CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 51 year-old
gentleman with a past medical history of hypertension,
depression, anxiety and lower back pain.  He works at the
[**Location (un) 538**] [**Hospital **] Hospital and at 2:00 p.m. on the day of
admission he had dropped a note out of his left hand and
noted it to be weak.  He walked down to the urgent care and
when he arrived there he had developed slurred speech.  For a
20 minute period he developed a left facial droop and
worsening left sided weakness.  He was transferred to [**Hospital1 1444**] for further management.

MEDICAL HISTORY: As above.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married and lives with his
wife and two children.  He works for the [**Company 44585**].
Intracerebral hemorrhage,Unspecified essential hypertension,Mitral valve disorders
Intracerebral hemorrhage,Hypertension NOS,Mitral valve disorder
Admission Date:  [**2198-5-14**]       Discharge Date:  [**2198-5-21**]

Date of Birth:   [**2146-11-12**]       Sex:  M

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  The patient is a 51 year-old
gentleman with a past medical history of hypertension,
depression, anxiety and lower back pain.  He works at the
[**Location (un) 538**] [**Hospital **] Hospital and at 2:00 p.m. on the day of
admission he had dropped a note out of his left hand and
noted it to be weak.  He walked down to the urgent care and
when he arrived there he had developed slurred speech.  For a
20 minute period he developed a left facial droop and
worsening left sided weakness.  He was transferred to [**Hospital1 1444**] for further management.

PHYSICAL EXAMINATION:  His blood pressure was 192/95.  Heart
rate 62.  Respiratory rate 14.  He was alert and oriented,
fluent, but dysarthric speech.  Comprehension and repetition
were intact.  He had no neglect.  Extraocular movements
intact.  Visual fields were full.  He had decreased V1 to V3
sensation in his left face and a left facial droop.  Tongue
was midline.  Motor strength in the right arm was 5 out of 5.
In the left arm he was able to give some effort against
gravity.  Left leg he had decreased strength and right leg
was 5 out of 5.  His sensation was decreased.  His gait was
not tested.  Head CT showed a right posterior frontal
hemorrhage primary lobar in location.

PAST MEDICAL HISTORY:  As above.

MEDICATIONS:
1.  Wellbutrin.
2.  Altace.
3.  Klonopin.
4.  Celebrex.

HOSPITAL COURSE:  The patient was admitted to the
neurological Intensive Care Unit.  He was taken emergently to
the Operating Room on [**2198-5-14**] for an emergent evacuation of
posterior frontal craniotomy for evacuation of hematoma.
Postoperatively, the patient's vital signs were stable.  He
was afebrile.  He was neurologically alert, fluent speech. He had
left severe facial weakness and a left field
cut.  Strength wise he was 2 out of 5 in the deltoids and 4
out of 5 in the biceps, 4 out of 5 in the triceps and 0 out
of 5 in the hands on the left side.  His hematocrit was 32
postop.  His INR 1.2.  On postoperative day number one he was
alert, fluent speech, and was oriented times three.  The left
facial weakness continued.  Strength had greatly improved.
He had 3 out of 5 deltoid strength, 4 out of 5 biceps, 4 out
of 5 tricep and IP was 4 out of 5 on the left side.  Right
side remains 5 out of 5.  Repeat head CT showed good
evacuation of subdural hematoma.  He was also evaluated by
the stroke service and was transferred to the regular floor
after coming of his intravenous Nipride and keeping his blood
pressure less then 140.  He was seen by physical therapy and
occupational therapy and found to acquire rehab prior to
discharge to home.  The patient remained neurologically
stable and was discharged to rehab on [**2198-5-21**] and will
follow up with Dr. [**Last Name (STitle) 1132**] in two weeks time.  The staples
should be removed on postoperative day number ten.






                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2198-5-21**]  11:44
T:  [**2198-5-21**]  12:34
JOB#:  [**Job Number 44583**]


Admission Date:  [**2198-5-14**]       Discharge Date:  [**2198-5-22**]

Date of Birth:   [**2146-11-12**]       Sex:  M

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  The patient is a 51-year-old
gentleman who, at 2 o'clock on the day of admission, was at
work and noted that he could not move his left hand and had
difficulty standing.  His speech became slurred and he was
transported to our Emergency Room at [**Hospital1 **]
for further management.  On arrival, his head CT showed a
right frontal interparenchymal bleed.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  L4-L5 disc herniation.
3.  Depression.
4.  Panic attacks.
5.  Anxiety attacks.

MEDICATIONS:
1.  Serzone.
2.  Wellbutrin.
3.  Klonopin.
4.  Celebrex.
5.  Altace.

PHYSICAL EXAMINATION:  Blood pressure was 180/100, heart rate
85, respiratory rate 22.  Saturation 98% on three liters.  He
was awake, alert, oriented times three, tearful.  HEENT:
Pupils equal, round, reactive to light, 4 down to 2 mm.
Tongue was midline.  Lungs: Clear to auscultation.  Cardiac:
regular rate and rhythm.  S1 and S2.  GI: Abdomen soft,
nontender.  Positive bowel sounds.  Extremities: No edema.
Neuro: Awake, oriented times three.  Speech was fluent,
however, garbled.  Pupils, as above, were equal and reactive.
He had a left-sided hemiplegia and a left facial droop.

LABORATORY/DIAGNOSTICS:  CT shows a 5.5 cm x 2.6 cm posterior
frontal right interparenchymal hemorrhage.

HOSPITAL COURSE:  The patient was taken emergently to the OR
for evacuation of this interparenchymal hemorrhage.
Postoperatively, monitored in the ICU, keeping his blood
pressure less than 140.  His vital signs were stable.  He was
afebrile.  He continued to have a left facial droop, but
improving left-sided strength.  He remained neurologically
stable.  He was continued to be monitored in the ICU until
[**2198-5-16**] when he was transferred to the regular floor.  His
left hemiparesis greatly improved.  He had anti-gravity
strength in the left upper extremity, although his sensation
in the left lower extremity was greatly diminished.  He
continued to be awake and alert with full visual fields.
Pupils equal, round, reactive to light.  He was seen by
Physical Therapy and Occupational Therapy and felt to require
a rehab stay prior to discharge to home.

DISCHARGE MEDICATIONS:
1.  Colace, 100 mg PO b.i.d..
2.  Pantoprazole, 40 mg PO q 24 hours.
3.  Metoprolol, 100 mg PO b.i.d..
4.  Nefazodone, 300 mg PO q p.m..
5.  Nefazodone, 200 mg PO q a.m..
6.  Hydralazine, 50 mg PO q 6 hours, hold for systolic less
than 110.
7.  Clonazepam, 0.5 mg PO q h.s..

FOLLOW-UP:  Patient will follow-up with Dr. [**Last Name (STitle) 1132**] in two
weeks time with repeat head CT.  Staples should be removed on
postoperative day number ten.

CONDITION ON DISCHARGE:  Stable.






                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2198-5-21**]  11:51
T:  [**2198-5-21**]  14:18
JOB#:  [**Job Number 44584**]


Admission Date:  [**2198-5-14**]     Discharge Date:  [**2198-5-25**]

Date of Birth:   [**2146-11-12**]     Sex:  M

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  This is a 51-year-old male, who
on the [**6-13**] at approximately 2 pm, was at work and
noted that he cannot move his left hand and had difficulty
standing.  His speech became slurred, and he was transported
to [**Hospital1 **] [**First Name (Titles) 2142**] [**Last Name (Titles) **].  On arrival, his CT
scan showed a right frontal intraparenchymal bleed.

ADMISSION MEDICATIONS:
1. Serzone.
2. Wellbutrin.
3. Klonopin.
4. Celebrex.
5. Altace.

ALLERGIES:  No known drug allergies.

PAST MEDICAL HISTORY:
1. Hypertension.
2. L4-L5 disk herniation.
3. Depression.
4. Panic and anxiety attacks.
5. Mitral valve prolapse.

SOCIAL HISTORY:  The patient is married and lives with his
wife and two children.  He works for the [**Company 44585**].

PHYSICAL EXAMINATION:  Blood pressure 180/100, pulse of 85,
22, 98% on 3 liters.  General:  Awake, alert, and oriented
times three, anxious and tearful male.  HEENT:  Pupils [**2-28**],
moist.  Tongue midline.  Pulmonary:  Lungs are clear
bilaterally.  Cardiac:  Regular, rate, and rhythm, S1, S2.
Abdomen is soft, nondistended, and bowel sounds positive.
Extremities:  No edema.  Patient is awake, alert, and
oriented times three.  Speech fluent, however, slightly
garbled.  Pupils were [**2-28**].  EOMs were full.  Left arm was
plegic.  Left leg was able to lift off the bed.  His anterior
tibialis, [**Last Name (un) 938**], and gastrocs were [**1-31**].  His right strength on
the right side were [**4-2**].  He had a left facial droop and was
unable to hold up his arm.

LABORATORIES:  His white count was 5.2, his hematocrit was
37.7, platelets was 319.  His PT was 14.1, PTT is 28, INR is
1.3, sodium 141, potassium 4.1, chloride 104, CO2 26, BUN 20,
and creatinine 1.2.

The CT scan showed a 5.5 cm x 2.6 cm posterior-frontal
intraparenchymal hemorrhage.

The patient was seen in the Emergency Room by Dr. [**Last Name (STitle) 1132**],
where he had a MRI and MRA.  He was also seen by the Stroke
Service.  It was decided that the patient should be brought
to the operating room for urgent decompression.

The patient had a right posterior-frontal craniotomy with
evacuation of the intracranial hemorrhage without procedural
complications.

The patient was brought to the Intensive Care Unit, and where
he was monitored overnight.  His blood pressure was
controlled with Nipride to kept less than 140.  Patient's
examination showed that he was now able to lift his left arm.
His strength was [**1-31**] on deltoids.  Biceps was [**3-3**].  Triceps
were [**3-3**].  A repeat CT scan showed stable.  Patient was also
followed by the Stroke Service.

Patient did continue to have a left facial droop.  His repeat
CT scan from the 18th showed small amounts of blood, minimal
midline shift improved compared to previous one.  Patient was
transitioned from IV antihypertensives to oral regimen.  His
diet was brought to a regular diet.  Patient was seen by
Social Work.

On the [**6-16**], the patient was transferred to the
regular surgical floor.  His IV antihypertensives were
converted to po.  He was getting po hydralazine and po
Lopressor.  His blood pressure was in the range of 130's.  He
was alert, awake, oriented, moving the left arm completely,
and he was moved to the floor, where he started to receive
Physical Therapy and Occupational Therapy, who found that he
had impaired muscle performance, balance, sensation, and
function mobility.  He is recommended to see Physical Therapy
2-5x a week and continue intensive therapy.

Occupational Therapy also saw the patient to help him with
his activities of daily living, his function immobility,
transfers.  It was felt that patient would need to go to a
rehabilitation facility, however, patient's insurance did not
allow for patient to go to a rehabilitation facility.  The
patient had a longer hospital stay, while he received
rehabilitation services.  He needs at least three hours of
rehabilitation 5-7x a week.

On the [**6-18**], the patient had his last CT scan of his
head, which showed negligible change in the extensive
hemorrhage and edema within the operative site.  The patient
continued to be monitored on the floor, where his vital signs
remained stable and his blood pressure was well within
control.  He did gradually regain some strength and had been
walking with assistance Physical Therapy.

The final Physical Therapy evaluation was that the patient
had improved significantly during hospital course, but still
required assistance with ambulation and modified stair
negotiation.  Due to insurance, the patient is unable to
discharge to rehabilitation setting.  Wife was educated on
the needs that the patient can assist him with physical
therapy, and patient will also go home with physical therapy.
Cane was ordered, and a gait belt was given to his wife, and
was discharged with physical therapy services.

DISCHARGE MEDICATIONS:
1. Hydralazine 50 mg one q6h.
2. Lopressor 50 mg two twice a day.
3. Nefazodone 100 mg two q am.
4. Nefazodone three q pm.

FOLLOW-UP INSTRUCTIONS:  The staples were removed before
discharge.  The area was clean, dry, no signs and symptoms of
infection or bleeding.  He is to followup with Dr. [**Last Name (STitle) 1132**] in
one month's time.



                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern1) 12790**]

MEDQUIST36

D:  [**2198-5-25**]  15:25
T:  [**2198-6-1**]  08:16
JOB#:  [**Job Number 44586**]
{'Intracerebral hemorrhage,Unspecified essential hypertension,Mitral valve disorders'}


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: 

PRESENT ILLNESS: The patient is a 51 year-old
gentleman with a past medical history of hypertension,
depression, anxiety and lower back pain.  He works at the
[**Location (un) 538**] [**Hospital **] Hospital and at 2:00 p.m. on the day of
admission he had dropped a note out of his left hand and
noted it to be weak.  He walked down to the urgent care and
when he arrived there he had developed slurred speech.  For a
20 minute period he developed a left facial droop and
worsening left sided weakness.  He was transferred to [**Hospital1 1444**] for further management.

MEDICAL HISTORY: As above.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is married and lives with his
wife and two children.  He works for the [**Company 44585**]. 

### Response:
{'Intracerebral hemorrhage,Unspecified essential hypertension,Mitral valve disorders'}
