CHIEF COMPLAINT: Word finding difficulties

PRESENT ILLNESS: Mr. [**Known lastname **] is a [**Age over 90 **] yo man with a history of dementia who
presents as a transfer from [**First Name8 (NamePattern2) 3075**] [**Last Name (NamePattern1) **] Hospital for
evaluation of a left temporal ICH.  History was obtained from
the
patient's daughter and son.

MEDICAL HISTORY: - s/p PPM 1 year ago for sick sinus syndrome, set at 60bpm
- mild HTN, recently started medication
- Dementia, with hallucinations over last year
- s/p right femur fracture in [**2133-12-25**]
- hx of "tias" with apparent bleeding in his brain from his
brain
shriking and vessels tearing.  These presented as staring spells
with bleeds confirmed by CT.
- Known Thoracic aortic aneurysm
- bilateral hearing aids
- hx of bilateral cataracts no surgery

MEDICATION ON ADMISSION: - VPA 125mg [**Hospital1 **]
- Risperidone 0.25mg TID, q8 PRN hallucinations
- Norvasc ?
- Colace 100mg [**Hospital1 **]
- Ferrous sulfate 325mg daily
- ASA 325mg
- Cyanocobalamine 1000mcg daily
- Tylenol 100mg daily
- Vitamin D 1000units daily
- MOM 30ml PRN constipation
- Fish oil 1000mg daily

ALLERGIES: Dilantin / Blue Dye

PHYSICAL EXAM: GENERAL: Sleeping in bed, snoring.
HEENT: NO evidence of trauma, MM Dry
Chest: CTA b/l
Cardiovascular: Regular Rate and Rhythm, no murmur appreciated,
no carotid bruits
Abdominal: Soft, No apparent tenderness
Extrm: dry skin, no edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Former building inspector for the city of [**Location (un) 86**]. Lived in his
own home until [**Month (only) 404**] of this past year when he sustained a
femur fracture.  Lived with his wife in [**Name (NI) 86929**] [**Doctor Last Name 3549**] Skilled
nursing facility.  His wife died in [**Name (NI) **] and he has had alot of
psychological stress related to that.  He is a very independent
person at baseline.  He walks with a walker but sometimes does
not use it.  Smoked cigars but quit30 years ago.  No hx of
alcohol abuse.
Subdural hemorrhage,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Aphasia,Other persistent mental disorders due to conditions classified elsewhere,Cardiac pacemaker in situ,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Thoracic aneurysm without mention of rupture,Unspecified cataract,Other convulsions
Subdural hemorrhage,Food/vomit pneumonitis,Urin tract infection NOS,Parox ventric tachycard,Aphasia,Mental disor NEC oth dis,Status cardiac pacemaker,Hypertension NOS,Hx TIA/stroke w/o resid,Thoracic aortic aneurysm,Cataract NOS,Convulsions NEC
Admission Date:  [**2134-8-14**]              Discharge Date:   [**2134-8-17**]


Service: NEUROLOGY

Allergies:
Dilantin / Blue Dye

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Word finding difficulties

Major Surgical or Invasive Procedure:
Surgical intervention was discussed, but due to concerns of the
high risks associated with this procedure, no surgical
intervention was performed.


History of Present Illness:
Mr. [**Known lastname **] is a [**Age over 90 **] yo man with a history of dementia who
presents as a transfer from [**First Name8 (NamePattern2) 3075**] [**Last Name (NamePattern1) **] Hospital for
evaluation of a left temporal ICH.  History was obtained from
the
patient's daughter and son.

The patient lives in a skilled nursing facility and is visited
regularly by his children.  He was last seen on Tuesday when he
was noted to have a slight cold, but no other complaints. His
daughter then caught the cold and did not return to see him
until
today.  At 3pm, she saw her father sitting in his wheelchair.
He
was rolling over to his friend when she heard him say "You
know..." with a string of unintelligable sounds/words following.

He attempted to get up and go to the window and appeared to be
walking well.  She called his nurse and his vitals where taken,
noted to be normal.  However, his nurse heard him speak and
agreed he did not sound like himself.  He was given an aspirin
and EMS was called.  He was taken to the OSH where a CT scan of
the head showed a large left temporal ICH and the patient was
transferred here for further care.  He was evaluated by
neurosurgery who did not feel the patient was a surgical
candidate.  Neurology was consulted for additional management.

The patient is unable to offer additional history.  There where
no witnessed falls, no recent illnesses other than above.

Past Medical History:
- s/p PPM 1 year ago for sick sinus syndrome, set at 60bpm
- mild HTN, recently started medication
- Dementia, with hallucinations over last year
- s/p right femur fracture in [**2133-12-25**]
- hx of "tias" with apparent bleeding in his brain from his
brain
shriking and vessels tearing.  These presented as staring spells
with bleeds confirmed by CT.
- Known Thoracic aortic aneurysm
- bilateral hearing aids
- hx of bilateral cataracts no surgery

Social History:
Former building inspector for the city of [**Location (un) 86**]. Lived in his
own home until [**Month (only) 404**] of this past year when he sustained a
femur fracture.  Lived with his wife in [**Name (NI) 86929**] [**Doctor Last Name 3549**] Skilled
nursing facility.  His wife died in [**Name (NI) **] and he has had alot of
psychological stress related to that.  He is a very independent
person at baseline.  He walks with a walker but sometimes does
not use it.  Smoked cigars but quit30 years ago.  No hx of
alcohol abuse.

Family History:
Non-contributory

Physical Exam:
GENERAL: Sleeping in bed, snoring.
HEENT: NO evidence of trauma, MM Dry
Chest: CTA b/l
Cardiovascular: Regular Rate and Rhythm, no murmur appreciated,
no carotid bruits
Abdominal: Soft, No apparent tenderness
Extrm: dry skin, no edema

NEURO:
Wakes easily to voice.  Turns towards examiner when requsted to
look at me.  Answer yes to all yes no questions (am I am man, is
his name [**Doctor First Name **], is his daughter's name [**Doctor First Name **]).  Attempts to
stick out his tongue when requested, does not close his eyes,
does not point to the ceililng.  Is able to speak clearly
phrases
such as "what are you doing" when being examined, and "leave me
alone" with out notable dysarthria.  Otherwise, no intelligible
words.  PEERL 3->2mm.  EOM.I No facial asymmetry. Increased
[**Last Name (un) **]
throughout.  DTRs brisk the upper extremities.  Unable to elicit
patellar and AJ bilaterally.  Toes down.

During the time of discharge, his exam was virtually unchanged.


Pertinent Results:
[**2134-8-14**] 06:15PM   GLUCOSE-93 UREA N-22* CREAT-0.8 SODIUM-137
POTASSIUM-4.5 CHLORIDE-101 TOTAL CO2-27 ANION GAP-14

[**2134-8-14**] 06:15PM   WBC-7.6 RBC-3.73* HGB-12.0* HCT-35.5* MCV-95
MCH-32.2* MCHC-33.8 RDW-14.3
[**2134-8-14**] 06:15PM   NEUTS-76.3* LYMPHS-16.3* MONOS-6.7 EOS-0.5
BASOS-0.2

[**2134-8-14**] 06:15PM   PT-12.9 PTT-28.7 INR(PT)-1.1

ECG [**2134-8-13**]
Sinus rhythm (72) with ventricular premature beats. Left
anterior fascicular block. Non-specific inferior ST-T wave
changes. No previous tracing available for comparison.

CXR [**2134-8-16**]
REASON FOR EXAMINATION: Hemorrhagic stroke.
Portable AP chest radiograph was compared to chest CT from
[**2134-8-14**]. The known massive aneurysm of aortic arch is
redemonstrated. Minimal
subpleural interstitial opacities are unchanged in the
short-term interim. No new consolidation worrisome for interval
development of infectious process or aspiration has been noted.
No interval development of pleural effusion has been
demonstrated. Pacemaker leads terminate in right atrium and
right ventricle. The right tracheal shift is related to large
aneurysm.

CT-angio chest [**2134-8-15**]
IMPRESSION:
1. Large thoracic aortic aneurysm beginning at the level of the
left
subclavian artery and extending to the mid thoracic aorta. The
thoracic aorta at the level of the diaphragmatic hiatus is
ectatic.
2. No evidence for dissection, intramural hematoma, or
penetrating ulcer.
3. Bibasilar bronchiectasis and atelectasis may reflect sequela
of chronic
aspiration.
4. Cholelithiasis.

NCHCT [**2134-8-15**]
NONCONTRAST HEAD CT: There is significant motion distortion
limiting current exam; however, within that limitation, a 5.5 x
3.0 cm left temporal hematoma is redemonstrated, with a thin
peripheral zone of edema and mild effacement of the lateral
ventricle and adjacent sulci. There is intraventricular
extension of hemorrhage with hyperdense material layering in the
occipital horns. A tiny 3mm left frontal subdural hemorrhage is
also present. Hyperdense material along the left leaflet of the
tentorium is suggestive of additional subdural hemorrhage. A
punctate focus of hyperdensity within the interpeduncular
cistern and equivocal hyperdense material layering along the
left frontal sulci (2A, 13) are suggestive of a component of
subarachnoid hemorrhage. There is no new focus of hemorrhage.
Stable 6-mm rightward midline shift is maintained since four
hours prior. Confluent and discrete areas of white matter
hypodensities in the subcortical and periventricular white
matter likely represent underlying small vessel ischemic
disease. Suprasellar and basilar cisterns are patent. Vascular
calcifications are noted within the cavernous carotid arteries.
There is mild mucosal thickening within the left maxillary and
ethmoid sinuses. The mastoid air cells appear well aerated.
Within the limitation of significant motion artifacts, no
definite displaced acute osseous injury is evident. Globes and
soft tissues appear unremarkable.
   IMPRESSION: Left temporal hematoma with intraventricular
extension of blood products. Concurrent small left frontal and
left supratentorial subdural hemorrhage. Hyperdense material
within the interpeduncular cistern and left frontal sulci are
suggestive of additional subarachnoid component. 6-mm rightward
midline shift is unchanged since four hours prior. There is no
evidence of transtentorial or tonsillar herniation.


Brief Hospital Course:
He had been admitted to the ICU initially for q2h neuro-checks
(not out of a medical necessity; no beds were available on our
Neurology floor, [**Hospital Ward Name 121**] 11). He arrived from the ICU on [**2134-8-15**]
and was more calm on exam (although still requiring two-point
restraints, non-responsive to commands and AOx0) on the morning
of [**2134-8-16**], and moved from the SDU to a regular floor bed
without incident, on IVF at 50mL/h.

On [**2134-8-16**], a goals-of-care family discussion was held with Dr.
[**First Name (STitle) **] and patient's son and daughter. They made the patient
DNR/DNI, with feeding for comfort only (pureed nectar-thick
liquids, and are considering changing to CMO
(comfort-measures-only) status. Palliative care consult called
re. planning for hospice care, and SW c/s called for family
comfort.

[**Last Name (un) 86930**] on [**2134-8-16**], broad-spectrum antibiotic coverage (Vanc 1g
q12h and CTX 1g q24h) were started as empiric treatment for
HAP/aspiration PNA as the patient remained febrile, coughed
several times on exam, and showed a persistent RML +/- RLL
infiltrate (likely aspiration, possible PNA). BCx/SpCx/UA/Cx
were pending. He was started on SQH for DVT ppx.

On [**2134-8-17**] we had a family meeting with palliative care, and the
patient is having hospice care in his previous facility, but
having antibiotics, and food for comfort.

Medications on Admission:
- VPA 125mg [**Hospital1 **]
- Risperidone 0.25mg TID, q8 PRN hallucinations
- Norvasc ?
- Colace 100mg [**Hospital1 **]
- Ferrous sulfate 325mg daily
- ASA 325mg
- Cyanocobalamine 1000mcg daily
- Tylenol 100mg daily
- Vitamin D 1000units daily
- MOM 30ml PRN constipation
- Fish oil 1000mg daily

Discharge Medications:
1. Docusate Sodium 100 mg Capsule [**Hospital1 **]: One (1) Capsule PO BID (2
times a day).
2. Risperidone 0.5 mg Tablet, Rapid Dissolve [**Hospital1 **]: 0.5 Tablet,
Rapid Dissolve PO Q8HOURS () as needed for hallucinations.
3. Risperidone 0.5 mg Tablet, Rapid Dissolve [**Hospital1 **]: 0.5 Tablet,
Rapid Dissolve PO TID (3 times a day).
4. Acetaminophen 650 mg Suppository [**Hospital1 **]: One (1) Suppository
Rectal Q6H (every 6 hours) as needed for pain, fever.
5. Heparin (Porcine) 5,000 unit/mL Solution [**Hospital1 **]: One (1)
Injection TID (3 times a day) as needed for DVT-prophylaxis.
6. Divalproex 125 mg Capsule, Sprinkle [**Hospital1 **]: One (1) Capsule,
Sprinkle PO BID (2 times a day).
7. Divalproex 125 mg Capsule, Sprinkle [**Hospital1 **]: Two (2) Capsule,
Sprinkle PO NOON (At Noon).
8. Senna 8.6 mg Tablet [**Hospital1 **]: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
9. Ciprofloxacin 500 mg Tablet [**Hospital1 **]: One (1) Tablet PO Q12H
(every 12 hours) for 10 days.
10. Clindamycin HCl 150 mg Capsule [**Hospital1 **]: Three (3) Capsule PO Q6H
(every 6 hours) for 2 weeks.
11. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] once a day.
12. Cyanocobalamin (Vitamin B-12) 1,000 mcg Tablet [**Last Name (STitle) **]: One (1)
Tablet PO once a day.
13. Norvasc 10 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day: Hold
for SBP<110.
14. Ativan 1 mg Tablet [**Last Name (STitle) **]: 1-2 Tablets PO q4h prn as needed for
seizures: for a cluster of 3 or more seizures lasting greater
than 5 mins.


Discharge Disposition:
Extended Care

Facility:
[**Hospital 3548**] [**Hospital 3549**] Nursing and Rehab

Discharge Diagnosis:
Primary diagnosis
Left temporal hemorrhage
Left subdural hematoma
Pneumonia
Urinary tract infection

Secondary diagnosis
Hypertension
Seizure disorder


Discharge Condition:
Aphasic, bed-bound, waxing and [**Doctor Last Name 688**] mental status.


Discharge Instructions:
You have had a stroke (left temporal hemorrhage), which has
affected your speech. Your family (and health-care-proxy) have
decided to make you comfort measures only, with some medical
treatments, such as oral antibiotics.

You have an infection in your urine and in your lungs, for which
we are giving you antibiotics.


Followup Instructions:
Not applicable


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]

Completed by:[**2134-8-17**]
{'Subdural hemorrhage,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Aphasia,Other persistent mental disorders due to conditions classified elsewhere,Cardiac pacemaker in situ,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Thoracic aneurysm without mention of rupture,Unspecified cataract,Other convulsions'}


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: Word finding difficulties

PRESENT ILLNESS: Mr. [**Known lastname **] is a [**Age over 90 **] yo man with a history of dementia who
presents as a transfer from [**First Name8 (NamePattern2) 3075**] [**Last Name (NamePattern1) **] Hospital for
evaluation of a left temporal ICH.  History was obtained from
the
patient's daughter and son.

MEDICAL HISTORY: - s/p PPM 1 year ago for sick sinus syndrome, set at 60bpm
- mild HTN, recently started medication
- Dementia, with hallucinations over last year
- s/p right femur fracture in [**2133-12-25**]
- hx of "tias" with apparent bleeding in his brain from his
brain
shriking and vessels tearing.  These presented as staring spells
with bleeds confirmed by CT.
- Known Thoracic aortic aneurysm
- bilateral hearing aids
- hx of bilateral cataracts no surgery

MEDICATION ON ADMISSION: - VPA 125mg [**Hospital1 **]
- Risperidone 0.25mg TID, q8 PRN hallucinations
- Norvasc ?
- Colace 100mg [**Hospital1 **]
- Ferrous sulfate 325mg daily
- ASA 325mg
- Cyanocobalamine 1000mcg daily
- Tylenol 100mg daily
- Vitamin D 1000units daily
- MOM 30ml PRN constipation
- Fish oil 1000mg daily

ALLERGIES: Dilantin / Blue Dye

PHYSICAL EXAM: GENERAL: Sleeping in bed, snoring.
HEENT: NO evidence of trauma, MM Dry
Chest: CTA b/l
Cardiovascular: Regular Rate and Rhythm, no murmur appreciated,
no carotid bruits
Abdominal: Soft, No apparent tenderness
Extrm: dry skin, no edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Former building inspector for the city of [**Location (un) 86**]. Lived in his
own home until [**Month (only) 404**] of this past year when he sustained a
femur fracture.  Lived with his wife in [**Name (NI) 86929**] [**Doctor Last Name 3549**] Skilled
nursing facility.  His wife died in [**Name (NI) **] and he has had alot of
psychological stress related to that.  He is a very independent
person at baseline.  He walks with a walker but sometimes does
not use it.  Smoked cigars but quit30 years ago.  No hx of
alcohol abuse. 

### Response:
{'Subdural hemorrhage,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Paroxysmal ventricular tachycardia,Aphasia,Other persistent mental disorders due to conditions classified elsewhere,Cardiac pacemaker in situ,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Thoracic aneurysm without mention of rupture,Unspecified cataract,Other convulsions'}
