CHIEF COMPLAINT: Left hemiparesis, transferred here from OSH with
"hyperdense R MCA sign."

PRESENT ILLNESS: Patient is a 77 year old man with afib (NOT on coumadin) and
cancer who was last seen normal at 11:45am by his wife.  At
[**Name2 (NI) **],
she heard a thud and discovered him slumped over.  EMS
transported the patient to [**Hospital **] Hospital.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Dyslipidemia, + Hypertension
2. CARDIAC HISTORY:
-CABG:  5 vessel CABG ten years ago at [**Hospital3 **],anatomy
unknown
-PACING/ICD:  None
3. OTHER PAST MEDICAL HISTORY:
Unresectable cholangiocarcinoma diagnosed in [**12/2163**] who has
been receiving gemcitabine chemotherapy for this disease with
plans for initiation of cisplatin in the near future
Parotid Cancer noted [**4-25**] being considered for palliative
radiation
parotid gland raising the possibility that he had a second
primary parotid tumor.
Hypertension
Status post cerebral hemorrhage 20 years ago
Peptic ulcer disease complicated by GI bleeding
Diverticulitis
Chronic renal insufficiency
Hidradentis suppurativa
Mastoid bone operation at age 5

MEDICATION ON ADMISSION: 1. Lasix 10
2. Percocet
3. Lisinopril 5
4. Metoprolol 25mg [**Hospital1 **]
5. KCl 24/16
6. Prochlorperazine 10 QID
7. Allopurinol 150mg daily
8. Xanax 0.25mg [**Hospital1 **]
9. Amlodipine/Benazepril [**6-25**]
10. Dexamethasone 4mg [**Hospital1 **]
11. Diltiazem 120mg
12. CoQ
13. Thiamine
14. ASA 81mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam: T 98.5 BP 157/82 HR 72 Afib RR 10 O2Sat 100% face mask
Gen:
Lying in bed, appears agitated. HEENT: Lots of secretions from
the nose. CV: Irregularly irregular but no murmurs/gallops/rubs
Lung: Clear anteriorly Abd: +BS, soft, nontender Ext: No edema

FAMILY HISTORY: His mother died from bone cancer at age 66.  His father died at
age 62 from either a myocardial infarction or a stroke.  His
maternal grandmother died from liver cancer at an unknown age.
He has no siblings.

SOCIAL HISTORY: Mr. [**Known lastname 84682**] is married and lives with his wife.  [**Name (NI) **] is a
former smoker, quitting 20 years ago.  He used to smoke a pack a
day for 40 years.  He denies illicit drug use, reports
occasional alcohol use.  He has no children.  He is retired and
used to work in sales.  He also used to be in the Marine Corps.
Cerebral artery occlusion, unspecified with cerebral infarction,Cerebral edema,Flaccid hemiplegia and hemiparesis affecting nondominant side,Acidosis,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Malignant neoplasm of other specified sites,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Malignant neoplasm of parotid gland,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use
Crbl art ocl NOS w infrc,Cerebral edema,Flccd hmiplg nondmnt sde,Acidosis,Atrial fibrillation,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Hyperlipidemia NEC/NOS,Malig neo site NEC,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Malig neo parotid,Hx TIA/stroke w/o resid,History of tobacco use
Admission Date:  [**2164-7-7**]              Discharge Date:   [**2164-7-8**]

Date of Birth:  [**2087-2-15**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Left hemiparesis, transferred here from OSH with
"hyperdense R MCA sign."


Major Surgical or Invasive Procedure:
intubated

History of Present Illness:
Patient is a 77 year old man with afib (NOT on coumadin) and
cancer who was last seen normal at 11:45am by his wife.  At
[**Name2 (NI) **],
she heard a thud and discovered him slumped over.  EMS
transported the patient to [**Hospital **] Hospital.

There, he was noted to be in afib, to have left hemiparesis, and
to be hypertensive to SBP = 210.  He was given nitropaste and
diltiazem. NCHCT apparently showed "hyperdense R MCA sign,"
though we are not able to view these images directly.  Patient
did not receive ivTPA (which I presume is because he has distant
history of cerebral hemorrhage) and was transferred to [**Hospital1 18**] for
further care.

Here, NIHSS = 23 at 5:45pm
LOC 1
Questions 2
Commands 0
Gaze 1
Visual fields 2
Face 2
Motor 3 + 3 = 6
Ataxia  0
Sensory 2
Language 3
Dysarthria 2
Extinction/inattention 2

ROS:
Wife says patient has had no recent complaints.


Past Medical History:
1. CARDIAC RISK FACTORS: + Dyslipidemia, + Hypertension
2. CARDIAC HISTORY:
-CABG:  5 vessel CABG ten years ago at [**Hospital3 **],anatomy
unknown
-PACING/ICD:  None
3. OTHER PAST MEDICAL HISTORY:
Unresectable cholangiocarcinoma diagnosed in [**12/2163**] who has
been receiving gemcitabine chemotherapy for this disease with
plans for initiation of cisplatin in the near future
Parotid Cancer noted [**4-25**] being considered for palliative
radiation
parotid gland raising the possibility that he had a second
primary parotid tumor.
Hypertension
Status post cerebral hemorrhage 20 years ago
Peptic ulcer disease complicated by GI bleeding
Diverticulitis
Chronic renal insufficiency
Hidradentis suppurativa
Mastoid bone operation at age 5


Social History:
Mr. [**Known lastname 84682**] is married and lives with his wife.  [**Name (NI) **] is a
former smoker, quitting 20 years ago.  He used to smoke a pack a
day for 40 years.  He denies illicit drug use, reports
occasional alcohol use.  He has no children.  He is retired and
used to work in sales.  He also used to be in the Marine Corps.


Family History:
His mother died from bone cancer at age 66.  His father died at
age 62 from either a myocardial infarction or a stroke.  His
maternal grandmother died from liver cancer at an unknown age.
He has no siblings.

Physical Exam:
Exam: T 98.5 BP 157/82 HR 72 Afib RR 10 O2Sat 100% face mask
Gen:
Lying in bed, appears agitated. HEENT: Lots of secretions from
the nose. CV: Irregularly irregular but no murmurs/gallops/rubs
Lung: Clear anteriorly Abd: +BS, soft, nontender Ext: No edema

Neurologic examination: Mental status: Awake and alert - follow
motor commands including opening eyes and showing R thumb,
wiggling R toes and sticking tongue out. Frequent groaning only
-nonverbal otherwise. Cranial Nerves: L pupil larger than R (L
6mm and R 4mm) - reactive but not brisk. L facial droop. Eyes
cross midline. Blinks to visual threat on R only. Motor: Normal
tone on R but decreased tone on L. Moves R arm and leg
anti-gravity with some resistance but does not move the L.
Extensor posturing to noxious stim on LUE only. No adventitious
movements. Sensation: Intact to noxious stim. Reflexes: 2s on R
biceps and patellar but none for L. Toes are upgoing
bilaterally.


Pertinent Results:
CT
1. Right MCA territory infarction with cerebral edema and a new
right basal ganglia intraparenchymal hemorrhagic transformation,
with
significant subfalcine herniation, effacement of the suprasellar
cisterns and
uncal herniation. There is no transtentorial herniation at this
time.

2. Small amount of intraventricular hemorrhage and entrapment of
the left
lateral ventricle.

3. New air-fluid levels in the sphenoid sinuses can represent
acute
sinusitis. Clinical correlation is recommended. Aerosolized
mucosal
thickening in the maxillary sinuses.

The study and the report were reviewed by the staff radiologist.



Brief Hospital Course:
Patient was admitted with large left MCA stroke.  He was
admitted to the ICU and needed to be intubated on arrival.  The
following morning the patient was noted to have a blown R pupil
and was extensor posturing in all extremities.  On a repeat head
CT scan he was noted to have a large hemorrhage in the area of
the MCA.  Prognosis was discussed with family and the decision
to withdraw care was made.  The patient expired on [**2164-7-8**].

Medications on Admission:
1. Lasix 10
2. Percocet
3. Lisinopril 5
4. Metoprolol 25mg [**Hospital1 **]
5. KCl 24/16
6. Prochlorperazine 10 QID
7. Allopurinol 150mg daily
8. Xanax 0.25mg [**Hospital1 **]
9. Amlodipine/Benazepril [**6-25**]
10. Dexamethasone 4mg [**Hospital1 **]
11. Diltiazem 120mg
12. CoQ
13. Thiamine
14. ASA 81mg daily


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
L MCA stroke

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Cerebral edema,Flaccid hemiplegia and hemiparesis affecting nondominant side,Acidosis,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Malignant neoplasm of other specified sites,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Malignant neoplasm of parotid gland,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use'}


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 hemiparesis, transferred here from OSH with
"hyperdense R MCA sign."

PRESENT ILLNESS: Patient is a 77 year old man with afib (NOT on coumadin) and
cancer who was last seen normal at 11:45am by his wife.  At
[**Name2 (NI) **],
she heard a thud and discovered him slumped over.  EMS
transported the patient to [**Hospital **] Hospital.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: + Dyslipidemia, + Hypertension
2. CARDIAC HISTORY:
-CABG:  5 vessel CABG ten years ago at [**Hospital3 **],anatomy
unknown
-PACING/ICD:  None
3. OTHER PAST MEDICAL HISTORY:
Unresectable cholangiocarcinoma diagnosed in [**12/2163**] who has
been receiving gemcitabine chemotherapy for this disease with
plans for initiation of cisplatin in the near future
Parotid Cancer noted [**4-25**] being considered for palliative
radiation
parotid gland raising the possibility that he had a second
primary parotid tumor.
Hypertension
Status post cerebral hemorrhage 20 years ago
Peptic ulcer disease complicated by GI bleeding
Diverticulitis
Chronic renal insufficiency
Hidradentis suppurativa
Mastoid bone operation at age 5

MEDICATION ON ADMISSION: 1. Lasix 10
2. Percocet
3. Lisinopril 5
4. Metoprolol 25mg [**Hospital1 **]
5. KCl 24/16
6. Prochlorperazine 10 QID
7. Allopurinol 150mg daily
8. Xanax 0.25mg [**Hospital1 **]
9. Amlodipine/Benazepril [**6-25**]
10. Dexamethasone 4mg [**Hospital1 **]
11. Diltiazem 120mg
12. CoQ
13. Thiamine
14. ASA 81mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam: T 98.5 BP 157/82 HR 72 Afib RR 10 O2Sat 100% face mask
Gen:
Lying in bed, appears agitated. HEENT: Lots of secretions from
the nose. CV: Irregularly irregular but no murmurs/gallops/rubs
Lung: Clear anteriorly Abd: +BS, soft, nontender Ext: No edema

FAMILY HISTORY: His mother died from bone cancer at age 66.  His father died at
age 62 from either a myocardial infarction or a stroke.  His
maternal grandmother died from liver cancer at an unknown age.
He has no siblings.

SOCIAL HISTORY: Mr. [**Known lastname 84682**] is married and lives with his wife.  [**Name (NI) **] is a
former smoker, quitting 20 years ago.  He used to smoke a pack a
day for 40 years.  He denies illicit drug use, reports
occasional alcohol use.  He has no children.  He is retired and
used to work in sales.  He also used to be in the Marine Corps. 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Cerebral edema,Flaccid hemiplegia and hemiparesis affecting nondominant side,Acidosis,Atrial fibrillation,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Other and unspecified hyperlipidemia,Malignant neoplasm of other specified sites,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Malignant neoplasm of parotid gland,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use'}
