum ACE level [**11-7**] was negative and serum protein was low.
SPEP/UPEP were negative, less suggestive of an neoplasm
producing paraproteins.  Flow cytometry of CSF did not identify
a monotypic B-cell population; however, most lymphocytes in the
specimen are represented by CD4 positive T-cells. Cytology  was
negative for malignant cells and there were no CSF peptides. On
[**11-8**], patient was started on mannitol 50mg q6 for cord edema
with minimal effect and was weaned off by [**11-12**].  An MRI/MRA
spine to evaluate for dural AVM was negative. Initial multiple
sclerosis profile and NMO antibody for neuromyelitis
optica/Devics were both negative. CSF had no oligoclonal bands.
Patient was unable to receive IVIG given coagulopathy or
plasmapheresis given his cardiac issues (EF 30%). After
receiving a full 2 week course of IV steroids, on [**11-22**], patient
was switched from IV Solumedrol to Prednisone 60mg [**11-22**].
Tizanidine 4 TID and Neurontin 600 QID were added for
neuropathic abdominal pain and doses titrated to pain control.
Visual evoked potentials ultimately showed evidence conduction
delay and suggest a defect in the optic conducting system
anterior to the chiasm on the right. This makes it most likely
that his underlying diagnosis is multiple sclerosis or an MS
variant. To exclude other possible inflammatory diseases which
may have altered long term therapy, he underwent biopsy of his
right frontal lesion on Tuesday [**11-25**]. Final patholgy was still
pending at time of discharge but preliminary results just showed
gliotic and reactive changes. Sadly, he did not improve with
standard treatment with high dose steroids and remains with a
flaccid paralysis of the lower extremties and T8 sensory level.
He will be followed in the general neurology and MS clinics as
an outpatient.
.
Please note: the sutures from his right frontal biopsy site
should be removed on [**2104-12-5**].
.
2. ID: Differential diagnosis included viral infection including
HTLV-1 which causes spastic paraparesis. CSF studies were
negative for HSV 1 and 2, EBV, HTLV-1, CMV, TB PCR and VZV.
Crytococcal antigen was negative. Oligoclonal bands and IgG
index were unrevealing. CSF bacterial, viral and fungal cultures
were negative. In the serum, testing for HIV, HBV, HCV, VZV,
CMV, HTLV, HSV, EBV were all negative. RPR was non-reactive.
Serum crytococcal antigen was negative. Serum antibodies for
Lyme and toxoplasmosis were negative. SPEP and UPEP were
unrevealing. PPD was placed [**11-3**] and was negative. Urine viral
cx prelim no growth.
.
Of note, patient had a urinary tract infection on [**11-21**]
associated with foley and completed a 7 day course of
Ciprofloxacin (last 2 days on Ceftazidime).  Pansensitive
Pseudamonas aeruginosa grew from urine culture. Foley was
discontinued and patient was instructed on how to
self-catheterize approximately every 6 hours but was unable to
do so due to prostatism and lack of sensation. He will remain
with indwelling foley, but suprapubic catheterization should be
considered in the future.

On [**11-26**], patient was presistently tachycardic and hyptotensive.
He was given stress dose steroids and started on broad spectrum
antibiotics (ceftazidime, vancomycin) given concern for
developing pneumonia (+productive cough and bronchitis seen on
last CXR). Ultimately, he stabilized simply with volume
resuscitation and cultures were negative. He is on a slow oral
steroid taper given his previous issues with blood pressure.
.
3. Hematology: He was found to have a large DVT and asymptomatic
pulmonary embolus. This was likely due to immobility and statis.
Anti Phospholipid screen negative. He was started on warfarin
after bridging with heparin. Goal INR is 2.0-3.0. Ultimately, we
decided not to proceed with plasmapheresis or IVIG for treatment
of his inflammatory spinal cord disease given risk of heart
failure with the former and hypercoagulability with the latter
with questionable benefit. Had IVC filter placed under IR on
[**11-24**].
.
4. Cardiovascular: Echocardiogram showed no PFO, ASD, or VSD. He
has an ejection fraction of 30%. Has been relatively hypotensive
at times, but asymptomatic with systolic blood pressure in low
100s.
.
5. GI: Given his paraplegia and spinal cord inflammation,
constipation has been an issue. He will need to be maintained on
an aggressive bowel regimen to prevent obstruction or impaction.
He responds well to daily Lactulose and prn Golytely.
.
6. Social: Social work was consulted as patient lives alone and
is estranged from family. Has relatives in [**Location (un) 686**]. Getting
OOB to wheelchair. While a patient here, social work and
physician filled out paperwork to initiate getting handicap
accessible housing for the patient. He will need extensive
social supports in place in order to transfer from rehab to
independent or assistive living.



Medications on Admission:
1. Oxycodone/APAP 5/325mg po prn
2. Lisinopril 10 mg QD
3. Singulair 10 mg QD
4. Toprol XL 50 mg QD
5. Omeprazole 20 mg QD
6. Lipitor 20mg QD
7. Advair diskus 500/50 QD


Discharge Medications:
1. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
6. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig:
One (1) Adhesive Patch, Medicated Topical  DAILY (Daily).
7. Simethicone 80 mg Tablet, Chewable Sig: 1.5 Tablet, Chewables
PO TID (3 times a day).
8. Fluticasone-Salmeterol 500-50 mcg/Dose Disk with Device Sig:
50-500 mcg Disk with Devices Inhalation [**Hospital1 **] (2 times a day).
9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
10. Tizanidine 2 mg Tablet Sig: Two (2) Tablet PO TID (3 times a
day).
11. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed for shortness of breath or
wheezing.
12. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO TID (3
times a day).
13. Insulin Regular Human 100 unit/mL Solution Sig: variable
units Injection ASDIR (AS DIRECTED): per sliding scale while on
steroid taper.
14. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
15. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
16. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day) as needed.
17. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
[**Hospital1 **] (2 times a day) as needed.
18. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
19. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  QID
(4 times a day) as needed.
20. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime): Please follow INR. Goal is 2.0-3.0.
21. Prednisone 20 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily) for 1 days: Thereafter, taper by 10 mg every 5 days
until off. Needs slow taper please!.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Inflammatory disease of the spinal cord
Right frontal lobe lesion
Abnormal visual evoked potentials
Status post brain biopsy of right frontal lobe lesion
Pulmonary embolus
Status post IVC filter placement
Asthma
Coronary artery disease
Status post liver surgery for liver laceration following stab
wound
Chronic back pain
Vitiligo


Discharge Condition:
Patient continues to have a flaccid paraplegia of both lower
extremities. He is incontinent of bowel and bladder. He has a
sensory level at ~T8 anteriorly.


Discharge Instructions:
Please call your outpatient Neurologist or return to the nearest
Emergency Room if you experience any increased weakness, sensory
changes, visual changes, fevers, chills, or any other worrisome
symptoms.

Please keep all of your follow up appointments.


Followup Instructions:
The following appointments have already been scheduled:
1. Provider: [**Name Initial (NameIs) 43**]/[**Doctor Last Name **] Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2105-1-29**] 4:00
2. Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7598**], MD Phone:[**Telephone/Fax (1) 5434**]
Date/Time:[**2105-2-17**] 10:30
{'Unspecified causes of encephalitis, myelitis, and encephalomyelitis,Multiple sclerosis,Other pulmonary embolism and infarction,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Paraplegia,Constipation, unspecified,Abdominal pain, generalized,Acute (transverse) myelitis NOS,Prostatitis, unspecified,Vitiligo,Aortocoronary bypass status,Asthma, unspecified type, unspecified,Long-term (current) use of steroids'}


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: Bilateral leg weakness

PRESENT ILLNESS: Patient is a 66 year-old right-handed man with past medical
history of back injury 36years ago, coronary artery disease
status post CABG four years ago who presented to [**Hospital1 18**] ED on
[**2104-11-1**] with bilateral leg weakness and backache, with onset ten
days prior to admission and worsening over the three days
leading up to admission. He was in his usual state of health
until ten days prior to admission, when patient twisted his
lower back when he was standing in the bus, when it turned. He
noticed sharp shooting pain thru his legs bilaterally. Paint was
transient at that time and was followed by numbness. The
symptoms got worse three days prior to admission with bilateral
leg numbness, pain, weakness, and difficulty with ambulation.
Patient stayed in the bed. Noted difficulty with urination two
days prior to admission and no bowel movement for three days.

MEDICAL HISTORY: Inflammatory disease of the spinal cord
Right frontal lobe lesion
Abnormal visual evoked potentials
Status post brain biopsy of right frontal lobe lesion
Pulmonary embolus
Status post IVC filter placement
Asthma
Coronary artery disease
Status post liver surgery for liver laceration following stab
wound
Chronic back pain
Vitiligo

MEDICATION ON ADMISSION: 1. Oxycodone/APAP 5/325mg po prn
2. Lisinopril 10 mg QD
3. Singulair 10 mg QD
4. Toprol XL 50 mg QD
5. Omeprazole 20 mg QD
6. Lipitor 20mg QD
7. Advair diskus 500/50 QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T-98.9 BP-120/85 HR-106, reg RR-20 SaO2 97% on room air
Gen: Awake, alert, no distress.
HEENT: Clear ears, conjunctivas, oral membrane, no neck bruit,
no goiter.
Chest: Vesicular sound, symmetrical, symmetrical chest.
Heart: S1, S2 nl, no murmur.
Abd: Soft nt/nd, no hepatosplenomegaly.
Skin: No lesions, skin stigmata.
Exts: No clubbing, cyanosis, or edema.

FAMILY HISTORY: No stroke, aneurysm, no seizure, no AAA.

SOCIAL HISTORY: Patient lives alone and is divorced. Has 3 healthy children.
Retired due to back pain, used to work as [**Doctor Last Name 9808**] driver. 

### Response:
{'Unspecified causes of encephalitis, myelitis, and encephalomyelitis,Multiple sclerosis,Other pulmonary embolism and infarction,Infection and inflammatory reaction due to indwelling urinary catheter,Urinary tract infection, site not specified,Paraplegia,Constipation, unspecified,Abdominal pain, generalized,Acute (transverse) myelitis NOS,Prostatitis, unspecified,Vitiligo,Aortocoronary bypass status,Asthma, unspecified type, unspecified,Long-term (current) use of steroids'}
