CHIEF COMPLAINT: Left leg and arm weakness

PRESENT ILLNESS: 65yo M with HTN, hyperlipidemia, CAD s/p CABG, ? h/o PAF
oncoumadin presents with intracerebral hemorrhage. Pt was
welluntil this evening while taking a shower he called out to
hiswife. When wife entered the bathroom she noticed he was
sittingin the bathtub and stated, "My left leg and arm just went
out."EMS noted left facial droop and L hemiparesis. OSH CT
scanrevealed large left intraparenchymal hemorrhage with
extension tolateral ventricles 3rd and 4th ventricles. He was
given VitaminK, FFP at the OSH and transferred to [**Hospital1 18**].

MEDICAL HISTORY: Diabetes Mellitus
MI and CABG x3 ([**2169**])
Chest Melanoma

MEDICATION ON ADMISSION: Coumadin 5mg QDay
Amiodarone 200mg QOD
Lopressor 50mg Qday
Vasotec 20mg QDay
Zocor 80mg QDay
ASA 81mg QDay
Zetia 10mg QHS
Novalog (rapid acting) implanted insulin pump.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97 BP: 153/54   HR:81 R 14 O2Sats-100% intubated on
CMV
Gen- critically ill, intubated off sedation.
HEENT: NCAT, blood at ET tube tip, anicteric..
Neck- no carotid bruits
CV- RRR
Pulm- CTA B
Abd- obese, soft, ND, BS+
Extrem- 1+ pitting LE edema bilat

FAMILY HISTORY: not elicited

SOCIAL HISTORY: Married, lives with his wife, daughter in the area, son in
[**Name (NI) 108**], works as a firefighter.
Subarachnoid hemorrhage,Obstructive hydrocephalus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Personal history of malignant melanoma of skin,Intracerebral hemorrhage
Subarachnoid hemorrhage,Obstructiv hydrocephalus,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,Atrial fibrillation,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Long-term use anticoagul,Hx-malig skin melanoma,Intracerebral hemorrhage
Admission Date:  [**2184-10-6**]              Discharge Date:   [**2184-10-8**]

Date of Birth:  [**2119-2-4**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
Left leg and arm weakness

Major Surgical or Invasive Procedure:
Intubation/Extubation

History of Present Illness:
65yo M with HTN, hyperlipidemia, CAD s/p CABG, ? h/o PAF
oncoumadin presents with intracerebral hemorrhage. Pt was
welluntil this evening while taking a shower he called out to
hiswife. When wife entered the bathroom she noticed he was
sittingin the bathtub and stated, "My left leg and arm just went
out."EMS noted left facial droop and L hemiparesis. OSH CT
scanrevealed large left intraparenchymal hemorrhage with
extension tolateral ventricles 3rd and 4th ventricles. He was
given VitaminK, FFP at the OSH and transferred to [**Hospital1 18**].

His wife and daughter state that the patient lived an active
lifeand would not want to live his life with a hemiparesis or
worse.They have decided to defer offer by neurosurgery
forintraventricular drain. Repeat CT scan on arrival to
BIDMCreveals hydrocephalus and enlarged area of hemorrhage.
CTAreveals ruptured PCOM aneurysm.

Past Medical History:
Diabetes Mellitus
MI and CABG x3 ([**2169**])
Chest Melanoma

Social History:
Married, lives with his wife, daughter in the area, son in
[**Name (NI) 108**], works as a firefighter.


Family History:
not elicited


Physical Exam:
Vitals: T: 97 BP: 153/54   HR:81 R 14 O2Sats-100% intubated on
CMV
Gen- critically ill, intubated off sedation.
HEENT: NCAT, blood at ET tube tip, anicteric..
Neck- no carotid bruits
CV- RRR
Pulm- CTA B
Abd- obese, soft, ND, BS+
Extrem- 1+ pitting LE edema bilat

Neurologic Exam:
MS- no response to noxious stimulation.

CN- absent corneals, absent oculocephalic reflex, pupils 2mm and
unreactive to light. Unable to visualize optic discs. Intact gag
reflex.

Motor/Sensory- no response to nailbed pressure in all
extremities.

Reflexes: unable to elicit any DTR's.

Toes upgoing bilaterally.

Brief Hospital Course:
65yo M with HTN, Hyperlipid, CAD, Paroximal AF on coumadin
presents with large intracerebral hemorrhage with
intraventricular spread. His exam is limited due to likely
resdual effect of midazolam gtt (off x 1hr prior to exam).
However remarkable only for intact gag and otherwise absent
other brainstem reflexes. Family wishes to make pt [**Name (NI) 3225**] in
accordance with the patient's expressed wishes prior to the
event. The team informed the family about the prognosis.
The patient was transferred out the critical care unit to the
regular neurology floors. He was DNR/DNI and [**Name (NI) 3225**]. Hence, he was
kept on a Morphine gtt and a scopalamine patch for secretions
once extubated. He also received ativan PRN agitation.

He was pronounced on 09 12 08 at 15:35.


Medications on Admission:
Coumadin 5mg QDay
Amiodarone 200mg QOD
Lopressor 50mg Qday
Vasotec 20mg QDay
Zocor 80mg QDay
ASA 81mg QDay
Zetia 10mg QHS
Novalog (rapid acting) implanted insulin pump.


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Intraventricular brain bleed

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired

                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Subarachnoid hemorrhage,Obstructive hydrocephalus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Personal history of malignant melanoma of skin,Intracerebral hemorrhage'}


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 leg and arm weakness

PRESENT ILLNESS: 65yo M with HTN, hyperlipidemia, CAD s/p CABG, ? h/o PAF
oncoumadin presents with intracerebral hemorrhage. Pt was
welluntil this evening while taking a shower he called out to
hiswife. When wife entered the bathroom she noticed he was
sittingin the bathtub and stated, "My left leg and arm just went
out."EMS noted left facial droop and L hemiparesis. OSH CT
scanrevealed large left intraparenchymal hemorrhage with
extension tolateral ventricles 3rd and 4th ventricles. He was
given VitaminK, FFP at the OSH and transferred to [**Hospital1 18**].

MEDICAL HISTORY: Diabetes Mellitus
MI and CABG x3 ([**2169**])
Chest Melanoma

MEDICATION ON ADMISSION: Coumadin 5mg QDay
Amiodarone 200mg QOD
Lopressor 50mg Qday
Vasotec 20mg QDay
Zocor 80mg QDay
ASA 81mg QDay
Zetia 10mg QHS
Novalog (rapid acting) implanted insulin pump.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 97 BP: 153/54   HR:81 R 14 O2Sats-100% intubated on
CMV
Gen- critically ill, intubated off sedation.
HEENT: NCAT, blood at ET tube tip, anicteric..
Neck- no carotid bruits
CV- RRR
Pulm- CTA B
Abd- obese, soft, ND, BS+
Extrem- 1+ pitting LE edema bilat

FAMILY HISTORY: not elicited

SOCIAL HISTORY: Married, lives with his wife, daughter in the area, son in
[**Name (NI) 108**], works as a firefighter. 

### Response:
{'Subarachnoid hemorrhage,Obstructive hydrocephalus,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Atrial fibrillation,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Long-term (current) use of anticoagulants,Personal history of malignant melanoma of skin,Intracerebral hemorrhage'}
