CHIEF COMPLAINT: Left-sided weakness and sensory changes

PRESENT ILLNESS: The pt is a  53 y/o woman with no prior medical history who
came as a med-flight for ICH. She was at school (is a teacher)
when she had sudden onset left side numbness and weakness. She
was taken to an OSH where she was on report A&O x3 and
hypertensive to the 200's. A head CT demonstrated a right BG
bleed with 7mm of shift. She was given 90g of mannitol and
intubated for airway protection. For blood pressure she was
started on nipride and propofol.
On arrival here she was off drips for several minutes and her
blood pressure was up to 190's systolic. Because of this she was
quickly placed on propofol and sent to the CT scanner for a
repeat head CT.

MEDICAL HISTORY: - pre-menopausal migraines

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: At admission:
Vitals: T:98  P: 75 R: 16  BP:193/125  SaO2:100 intubated
General: intubated sedated
HEENT: NC/AT.
Neck: No nuchal rigidity
Pulmonary: Lungs CTA bilaterally
Cardiac: RRR.
Abdomen: obese.
Extremities: No edema
Skin: no rashes or lesions noted.
.
Neurologic:
Intubated and sedated. Exam limited by need for propofol for
blood pressure control in the acute setting. Off propofol though
she has her eyes shut, did not open them to voice or pain. her
pupils were equal and reactive at 1.5mm, hard to see if VOR
intact, + gag and cough with weak corneals b/l. She was
localizing on the RUE, withdrawing on the RLE. On the left she
had shoulder shrug to pain and triple flexion on the left to toe
pain. Tone increased over the LLE. Toe was downgoing on the
right
and up on the left.
.
At discharge:
Neurological examination is notable for a left facial droop
(upper motor neuron pattern) with left inverted ptosis and left
hemiparesis (arm>leg). She is able to abduct the left leg (2)
and adduct the left leg (1+). The left limbs are otherwise
essentially plegic.  At times, she seems to neglect the left
visual field/extinguish left-sided stimuli with double
simultaneous stimulation(though secondary to diaschisis).

FAMILY HISTORY: FAMILY HISTORY:
- positive for migraine (sister), stroke in grandfather (in
setting of hip replacement)
- negative for other known neurological disorders including
'unprovoked' stroke, seizure

SOCIAL HISTORY: - works as a school teacher
.
HABITS
- Tobacco: denies
- Alcohol: [**2-13**] drinks/week
- Recreational Drug Use: denies
Intracerebral hemorrhage,Hemiplegia, unspecified, affecting unspecified side,Body Mass Index 40.0-44.9, adult,Unspecified essential hypertension,Obesity, unspecified,Examination of participant in clinical trial
Intracerebral hemorrhage,Unsp hemiplga unspf side,BMI 40.0-44.9, adult,Hypertension NOS,Obesity NOS,Exam-clincal trial
Admission Date:  [**2111-2-5**]              Discharge Date:   [**2111-2-10**]

Date of Birth:  [**2057-3-27**]             Sex:   F

Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

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


Major Surgical or Invasive Procedure:
None


History of Present Illness:
The pt is a  53 y/o woman with no prior medical history who
came as a med-flight for ICH. She was at school (is a teacher)
when she had sudden onset left side numbness and weakness. She
was taken to an OSH where she was on report A&O x3 and
hypertensive to the 200's. A head CT demonstrated a right BG
bleed with 7mm of shift. She was given 90g of mannitol and
intubated for airway protection. For blood pressure she was
started on nipride and propofol.
On arrival here she was off drips for several minutes and her
blood pressure was up to 190's systolic. Because of this she was
quickly placed on propofol and sent to the CT scanner for a
repeat head CT.


Past Medical History:
- pre-menopausal migraines

Social History:
- works as a school teacher
.
HABITS
- Tobacco: denies
- Alcohol: [**2-13**] drinks/week
- Recreational Drug Use: denies

Family History:
FAMILY HISTORY:
- positive for migraine (sister), stroke in grandfather (in
setting of hip replacement)
- negative for other known neurological disorders including
'unprovoked' stroke, seizure

Physical Exam:
At admission:
Vitals: T:98  P: 75 R: 16  BP:193/125  SaO2:100 intubated
General: intubated sedated
HEENT: NC/AT.
Neck: No nuchal rigidity
Pulmonary: Lungs CTA bilaterally
Cardiac: RRR.
Abdomen: obese.
Extremities: No edema
Skin: no rashes or lesions noted.
.
Neurologic:
Intubated and sedated. Exam limited by need for propofol for
blood pressure control in the acute setting. Off propofol though
she has her eyes shut, did not open them to voice or pain. her
pupils were equal and reactive at 1.5mm, hard to see if VOR
intact, + gag and cough with weak corneals b/l. She was
localizing on the RUE, withdrawing on the RLE. On the left she
had shoulder shrug to pain and triple flexion on the left to toe
pain. Tone increased over the LLE. Toe was downgoing on the
right
and up on the left.
.
At discharge:
Neurological examination is notable for a left facial droop
(upper motor neuron pattern) with left inverted ptosis and left
hemiparesis (arm>leg). She is able to abduct the left leg (2)
and adduct the left leg (1+). The left limbs are otherwise
essentially plegic.  At times, she seems to neglect the left
visual field/extinguish left-sided stimuli with double
simultaneous stimulation(though secondary to diaschisis).


Pertinent Results:
ADMISSION LABS:
GLUCOSE-125* UREA N-12 CREAT-0.7 SODIUM-133 POTASSIUM-4.1
CHLORIDE-97 TOTAL CO2-24 ANION GAP-16
WBC-12.4* RBC-5.27 Hgb-14.2 Hct-42.3 MCV-80* MCH-27.0 MCHC-33.7
RDW-13.3 Plt Ct-214
Calcium-8.5 Phos-3.5 Mg-2.0 Cholest-199
ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG
Tricycl-NEG
.
MODIFIABLE RISK FACTORS FOR STROKE:
Triglyc-91 HDL-66 CHOL/HD-3.0 LDLcalc-115
.
DISCHARGE LABS:
WBC-6.2 RBC-4.67 Hgb-12.8 Hct-37.4 MCV-80* MCH-27.5 MCHC-34.4
RDW-13.1 Plt Ct-197
Calcium-8.5 Phos-3.2 Mg-1.9
.
ECG:
Artifact is present. Sinus rhythm. There is a late transition
which is
probably normal. Non-specific ST-T wave changes. No previous
tracing
available for comparison.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
86 194 90 364/409 56 -3 42
.
IMAGING:
.
Non-Contrast CT Head ([**2111-2-5**]):
IMPRESSION: Right basal ganglia bleed with surrounding edema
with 6-7 mm
leftward shift of normally midline structures. The location is
typical for
hemorrhage associated with hypertension although the etiology is
not specific. If hypertension is doubted as the likely etiology
on clinical grounds, then follow-up contrast-enhanced CT or
preferably MR imaging may be helpful to evaluate further if
clinically indicated.
.
Non-Contrast CT Head([**2111-2-6**]):
 IMPRESSION:
1. Slight increase in size of right basal ganglial hemorrhage.
2. Stable mass effect with effacement of the sulci and 4 mm of
leftward
midline shift.
.
MRI/A Head with and without Contrast ([**2111-2-6**]):
IMPRESSION:
1. Right basal ganglia hemorrhage which is unchanged since the
prior study
with unchanged shift of midline structures to the left. A small
focus of
enhancement is noted within the hemorrhage (series 1100b, image
69). Follow up imaging is advised.
.
2. No evidence of stenosis, occlusion, arteriovenous
malformation or aneurysm in arteries of head.
.
Chest X-ray 91/26/12):
ET tube in standard placement. Nasogastric tube ends in the
region of
pylorus. Heart size top normal. Lung volumes are low, but
opacification in
the left lower lobe is improving, probably resolving
atelectasis. Pleural
effusion is small, if any. No pneumothorax.
.


Brief Hospital Course:
Ms. [**Known lastname **] is a lovely 53-year old woman with no significant past
medical who initially presented to another facility with suddden
onset left-sided weakness and sensory changes and was
transferred to the [**Hospital1 18**] [**2111-2-5**] when imaging revealed a right
basal ganglia hemorrhage.  She was initially admitted to the
intensive care unit for careful monitoring and maintenance of a
blood pressure under a systolic of 160.  Although a repeated
non-contrast CT of the head showed minimal worsening of the
hemorrhage, an MRI of the head performed later the same day
([**2111-2-6**]) demonstrated no further interval change.  Although she
had no known history of hypertension prior to admission, the
location of the bleed is quite typical for hemorrhage caused by
high blood pressure. Vessel imaging showed no obvious
contributory abnormalities. An MRI was done to evaluate for
other underlying causes; although this initial study showed no
clear lesions, it will be very important to repeat an MRI of the
head with and without contrast in about 4-5 weeks (when the
hemorrhage resolves) to ensure there is no underlying etiology.
.
Ms [**Known lastname **] was ultimately transferred to the stroke [**Hospital1 **] service.
To help maintain normotension, amlodipine, lisinopril, and
metoprolol were started in the course of the hospitalization.
Members of the physical therapy team partipated in the patient's
care and recommended discharge to rehabilitation as one element
as an optimal discharge plan.
.
For the near future, aspirin and non-steroidal
anti-inflammatories should be avoided.  It is, however,
considered safe to use subcutaneous heparin for DVT prophylaxis.
 Normotension is the goal.
.
Contact:
[**Name (NI) 553**] [**Name (NI) **] ([**Telephone/Fax (1) 92056**])




Medications on Admission:
none

Discharge Medications:
1. acetaminophen 650 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain, fever.
2. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
5. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).


Discharge Disposition:
Extended Care

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

Discharge Diagnosis:
Right Basal Ganglia Hemorrhage
Hypertension


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.
Neurological examination is notable for a left facial droop
(upper motor neuron pattern) and left hemiparesis (arm>leg).
She is able to abduct the left leg (2) and adduct the left leg
(1+).  The left limbs are otherwise essentially plegic.  At
times, she seems to neglect the left visual field/extinguish
left-sided stimuli with double simultaneous stimulation(though
secondary to diaschisis).


Discharge Instructions:
Dear Ms. [**Known lastname **],
.
It has been a pleasure caring for you at the [**Hospital1 18**].  You
initially presented to another facility following the sudden
onset of left-sided weakness and sensory change.  You were
subsequently transeferred to the [**Hospital1 18**] when imaging revealed
evidence of bleeding in the right side of the brain. Although
you had no known history of hypertension, the location of the
bleed is quite typical for hemorrhage caused by high blood
pressure.  Vessel imaging showed no obvious contributory
abnormalities.  An MRI was done to evaluate for other underlying
causes; although this initial study showed no clear lesions, it
will be very important to have an MRI repeated in the future
when the hemorrhage resolves to make sure there is no other
etiology.
.
You were initially admitted to the intensive care unit for close
monitoring.  You were subsequently transferred to the stroke
[**Hospital1 **] service when blood pressure was optimized.  As you know,
the physical therapy team worked with you and suggested
rehabilitation represents one element of a safe discharge plan.
.
MEDICATION CHANGES:
- lisinopril was STARTED
- amlodipine was STARTED
- metoprolol was STARTED
.
PLEASE AVOID aspirin and non-steroidal anti-inflammatories such
as advil and ibuprofen for now, as they can increase the risk of
bleeding.  For discomfort, please use tylenol.
.
Please attend the following appointments with Dr.[**Last Name (STitle) **] [**Name (STitle) 53350**] and
[**Doctor Last Name **].

Followup Instructions:
* An appointment has been made with primary care physician [**Name9 (PRE) **]
[**Name9 (PRE) **], MD (Phone:[**Telephone/Fax (1) 250**]) at [**2111-2-20**] on 3:45 pm.

* Neurologist [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**], MD (Phone:[**Telephone/Fax (1) 2574**]) on [**2111-4-13**]
at 2:30 pm.  Dr.[**Name (NI) 17720**] office is located on the [**Hospital Ward Name 516**],
in the [**Hospital Ward Name 23**] Building, on the [**Location (un) **].
.
It will be important to call [**Telephone/Fax (1) **] #1 to schedule the MRI
head with and without contrast in [**4-17**] weeks.


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{'Intracerebral hemorrhage,Hemiplegia, unspecified, affecting unspecified side,Body Mass Index 40.0-44.9, adult,Unspecified essential hypertension,Obesity, unspecified,Examination of participant in clinical trial'}


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 and sensory changes

PRESENT ILLNESS: The pt is a  53 y/o woman with no prior medical history who
came as a med-flight for ICH. She was at school (is a teacher)
when she had sudden onset left side numbness and weakness. She
was taken to an OSH where she was on report A&O x3 and
hypertensive to the 200's. A head CT demonstrated a right BG
bleed with 7mm of shift. She was given 90g of mannitol and
intubated for airway protection. For blood pressure she was
started on nipride and propofol.
On arrival here she was off drips for several minutes and her
blood pressure was up to 190's systolic. Because of this she was
quickly placed on propofol and sent to the CT scanner for a
repeat head CT.

MEDICAL HISTORY: - pre-menopausal migraines

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: At admission:
Vitals: T:98  P: 75 R: 16  BP:193/125  SaO2:100 intubated
General: intubated sedated
HEENT: NC/AT.
Neck: No nuchal rigidity
Pulmonary: Lungs CTA bilaterally
Cardiac: RRR.
Abdomen: obese.
Extremities: No edema
Skin: no rashes or lesions noted.
.
Neurologic:
Intubated and sedated. Exam limited by need for propofol for
blood pressure control in the acute setting. Off propofol though
she has her eyes shut, did not open them to voice or pain. her
pupils were equal and reactive at 1.5mm, hard to see if VOR
intact, + gag and cough with weak corneals b/l. She was
localizing on the RUE, withdrawing on the RLE. On the left she
had shoulder shrug to pain and triple flexion on the left to toe
pain. Tone increased over the LLE. Toe was downgoing on the
right
and up on the left.
.
At discharge:
Neurological examination is notable for a left facial droop
(upper motor neuron pattern) with left inverted ptosis and left
hemiparesis (arm>leg). She is able to abduct the left leg (2)
and adduct the left leg (1+). The left limbs are otherwise
essentially plegic.  At times, she seems to neglect the left
visual field/extinguish left-sided stimuli with double
simultaneous stimulation(though secondary to diaschisis).

FAMILY HISTORY: FAMILY HISTORY:
- positive for migraine (sister), stroke in grandfather (in
setting of hip replacement)
- negative for other known neurological disorders including
'unprovoked' stroke, seizure

SOCIAL HISTORY: - works as a school teacher
.
HABITS
- Tobacco: denies
- Alcohol: [**2-13**] drinks/week
- Recreational Drug Use: denies 

### Response:
{'Intracerebral hemorrhage,Hemiplegia, unspecified, affecting unspecified side,Body Mass Index 40.0-44.9, adult,Unspecified essential hypertension,Obesity, unspecified,Examination of participant in clinical trial'}
