CHIEF COMPLAINT: Left sided weakness, blurry vision, facial droop

PRESENT ILLNESS: ** History obtained from chart, co-residents, patient and
patient's wife  **

MEDICAL HISTORY: 1. Anxiety
2. PTSD
3. ADHD
4. Depression
5. Alcohol abuse
6. Migraine
7. Status post C5-C6 laminectomy and fusion several years ago by
[**Doctor Last Name 1327**]
8. Diverticulitis, now status post partial colectomy
9. Asplenia secondary to trauma incurred during Vietman
10. Multiple sharpnel injuries while in Vietmam, [**2142**] - NO MRI!!

MEDICATION ON ADMISSION: Medications prior to admission:
Wellbutrin 400
Ritalin 20
Antabuse
Thiamine 1
Neurontin prn insomnia, up to 1000 mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam upon transfer to floor:

FAMILY HISTORY: adopted

SOCIAL HISTORY: Divorced. Lives with female partner for past 15 years. 2
biologic and 1 adopted child. Works as a real estate broker.
Smokes 1ppd for many years. History of alcohol abuse but no EtOH
for 6 weeks. No drug use.
Dissection of carotid artery,Occlusion and stenosis of carotid artery with cerebral infarction,Hemiplegia, unspecified, affecting nondominant side,Other syndromes affecting cervical region,Fall from other slipping, tripping, or stumbling,Alcohol abuse, unspecified,Posttraumatic stress disorder,Other acquired absence of organ,Attention deficit disorder with hyperactivity,Dysthymic disorder,Other late effects of cerebrovascular disease, facial weakness
Dissect carotid artery,Ocl crtd art w infrct,Unsp hmiplga nondmnt sde,Cervical syndrome NEC,Fall from slipping NEC,Alcohol abuse-unspec,Posttraumatic stress dis,Acq absence of organ NEC,Attn deficit w hyperact,Dysthymic disorder,Facial weakness
Admission Date:  [**2179-12-31**]              Discharge Date:   [**2180-1-5**]

Date of Birth:  [**2124-11-17**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5868**]
Chief Complaint:
Left sided weakness, blurry vision, facial droop

Major Surgical or Invasive Procedure:
IV t-PA
angiography by interventional neurosurgery
CT angio and multiple NCHCTs

History of Present Illness:
** History obtained from chart, co-residents, patient and
patient's wife  **

Patient is a 55 year old right handed male with past medical
history of alcohol abuse, PTSD, anxiety, ADHD who presented to
the [**Hospital1 18**] ED on [**2179-12-31**] for acute stroke. History supplemented
by info from girlfriend.

Patient reports that he fell backwards and hit his head on ice
while shoveling snow in the afternoon of new years eve.  He then
was watching TV just before 20:00 when he had acute onset of
blurred vision after coughing.  Called his girlfriend.  She
returned home between 20:00 and 20:15. His wife and her friend
are both nurses; they report that up to 20:20 pm, patient was
complaining of blurred vision, but was able to hold both arms
above head, walk, plantar flex. EMS called. By time EMS arrived
around 20:30, he was noted to have right gaze preference, dense
left hemiplegia and left neglect. BP 188/104 L, 150/80 right.

Transported to [**Hospital1 18**] ED where Code Stroke Called. ED notified at
20:40. Patient arrived at [**Hospital1 18**] at 20:55. Stroke Team called at
20:56; neurology on site by 21:00. CT ordered at 20:55, done and
interpreted by 21:20. CTA performed as well. Bolus dose tpa
started at 21:30.

Initial NIHSS 19. FSBG 111. Systolic blood pressures in 160s.
Patient with right gaze preference, left visual neglect, left
UMN facial palsy, left hemiplegia with no withdrawal to noxious
stimuli, mild dysarthria and left neglect.

Patient improved somewhat after tPA bolus with ability to hold
left upper extremity against gravity briefly, hold left lower
extremity and provide some resistance, decreased left neglect,
ability to gaze toward left, improved speech. However, as of
22:15, symptoms worsened with decreased movement of left side to
point of hemiplegia and more pronounced neglect. Final
interpretation of CTA suggestive of right ICA occlusion.

Patient was admitted to the Neuro ICU with post-tPA protocol
orders and placed on neosynephrine to keep SBP 160-170 range x
36 hrs.  He underwent angiography by Dr. [**Last Name (STitle) 1132**] on [**2180-1-1**] which
showed a right ICA dissection and pseudoaneurysm.  Repeat head
CT's after t-PA showed no evidence of bleeding, thus he was
placed on a full aspirin.  Then, on [**2179-1-2**], head CT showed a
stroke on the right, less than one-half of the hemisphere, thus
it was decided to start him on low dose heparin gtt and coumadin
with a goal PTT 40-50.

Prior to angiograph, TTE was done and showed no PFO and no
shunt.

He passed a swallow study in the ICU and thus may eat solid
foods.

Past Medical History:
1. Anxiety
2. PTSD
3. ADHD
4. Depression
5. Alcohol abuse
6. Migraine
7. Status post C5-C6 laminectomy and fusion several years ago by
[**Doctor Last Name 1327**]
8. Diverticulitis, now status post partial colectomy
9. Asplenia secondary to trauma incurred during Vietman
10. Multiple sharpnel injuries while in Vietmam, [**2142**] - NO MRI!!

Social History:
Divorced. Lives with female partner for past 15 years. 2
biologic and 1 adopted child. Works as a real estate broker.
Smokes 1ppd for many years. History of alcohol abuse but no EtOH
for 6 weeks. No drug use.


Family History:
adopted

Physical Exam:
Exam upon transfer to floor:

Tc 97.8 Tm 100.1 BP 155/128 HR 85 NSR RR 17 O2 sat 96% RA I/O:
2743/3750, LOS +550cc
Gen:  NAD, pleasant, conversant
Chest:  CTA bilat
CV:  RRR without mur
Extrem: no edema

MS: awake, alert, fluent, repeats, prosody normal, orients well
to the left (improved, no neglecct), no apraxia (brushes teeth)
CN:  no field cut, pupils 4->2mm bilat, EOMI, left face droop,
midline tongue
MOTOR:
- left arm: 0/5 throughout, hypotonic
- left leg:  externally rotated, some adduction but otherwise no
movement
- right side: full strength
[**Last Name (un) **]:  + extinction to DSS on left, very little sensation to LT
on left arm, withdrawl to pain left leg.  Right side normal.
DTRs:
       [**Name2 (NI) **] BR  Tri  Pat  Ach
Right   2  2   2    2    1
Left    2  2   2    2    1
toe left upgoing, toe right downgoing.

Gait: not tested

Pertinent Results:
As of [**2180-1-3**]

CBC: 10/44/301 diff 57/25/11
Chem:  140/4.2/108/27/8/0.8/119
Cal 8.6, phos 2.5, mag 1.9
PTT: 68 (on heparin), INR 1.1
ESR: 5
[**Doctor First Name **]: pending
Chol 151, LDL 97, HDL 47, TG 63
Tox: acetaminophen 8.6
Ruled OUT for MI

Blood Cx [**2180-1-1**] pending

TTE: The left atrium is normal in size. The right atrium is
dilated. Left
ventricular wall thickness, cavity size, and systolic function
are normal
(LVEF 60-70%). The right ventricular cavity is dilated. Right
ventricular
systolic function is normal. The aortic valve is not well seen.
The mitral  valve leaflets are structurally normal. There is no
pericardial effusion. Air bubble contrast imaging did not
demonstrate the presence of right-to-left shunt across the
interatrial septum, but the study is technically suboptimal.
The presence of right heart chamber enlargement raises the
suspicion of the presence of an atrial septal defrect with
left-to-right shunt, but this  abnormality was not demonstrated
on limited color-flow imaging.

NCHCT:
[**2180-1-2**]:  1. Continued evoluation of a known right MCA territory
infarct.
2. No intracranial hemorrhage.
[**2180-1-1**]:  1. Acute right middle cerebral artery territory
infarct.
2. No intracranial hemorrhage identified.
3. Stable ventricle size.
[**2179-12-31**]:  No definite intracranial hemorrhage is seen on this
study performed 90 minutes after a contrast-enhanced study.
Contrast enhancement limits evaluation for subtle intra or
extra-axial hemorrhage.

CT angio head [**2179-12-31**]:
1. Occlusion of the right internal carotid artery distal to the
bifurcation of the common carotid artery within the neck. There
is, however, reconstitution of flow within the intracranial
right internal carotid artery and middle cerebral artery
branches, possibly from collateral flow through the anterior
communicating artery.
2. [**Doctor Last Name **]/white matter distinction is preserved.


Brief Hospital Course:
55 yo man with right ICA dissection and occlusion, s/p t-PA on
[**2179-12-31**].  Transfer to the floor.  Exam:  left hemiparesis
(plegia in the arm, but paresis in the leg with some adduction),
improved left visual neglect and left sided sensation.

This patient was given t-PA without complication on [**2179-12-31**].
His blood pressure was maintained with neosynephrine while in
the ICU.  CT angio revealed right ICA occlusion.  (Patient
cannot have MRI 2o2 srapnel).  Angiography  on [**2180-1-1**] showed
right ICA dissection with pseudoaneurysm.  He was given asprin,
then transitioned to IV heparin drip and coumadin on [**2179-1-2**]
after repeated NCHCTs showed no hemorrhage and < [**1-2**] of right
hemisphere involved in the stroke. Once coumadin is theraputic
(INR 2-2.5), then heparin can be discontinued.  The dissection
was likely caused by his fall onto the ice while shoveling,
however ESR and [**Doctor First Name **] were sent as part of the work up.  ESR 5,
[**Doctor First Name **] pending.

Upon transfer to the floor, florinef was started to keep SBP >
120.  This should be continued for another week (d/c on
[**2180-1-11**]).

He complained of a headache, occipital, radiating to the front
of the head, reproducible with pressure applied to greater
occipital nerve.  Most likely etiology is occipital neuralgia
s/p fall on ice.  Given percocet for the pain and compazine (to
prevent emesis as could worsen dissection).  Neurontin should
help pain as well.

Cholesterol panel: 157, tg 63, hdl 47, ldl 97.  Glucose was
tightly controlled.

TTE showed no PFO, no veggitations or clot.

He passed a bedside swallow eval and was placed on a heart
healthy diet.  He was evaluated by PT/OT.  To be discharged to
rehab.

Re: Psych meds, neurontin was restarted and antabuse was
continued.  Ritalin was held.

Prophylaxis - Pneumoboots, PPI, RISS, on heparin drip

FULL CODE

Medications on Admission:
Medications prior to admission:
Wellbutrin 400
Ritalin 20
Antabuse
Thiamine 1
Neurontin prn insomnia, up to 1000 mg


Discharge Medications:
1. Prochlorperazine 10 mg Tablet Sig: 1-2 Tablets PO Q6H (every
6 hours) as needed for nausea: Take prophylactically with
percocet for nausea.
[**Date Range **]:*30 Tablet(s)* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
[**Date Range **]:*30 Tablet(s)* Refills:*0*
3. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day) as needed for constipation.
[**Date Range **]:*60 Tablet(s)* Refills:*0*
4. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Date Range **]:*60 Capsule(s)* Refills:*2*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Date Range **]:*60 Capsule(s)* Refills:*2*
6. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
[**Date Range **]:*30 Cap(s)* Refills:*2*
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Date Range **]:*30 Tablet(s)* Refills:*2*
8. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
[**Date Range **]:*30 Tablet(s)* Refills:*2*
9. Disulfiram 250 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
[**Date Range **]:*15 Tablet(s)* Refills:*2*
10. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain.
[**Date Range **]:*30 Tablet(s)* Refills:*0*
11. Bupropion HCl 100 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO BID (2 times a day).
[**Date Range **]:*120 Tablet Sustained Release(s)* Refills:*2*
12. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
[**Date Range **]:*250 ML(s)* Refills:*0*
13. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
[**Date Range **]:*60 Capsule(s)* Refills:*2*
14. Warfarin Sodium 2.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
[**Date Range **]:*30 Tablet(s)* Refills:*2*
15. Fludrocortisone Acetate 0.1 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily): discontinue on [**2179-1-10**].
[**Date Range **]:*30 Tablet(s)* Refills:*2*
16. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
[**Date Range **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
17. Insulin Regular Human 100 unit/mL Solution Sig: per sliding
scale Units, regular insulin Injection QACHS: Sliding scale:

BG 151-200: 2 units
BG 201-250: 4 units
BG 251-300: 6 units
BG 301-350: 8 units
BG 351-400: 10 units
BG >= 401: 12 units and call physician.
[**Name Initial (NameIs) **]:*QS Units, regular insulin* Refills:*2*
18. Heparin Sod (Porcine) in D5W 100 unit/mL Parenteral Solution
Sig: Nine Hundred (900) Units per hour Intravenous  Continuous
infusion: Check PTT Q 6 hours after starting or adjusting
Heparin and QD thereafter; adjust dose for target PTT of 45-55.
[**Name Initial (NameIs) **]:*QS Units per hour* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 7**] & Rehab Center - [**Hospital1 8**]

Discharge Diagnosis:
Rt sided MCA Stroke as complication of Rt. ICA dissection with
peudoaneurysm.


Discharge Condition:
Stable - left hemiplegia of face arm and leg (mild adduction of
left leg is present).  Left neglect improved.  Passed swallow
evaluation.

Discharge Instructions:
- discontinue florinef in one week on [**1-11**]
- check INR frequently, goal 2-2.5


Followup Instructions:
Provider: [**Name10 (NameIs) **] SCAN Where: RA [**Hospital Unit Name **] ([**Hospital Ward Name **]/[**Hospital Ward Name **]
COMPLEX) RADIOLOGY Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2180-4-12**] 11:30
Provider: [**Name10 (NameIs) **] SCAN Where: RA [**Hospital Unit Name **] ([**Hospital Ward Name **]/[**Hospital Ward Name **]
COMPLEX) RADIOLOGY Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2180-4-12**] 11:45

NOTE - do not eat any food or drink for three hours before the
above radiology appointments.

Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Where: [**Hospital6 29**] NEUROLOGY
Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2180-4-12**] 1:00





Name:  [**Known lastname 15024**],[**Known firstname **] G                 Unit No:   [**Numeric Identifier 15025**]

Admission Date:  [**2179-12-31**]              Discharge Date:   [**2180-1-5**]

Date of Birth:  [**2124-11-17**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 15026**]
Addendum:
Patient will need a hypercoagulable workup as an outpatient
either by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] or Dr. [**Last Name (STitle) 1801**], given h/o prior DVT as
well as clot formed on dissected artery. In Neurological
follow-up, after repeat CTA and lab work-up, determine whether
dissection has healed and whether hypercoagulable state is
absent. If healed, discontinue Coumadin and start antiplatelet
for stroke prophylaxis.

Also, patient should discontinue florinef on [**2180-1-11**].

Chief Complaint:
see d/c summ

Major Surgical or Invasive Procedure:
administration of t-PA
Angiogram by Dr. [**Last Name (STitle) 365**]
CT angio


History of Present Illness:
see d/c summ

Past Medical History:
1. Anxiety
2. PTSD
3. ADHD
4. Depression
5. Alcohol abuse
6. Migraine
7. Status post C5-C6 laminectomy and fusion several years ago by
[**Doctor Last Name **]
8. Diverticulitis, now status post partial colectomy
9. Asplenia secondary to trauma incurred during Vietman
10. Multiple sharpnel injuries while in Vietmam, [**2142**] - NO MRI!!

Social History:
see d/c summ

Family History:
see d/c summ

Physical Exam:
see d/c summ


Pertinent Results:
[**Doctor First Name **] negative

see d/c summ

Brief Hospital Course:
see d/c sum

Medications on Admission:
see d/c summ

Discharge Medications:
1. Prochlorperazine 10 mg Tablet Sig: 1-2 Tablets PO Q6H (every
6 hours) as needed for nausea: Take prophylactically with
percocet for nausea.
[**Doctor First Name 215**]:*30 Tablet(s)* Refills:*0*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain: Please take
compazine with each dose to prevent emesis.
[**Doctor First Name 215**]:*30 Tablet(s)* Refills:*0*
3. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day): hold for loose stools.
[**Doctor First Name 215**]:*60 Tablet(s)* Refills:*0*
4. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Doctor First Name 215**]:*60 Capsule(s)* Refills:*2*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Doctor First Name 215**]:*60 Capsule(s)* Refills:*2*
6. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
[**Doctor First Name 215**]:*30 Cap(s)* Refills:*2*
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Doctor First Name 215**]:*30 Tablet(s)* Refills:*2*
8. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
[**Doctor First Name 215**]:*30 Tablet(s)* Refills:*2*
9. Disulfiram 250 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
[**Doctor First Name 215**]:*15 Tablet(s)* Refills:*2*
10. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain.
[**Doctor First Name 215**]:*30 Tablet(s)* Refills:*0*
11. Bupropion HCl 100 mg Tablet Sustained Release Sig: Two (2)
Tablet Sustained Release PO BID (2 times a day).
[**Doctor First Name 215**]:*120 Tablet Sustained Release(s)* Refills:*2*
12. Guaifenesin 100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H (every 6
hours) as needed.
[**Doctor First Name 215**]:*250 ML(s)* Refills:*0*
13. Gabapentin 400 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
[**Doctor First Name 215**]:*60 Capsule(s)* Refills:*2*
14. Warfarin Sodium 2.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime): goal INR 2-2.5, to be followed by Dr. [**Last Name (STitle) 1801**] as an
outpatient.
[**Last Name (STitle) 215**]:*30 Tablet(s)* Refills:*2*
15. Fludrocortisone Acetate 0.1 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily): discontinue on [**2179-1-10**].
[**Date Range 215**]:*30 Tablet(s)* Refills:*2*
16. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.)
Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24
hours).
[**Date Range 215**]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
17. Insulin Regular Human 100 unit/mL Solution Sig: per sliding
scale Units, regular insulin Injection QACHS: Sliding scale:

BG 151-200: 2 units
BG 201-250: 4 units
BG 251-300: 6 units
BG 301-350: 8 units
BG 351-400: 10 units
BG >= 401: 12 units and call physician.
[**Name Initial (NameIs) 215**]:*QS Units, regular insulin* Refills:*2*
18. Heparin Sod (Porcine) in D5W 100 unit/mL Parenteral Solution
Sig: 1200 (1200) Units per hour Intravenous  Continuous
infusion: Check PTT Q 6 hours after starting or adjusting
Heparin and QD thereafter; adjust dose for target PTT of 45-55.
[**Name Initial (NameIs) 215**]:*QS Units per hour* Refills:*2*


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 14**] & Rehab Center - [**Hospital1 15**]

Discharge Diagnosis:
Rt sided MCA Stroke as complication of Rt. ICA dissection with
peudoaneurysm.


Discharge Condition:
Stable - left face and arm > leg hemiparesis (left leg can
mildly adduct).  Fluent.  Passed swallow study.

Discharge Instructions:
Please take all medications.  Please continue florinef x one
more week (to be discontinued on [**2180-1-11**]).  If you feel like
coughing or vomiting, ask for preventative medicine.  Return to
the ED or call your doctor if you experience bleeding, worsening
or new weakness, or other concerning symtpoms.


Followup Instructions:
Provider: [**Name10 (NameIs) **] SCAN Where: RA [**Hospital Unit Name **] ([**Hospital Ward Name **]/[**Hospital Ward Name **]
COMPLEX) RADIOLOGY Phone:[**Telephone/Fax (1) 491**] Date/Time:[**2180-4-12**] 11:30
Provider: [**Name10 (NameIs) **] SCAN Where: RA [**Hospital Unit Name **] ([**Hospital Ward Name **]/[**Hospital Ward Name **]
COMPLEX) RADIOLOGY Phone:[**Telephone/Fax (1) 491**] Date/Time:[**2180-4-12**] 11:45

NOTE - do not eat any food or drink for three hours before the
above radiology appointments.

Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Where: [**Hospital6 189**] NEUROLOGY
Phone:[**Telephone/Fax (1) 190**] Date/Time:[**2180-4-12**] 1:00


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **] MD [**MD Number(1) 9973**]

Completed by:[**2180-1-5**]
{'Dissection of carotid artery,Occlusion and stenosis of carotid artery with cerebral infarction,Hemiplegia, unspecified, affecting nondominant side,Other syndromes affecting cervical region,Fall from other slipping, tripping, or stumbling,Alcohol abuse, unspecified,Posttraumatic stress disorder,Other acquired absence of organ,Attention deficit disorder with hyperactivity,Dysthymic disorder,Other late effects of cerebrovascular disease, facial weakness'}


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 sided weakness, blurry vision, facial droop

PRESENT ILLNESS: ** History obtained from chart, co-residents, patient and
patient's wife  **

MEDICAL HISTORY: 1. Anxiety
2. PTSD
3. ADHD
4. Depression
5. Alcohol abuse
6. Migraine
7. Status post C5-C6 laminectomy and fusion several years ago by
[**Doctor Last Name 1327**]
8. Diverticulitis, now status post partial colectomy
9. Asplenia secondary to trauma incurred during Vietman
10. Multiple sharpnel injuries while in Vietmam, [**2142**] - NO MRI!!

MEDICATION ON ADMISSION: Medications prior to admission:
Wellbutrin 400
Ritalin 20
Antabuse
Thiamine 1
Neurontin prn insomnia, up to 1000 mg

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam upon transfer to floor:

FAMILY HISTORY: adopted

SOCIAL HISTORY: Divorced. Lives with female partner for past 15 years. 2
biologic and 1 adopted child. Works as a real estate broker.
Smokes 1ppd for many years. History of alcohol abuse but no EtOH
for 6 weeks. No drug use. 

### Response:
{'Dissection of carotid artery,Occlusion and stenosis of carotid artery with cerebral infarction,Hemiplegia, unspecified, affecting nondominant side,Other syndromes affecting cervical region,Fall from other slipping, tripping, or stumbling,Alcohol abuse, unspecified,Posttraumatic stress disorder,Other acquired absence of organ,Attention deficit disorder with hyperactivity,Dysthymic disorder,Other late effects of cerebrovascular disease, facial weakness'}
