CHIEF COMPLAINT: lethargy, decreased right sided movement

PRESENT ILLNESS: 81yo woman with PMH significant for recent R MCA and
bilateral ACA strokes, atrial fibrillation, and other vascular
risk factors, presents from rehab with one week of lethargy,
absence of speech, and right hemiparesis. She is known to the
neurology service, where she was admitted [**Date range (1) 16572**] with these
infarcts. She initially presented with left hemiparesis and was
found to have R MCA infarct, which was treated with IV tPA. She
did well initially with improvement in her left sided movement,
and was noted in angio to have had revascularization of the MCA
without IA tPA or MERCI retrieval. The next day she was noted to
be moving the left side better than the right, specifically in
the leg. Repeat scan showedd bilateral ACA infarcts, with both
ACAs deriving from the right circulation. She was abulic,
nonverval, with RLE plegia and decreased spontaneous movement
throughout. She was discharged to [**Hospital 38**] Rehab on [**2-25**].

MEDICAL HISTORY: -Afib dx 1 month ago-declined coumadin because of frequent blood
draws
-HTN (not well controlled per daughter)
-CABG stent x5 (20 y ago)
-CAD
   patient had 3 stents placed. One stent was placed in [**2132**] and

MEDICATION ON ADMISSION: Meds:
amantadine 50mg daily
ASA 81mg daily
cholestyramine
famotidine 20mg daily
MgOxide 400mg daily
metoprolol 50mg q8hrs
miconazole topical [**Hospital1 **]
MVI 5ml daily
simvastatin 80mg daily
coumadin 3mg qhs
prns:
tylenol 650mg q6h
bisacodyl 10mg daily
colace 100mg [**Hospital1 **]
sorbitol 30ml daily

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: VS: T 98, BP 164/48 on arrival, to 84/48 at time of exam on
propofol, HR 67, RR 14, SaO2 100%/vent
Genl: intubated, sedated, taken off just briefly before
examination
HEENT: NCAT, MMM, ETT in place
CV: unable to appreciate over vented BS
Chest: vented BS, sound clear to auscultation
Abd: soft, NTND, PEG in place
Ext: warm and dry

FAMILY HISTORY: Had daughter who died of brain aneurysm

SOCIAL HISTORY: Married, has 2 daughters, one of whom died in her 50s of an
aneurysm bleed
Unspecified intracranial hemorrhage,Acute respiratory failure,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Other ill-defined conditions,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Gastrostomy status,Personal history of malignant neoplasm of breast
Intracranial hemorr NOS,Acute respiratry failure,Late ef-hemplga side NOS,Ill-define condition NEC,Abnrml coagultion prfile,Adv eff anticoagulants,Atrial fibrillation,Crnry athrscl natve vssl,Status-post ptca,Gastrostomy status,Hx of breast malignancy
Admission Date:  [**2138-3-9**]              Discharge Date:   [**2138-3-15**]

Date of Birth:  [**2056-6-15**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins / Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
lethargy, decreased right sided movement

Major Surgical or Invasive Procedure:
none

History of Present Illness:
81yo woman with PMH significant for recent R MCA and
bilateral ACA strokes, atrial fibrillation, and other vascular
risk factors, presents from rehab with one week of lethargy,
absence of speech, and right hemiparesis. She is known to the
neurology service, where she was admitted [**Date range (1) 16572**] with these
infarcts. She initially presented with left hemiparesis and was
found to have R MCA infarct, which was treated with IV tPA. She
did well initially with improvement in her left sided movement,
and was noted in angio to have had revascularization of the MCA
without IA tPA or MERCI retrieval. The next day she was noted to
be moving the left side better than the right, specifically in
the leg. Repeat scan showedd bilateral ACA infarcts, with both
ACAs deriving from the right circulation. She was abulic,
nonverval, with RLE plegia and decreased spontaneous movement
throughout. She was discharged to [**Hospital 38**] Rehab on [**2-25**].

At rehab, she was seen by neurology and was started on coumadin
on [**2-26**]. Per her daughter, her examination began to improve, to
the point on [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1017**] that she was able to answer questions
about her family (where her sister-in-law lived, for example)
and
make a family joke. That night she became very tired, and
lethargy continued into Monday. She no longer spoke and stopped
moving the right side. This continued throughout the course of
the week, attributed to waxing/[**Doctor Last Name 688**] post-infarct, until she
appeared dehydrated and was brought in to [**Hospital1 18**] for further
evaluation.

Of note, INRs were 8.6 on [**3-6**].5 on [**3-7**], and 2.3 on [**3-9**].


Past Medical History:
-Afib dx 1 month ago-declined coumadin because of frequent blood
draws
-HTN (not well controlled per daughter)
-CABG stent x5 (20 y ago)
-CAD
   patient had 3 stents placed. One stent was placed in [**2132**] and

   another stent was placed in [**2135**]
-breast mass diagnosed in [**2137-7-10**]
   [**2137-8-10**]- breast cancer was resected (lumpectomy) with
   negative, clear margins
   No chemo or radiation
-Bilateral CEA


Social History:
Married, has 2 daughters, one of whom died in her 50s of an
aneurysm bleed

daughter Ms. [**Last Name (Titles) 56256**], [**Telephone/Fax (1) 56257**](C), [**Telephone/Fax (1) 56258**](H),
[**Telephone/Fax (1) 56259**](W)


Family History:
Had daughter who died of brain aneurysm


Physical Exam:
PE: VS: T 98, BP 164/48 on arrival, to 84/48 at time of exam on
propofol, HR 67, RR 14, SaO2 100%/vent
Genl: intubated, sedated, taken off just briefly before
examination
HEENT: NCAT, MMM, ETT in place
CV: unable to appreciate over vented BS
Chest: vented BS, sound clear to auscultation
Abd: soft, NTND, PEG in place
Ext: warm and dry

Neurologic examination:
MS: moves to noxious, no eye opening, does not follow commands
CN: pupils small and irregular, asymmetric, but reactive b/l,
unable to appreciate OCR, corneals R>L, no response to nasal
tickle, +cough
Motor: extends BUE to noxious, triple flexes BLE to noxious,
tone
decreased throughout
Sensory: responds to noxious throughout
DTRs: 2+ in RUE, 2 in LUE, unable to elicit in BLE, toes upgoing
bilaterally


Pertinent Results:
128  93  23
-----------< 114
5.0  25  0.8
estGFR: 69 / >75 (click for details)
CK: 101  MB: 5  Trop-T: 0.03
Ca: 9.5 Mg: 2.1 P: 3.6
9.6 > 35.4 < 503
 N:74.0 L:17.3 M:6.6 E:1.8 Bas:0.2
PT: 24.1  PTT: 24.3  INR: 2.3

Imaging: HCT: "Large intraparenchymal hemorrhage consistent with
hemorrhagic transformation in the known area of left anterior
cerebral artery infarct with intraventricular extension, and
surrounding edema causing rightward subfalcine herniation." ICH
appears to be 6cm x 6cm x 3cm, with 9mm MLS


Brief Hospital Course:
81yo woman with PMH significant for recent R MCA and bilateral
ACA strokes (both her ACAs oriinate from R ICA), in the context
of recent dx of atrial fibrillation not on Coumadin, and other
vascular risk factors, presents from rehab with one week of
lethargy. She was found to have large hemorrhagic transformation
into her L frontal infarct, likely in the setting of
supratherapeutic INR. Her ICH scale is at least 3, likely 4, for
volume, age, and poor GCS score.

She was initially admitted to the Neuro ICU, intubated, and
given prophylene to reverse her INR, as well as started on
Mannitol. After discussion with the family and in light of her
extremely poor prognosis, they decided to make her CMO status.
She was started on a Scopolamine patch, Morphine gtt and PRN
Ativan. She had a very irregular breathing pattern with
occasional apneic episodes during the ensuing few days while on
the [**Hospital1 **] but seemed comfortable. She died around noontime on
[**2138-3-15**].


Medications on Admission:
Meds:
amantadine 50mg daily
ASA 81mg daily
cholestyramine
famotidine 20mg daily
MgOxide 400mg daily
metoprolol 50mg q8hrs
miconazole topical [**Hospital1 **]
MVI 5ml daily
simvastatin 80mg daily
coumadin 3mg qhs
prns:
tylenol 650mg q6h
bisacodyl 10mg daily
colace 100mg [**Hospital1 **]
sorbitol 30ml daily

All: PCN, sulfa


Discharge Medications:
patient died

Discharge Disposition:
Expired

Discharge Diagnosis:
hemorrhagic conversion of L frontal infarct

Discharge Condition:
patient was made CMO and died on [**3-15**]/8

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2138-3-24**]
{'Unspecified intracranial hemorrhage,Acute respiratory failure,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Other ill-defined conditions,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Gastrostomy status,Personal history of malignant neoplasm of breast'}


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: lethargy, decreased right sided movement

PRESENT ILLNESS: 81yo woman with PMH significant for recent R MCA and
bilateral ACA strokes, atrial fibrillation, and other vascular
risk factors, presents from rehab with one week of lethargy,
absence of speech, and right hemiparesis. She is known to the
neurology service, where she was admitted [**Date range (1) 16572**] with these
infarcts. She initially presented with left hemiparesis and was
found to have R MCA infarct, which was treated with IV tPA. She
did well initially with improvement in her left sided movement,
and was noted in angio to have had revascularization of the MCA
without IA tPA or MERCI retrieval. The next day she was noted to
be moving the left side better than the right, specifically in
the leg. Repeat scan showedd bilateral ACA infarcts, with both
ACAs deriving from the right circulation. She was abulic,
nonverval, with RLE plegia and decreased spontaneous movement
throughout. She was discharged to [**Hospital 38**] Rehab on [**2-25**].

MEDICAL HISTORY: -Afib dx 1 month ago-declined coumadin because of frequent blood
draws
-HTN (not well controlled per daughter)
-CABG stent x5 (20 y ago)
-CAD
   patient had 3 stents placed. One stent was placed in [**2132**] and

MEDICATION ON ADMISSION: Meds:
amantadine 50mg daily
ASA 81mg daily
cholestyramine
famotidine 20mg daily
MgOxide 400mg daily
metoprolol 50mg q8hrs
miconazole topical [**Hospital1 **]
MVI 5ml daily
simvastatin 80mg daily
coumadin 3mg qhs
prns:
tylenol 650mg q6h
bisacodyl 10mg daily
colace 100mg [**Hospital1 **]
sorbitol 30ml daily

ALLERGIES: Penicillins / Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: VS: T 98, BP 164/48 on arrival, to 84/48 at time of exam on
propofol, HR 67, RR 14, SaO2 100%/vent
Genl: intubated, sedated, taken off just briefly before
examination
HEENT: NCAT, MMM, ETT in place
CV: unable to appreciate over vented BS
Chest: vented BS, sound clear to auscultation
Abd: soft, NTND, PEG in place
Ext: warm and dry

FAMILY HISTORY: Had daughter who died of brain aneurysm

SOCIAL HISTORY: Married, has 2 daughters, one of whom died in her 50s of an
aneurysm bleed 

### Response:
{'Unspecified intracranial hemorrhage,Acute respiratory failure,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Other ill-defined conditions,Abnormal coagulation profile,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Gastrostomy status,Personal history of malignant neoplasm of breast'}
