CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 77-year-old
man, transferred to the Neurology [**Hospital1 **] service after a four
day admission to the Intensive Care Unit.  Mr. [**Known lastname 19904**] is
not able to provide a coherent story at this time, but he
states that he came to the hospital on [**Holiday 1451**] because
he had a seizure.  Medical records documented that he became
dizzy at about 9:30 P.M. on [**12-27**], which was not
[**Holiday 1451**], and could not keep his eyes open.  He would
fall asleep quickly, and his wife noted a left facial droop.
He was brought to the Emergency Room and noted to have a
systolic blood pressure in the 200s.  His initial examination
documented him as alert, with limited verbal output,
comprehending commands, having a left facial droop and upper
motor neuron pattern, weakness in the left arm, intact
sensation, and a left visual field cut.  Signal abnormalities
were noted in both cerebellar hemispheres.  This symptoms
were not amenable to TPA, so Mr. [**Known lastname 19904**] received
intravenous heparin.

MEDICAL HISTORY: Chronic renal insufficiency, Type 2
diabetes, Bell's palsy, clubbed feet.

MEDICATION ON ADMISSION: Enalapril 10 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, Lopressor 25 mg by
mouth twice a day, Aggrenox one capsule by mouth once daily,
multivitamin one capsule by mouth once daily, Protonix 40 mg
by mouth once daily.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Unable to obtain.

SOCIAL HISTORY: No smoking, occasional alcohol use, married,
lives at home with wife.
Occlusion and stenosis of vertebral artery with cerebral infarction,Chronic airway obstruction, not elsewhere classified,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Talipes, unspecified,Bell's palsy
Ocl vrtb art w infrct,Chr airway obstruct NEC,Hyperosmolality,Acute kidney failure NOS,Hy kid NOS w cr kid I-IV,DMII renl nt st uncntrld,Talipes NOS,Bell's palsy
Admission Date:  [**2161-12-28**]       Discharge Date:  [**2162-1-2**]

Date of Birth:   [**2084-7-27**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 77-year-old
man, transferred to the Neurology [**Hospital1 **] service after a four
day admission to the Intensive Care Unit.  Mr. [**Known lastname 19904**] is
not able to provide a coherent story at this time, but he
states that he came to the hospital on [**Holiday 1451**] because
he had a seizure.  Medical records documented that he became
dizzy at about 9:30 P.M. on [**12-27**], which was not
[**Holiday 1451**], and could not keep his eyes open.  He would
fall asleep quickly, and his wife noted a left facial droop.
He was brought to the Emergency Room and noted to have a
systolic blood pressure in the 200s.  His initial examination
documented him as alert, with limited verbal output,
comprehending commands, having a left facial droop and upper
motor neuron pattern, weakness in the left arm, intact
sensation, and a left visual field cut.  Signal abnormalities
were noted in both cerebellar hemispheres.  This symptoms
were not amenable to TPA, so Mr. [**Known lastname 19904**] received
intravenous heparin.

In the Intensive Care Unit, Mr. [**Known lastname 19904**] was extubated, and
his strength improved somewhat.  He was transferred to the
regular Neurology floor on [**2161-12-31**], for further
management.

PAST MEDICAL HISTORY:  Chronic renal insufficiency, Type 2
diabetes, Bell's palsy, clubbed feet.

MEDICATIONS ON ADMISSION:  Enalapril 10 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, Lopressor 25 mg by
mouth twice a day, Aggrenox one capsule by mouth once daily,
multivitamin one capsule by mouth once daily, Protonix 40 mg
by mouth once daily.

FAMILY HISTORY:  Unable to obtain.

SOCIAL HISTORY:  No smoking, occasional alcohol use, married,
lives at home with wife.

PHYSICAL EXAMINATION:  Vital signs:  Temperature 98.9, blood
pressure 160/86, pulse 94, breathing at 28, oxygen saturation
96% on 2 liters.  In general, he is a well-developed,
well-nourished, elderly man, lying in bed, eating dinner.
Head, eyes, ears, nose and throat:  No evidence of trauma.
Neck:  No carotid bruits or thyromegaly.  Pulmonary:  Clear
to auscultation bilaterally.  Cardiovascular:  Regularly, no
murmurs.  Abdomen:  Soft, nontender, positive bowel sounds x
4.  Extremities:  Clubbed feet, no edema.  There is distal
wasting in the shins and calves.  Mental status:  He is
awake, alert and oriented times three.  Language is fluent,
with good comprehension and repetition.  He has a mild
anomia, and cannot do months of the year backwards
accurately.  Can perform simple calculations in his head.
Visual acuity is 20/70 in both eyes.  He has a left
homonymous hemianopsia that is greater in his inferior visual
fields.  Extraocular movements intact, pupils 3 to 2
bilaterally.  He has a left facial droop, upper motor neuron
type.  Facial sensation is intact.  Hearing is intact to
finger rub.  Palatal elevation is symmetric.  Shoulder shrug
and head turning are symmetric.  The tongue is midline.  On
motor examination, he has normal tone and bulk throughout.
There were no fasciculations.  His strength in the deltoids
was decreased bilaterally to 4+ on the left side, 4- on the
right.  He has 5- strength in his left triceps, and he has a
barely detectable pronator drift on the left.  His reflexes
are 1+ throughout.  His toes are upgoing bilaterally.  His
sensation is intact to pain and touch throughout.  Decreased
proprioception in his toes.  Coordination:  Finger-to-nose is
clumsy with both hands.  Rapid alternating movements is slow
bilaterally.

LABORATORY DATA:  On transfer to the Neurology [**Hospital1 **] service,
white count 11.9, hematocrit 28, platelets 240.  Sodium 147,
potassium 4.4, chloride 113, bicarbonate 24, BUN 56,
creatinine 2.1, glucose 59.  Calcium 8.7, magnesium 1.4,
phosphate 3.3.  Triglycerides 140, HDL 48, LDL 96.

RADIOLOGY:  MRI shows no diffusion abnormalities in the
cerebrum, however, there are slight changes in bilateral
cerebellar hemispheres, and there is mild to moderate
stenosis of bilateral vertebral arteries.

HOSPITAL COURSE:  After being admitted to the Intensive Care
Unit and extubated, he was transferred to the Neurology
floor.  His Lipitor, Aggrenox, Enalapril and Lopressor were
continued.  He had a transthoracic echocardiogram, which
showed no evidence of thrombus in the left atrium or left
atrial appendage, no atrioseptal defect or patent foramen
ovale.  He had an MR of his chest to look for potential
sources of posterior circulation emboli.  There was mild to
moderate focal stenosis at the origin of the right vertebral
artery and mild focal stenosis at the origin of the left
vertebral artery.  There was good anterograde flow in both
arteries.  Mild focal stenosis was also noted at the origin
of the left common carotid artery.

The patient remained stable while on the Neurology [**Hospital1 **].  He
will be discharged to rehabilitation.

DISCHARGE DIAGNOSIS:
1.  Bilateral cerebellar infarctions with minimal resulting
deficits
2.  Chronic renal insufficiency
3.  Type 2 diabetes
4.  Bell's palsy on left side
5.  Clubbed feet

DISCHARGE MEDICATIONS:
1.  Lipitor 10 mg by mouth once daily
2.  Lopressor 25 mg by mouth twice a day
3.  Aggrenox one capsule by mouth once daily
4.  Multivitamin one capsule by mouth once daily
5.  Protonix 40 mg by mouth once daily
6.  Avapro 300 mg by mouth once daily

He will follow with me, Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1206**], as an outpatient
for Neurology purposes.  He is being discharged in stable
condition.




                            [**Doctor Last Name **] [**Name8 (MD) 8346**], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern1) 5476**]
MEDQUIST36

D:  [**2162-1-1**]  17:55
T:  [**2162-1-2**]  01:24
JOB#:  [**Job Number **]
{"Occlusion and stenosis of vertebral artery with cerebral infarction,Chronic airway obstruction, not elsewhere classified,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Talipes, unspecified,Bell's palsy"}


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 77-year-old
man, transferred to the Neurology [**Hospital1 **] service after a four
day admission to the Intensive Care Unit.  Mr. [**Known lastname 19904**] is
not able to provide a coherent story at this time, but he
states that he came to the hospital on [**Holiday 1451**] because
he had a seizure.  Medical records documented that he became
dizzy at about 9:30 P.M. on [**12-27**], which was not
[**Holiday 1451**], and could not keep his eyes open.  He would
fall asleep quickly, and his wife noted a left facial droop.
He was brought to the Emergency Room and noted to have a
systolic blood pressure in the 200s.  His initial examination
documented him as alert, with limited verbal output,
comprehending commands, having a left facial droop and upper
motor neuron pattern, weakness in the left arm, intact
sensation, and a left visual field cut.  Signal abnormalities
were noted in both cerebellar hemispheres.  This symptoms
were not amenable to TPA, so Mr. [**Known lastname 19904**] received
intravenous heparin.

MEDICAL HISTORY: Chronic renal insufficiency, Type 2
diabetes, Bell's palsy, clubbed feet.

MEDICATION ON ADMISSION: Enalapril 10 mg by mouth once
daily, Lipitor 10 mg by mouth once daily, Lopressor 25 mg by
mouth twice a day, Aggrenox one capsule by mouth once daily,
multivitamin one capsule by mouth once daily, Protonix 40 mg
by mouth once daily.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: Unable to obtain.

SOCIAL HISTORY: No smoking, occasional alcohol use, married,
lives at home with wife. 

### Response:
{"Occlusion and stenosis of vertebral artery with cerebral infarction,Chronic airway obstruction, not elsewhere classified,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Talipes, unspecified,Bell's palsy"}
