CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 85 year-old
woman with a history of progressive dementia who was admitted
to [**Hospital1 **] Hospital on [**2153-9-16**] with
a chief complaint of a change in mental status as per her
daughter with right side weakness.  The patient had a history
been on Coumadin.  She also was being treated for a urinary
tract infection for which Levofloxacin was started on
[**9-10**].  The Levofloxacin was changed to Bactrim
Flagyl, because of culture resistance.  At that same time the
Coumadin had been switched to Lovenox, because of
interactions with the antibiotics.

MEDICAL HISTORY: Small vessel dementia, hypertension,
coronary artery bypass graft [**2137**], right arm fracture, deep
venous thrombosis in [**Month (only) 216**], transient ischemic attack,
cerebrovascular accident in [**2153-4-17**] with a residual right
hemiparesis.

MEDICATION ON ADMISSION: Procardia, aspirin, multi
vitamins, Senna, Colace, Lipitor, Lovenox, Lescol.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Intracerebral hemorrhage,Subendocardial infarction, initial episode of care,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Mitral valve disorders,Diseases of tricuspid valve,Congestive heart failure, unspecified,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere
Intracerebral hemorrhage,Subendo infarct, initial,Food/vomit pneumonitis,Urin tract infection NOS,Mitral valve disorder,Tricuspid valve disease,CHF NOS,Hypertension NOS,Mental disor NEC oth dis
Admission Date:  [**2153-9-17**]       Discharge Date:  [**2153-9-25**]


Service:NEUROLOGY
HISTORY OF PRESENT ILLNESS:  The patient is a 85 year-old
woman with a history of progressive dementia who was admitted
to [**Hospital1 **] Hospital on [**2153-9-16**] with
a chief complaint of a change in mental status as per her
daughter with right side weakness.  The patient had a history
been on Coumadin.  She also was being treated for a urinary
tract infection for which Levofloxacin was started on
[**9-10**].  The Levofloxacin was changed to Bactrim
Flagyl, because of culture resistance.  At that same time the
Coumadin had been switched to Lovenox, because of
interactions with the antibiotics.

movements in the patient's right side since the preceding
Friday, which did not improve.  Reportedly the daughter
stated she also noticed decreased mental status over two
weeks.

On admission a CT scan showed a large left basal ganglia
bleed extending into the left lateral ventricle.

PAST MEDICAL HISTORY:  Small vessel dementia, hypertension,
coronary artery bypass graft [**2137**], right arm fracture, deep
venous thrombosis in [**Month (only) 216**], transient ischemic attack,
cerebrovascular accident in [**2153-4-17**] with a residual right
hemiparesis.

MEDICATIONS ON ADMISSION:  Procardia, aspirin, multi
vitamins, Senna, Colace, Lipitor, Lovenox, Lescol.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 101.4.  Pulse
107.  Blood pressure 193/72.  Respiratory rate 20.  She was
breathing 94% on 2 liters of oxygen.  The patient was awake
and attentive and not speaking.  Cranial nerves, the right
pupil was less then 1 mm and the left was 2 mm and reactive.
The eyes moved.  There was a questionable facial droop.  The
patient responded to voice.  On motor examination the patient
was not moving the right arm.  She was moving the right leg
less then the left leg.  On sensory examination she was
withdrawing to stimuli of tickle bilaterally on her feet.
Reflexes, there was no clonus.  Plantar left toe was down,
right toe was up.  Reflexes was 2+ bilaterally in the
brachial radialis, biceps, triceps, patella and the ankle
reflex.

LABORATORIES ON ADMISSION:  White blood cell count 20.9,
hematocrit 38.5, INR 2.3, PTT 40.6, electrolytes were stable.
Chest x-ray showed a left lower lobe pneumonia.

HOSPITAL COURSE:  The patient was admitted for her acute left
basal ganglia bleed, which was measured to be 5 by 3 by 3 cm,
which was extending into the ventricle.  For her basal
ganglia bleed she was given blood pressure control with
Labetalol so that her systolic blood pressure was less then
150.  Her INR was controlled by getting 2 units of fresh
frozen platelets and vitamin K in the Emergency Department.
For her urinary tract infection she was given Bactrim and
Flagyl and for her pneumonia she was given Ceftriaxone and
the sensitivities were followed.  For her deep venous
thrombosis, vena cava filter was considered as
anticoagulation was no longer an option given her bleed.

Her hospital course was progressed as follows:  The INR was
kept below 1.3.  Her hypertension controlled by Labetalol,
Lopressor to keep a systolic blood pressure less then 150.
She was shown to have an elevated CKMB and troponin was
elevated as well on [**9-17**].  No electrocardiogram changes
were seen.  Her last echocardiogram showed a normal ejection
fraction, but careful use of IV fluids were monitored and
aspirin was held.  Antibiotics were continued on Ceftriaxone,
Levofloxacin was changed to Vancomycin and Flagyl.  The
patient was transferred to the CICU on [**9-17**] for blood
pressure management.  On [**9-17**] the Vancomycin and the
Flagyl were discontinued and she was continued on Ceftriaxone
intravenous.  Overnight on the night of [**9-17**] to [**9-18**] she ruled in for an myocardial infarction.  Echocardiogram
done on [**9-18**] showed left ventricular ejection fraction
at low normal with basal posterior hypokinesis, severe MR [**First Name (Titles) **]
[**Last Name (Titles) **].

On [**9-19**] the patient was transferred to the medical floor
with the intention of transferring the patient to the
neurology floor when a bed became available.  She was at that
time being controlled on Labetalol and Lopressor for her
blood pressure and she was on Ceftriaxone for her pneumonia.
Urine cultures were negative and blood cultures had been
negative.  Physical therapy evaluation showed that the
patient was not swallowing.  On [**9-22**] the patient had
still been spiking fevers.  She was being treated only by
intravenous Ceftriaxone.  X-ray on [**9-22**] showed new right
lung pleural effusion and left pleural effusion with
atelectasis on the right.  Clindamycin was started at 900 mg
IV q 8 hours to cover anaerobics.  Over the course of the
weekend of [**9-22**] and [**9-23**] the family decided to
proceed with insertion of a PEG tube.  The PEG was inserted
on Monday [**9-24**].  The Clindamycin antibiotics was changed
to 600 mg IV q 6 hours on [**9-23**].  At this point, on
[**9-24**] she had been covered with Ceftriaxone and
Clindamycin.  On [**9-24**], the Ceftriaxone was discontinued
and Levofloxacin IV 500 mg q.d. was started.

On the morning of [**9-25**], the patient was no longer
spiking fevers.  She was switched to po antibiotics, po
Clindamycin 450 mg q 6 hours and Levofloxacin 500 mg po q.d.
for a seven day course of treatment.  Her temperature max was
100.  Her pulse was 84.  Respirations 24.  Blood pressure
126/74.  The blood pressure medications were Lopressor 50 mg
b.i.d.  She had a gazed deviation to the left.  She would
only respond to voice by looking to the left.  She seemed to
have a right sided neglect, right sided hemiparesis.  She
will withdraw her left side to pain.  She will not follow any
commands.  She has a gastric tube placed with no hematomas.
Her lungs were clear bilaterally.  She has a regular rate and
rhythm with no murmurs in her heart.

DISCHARGE MEDICATIONS:  Colace 100 mg b.i.d., Tylenol 650 prn
fever, Lopressor 50 mg po b.i.d., Zestril 2.5 mg po q day,
Levaquin 500 mg po q.d., Clindamycin 450 mg po q 6 hours,
Zantac 5 mg po q 8, sliding scale insulin.  She is being fed
with Promote with fiber.  Her goal rate is 60 cc per hour.

DISPOSITION:  She is to be discharged to the [**Hospital 100**] Rehab.
Her Foley was discontinued on [**2153-9-25**].

DISCHARGE DIAGNOSIS:
Left basal ganglia bleed most likely due to anticoagulation
on Coumadin and Lovenox.

Follow up appointments will be made and written in the chart
prior to discharge.






                            [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern1) 106536**]
MEDQUIST36

D:  [**2153-9-25**]  10:34
T:  [**2153-9-25**]  10:48
JOB#:  [**Job Number 6235**]
{'Intracerebral hemorrhage,Subendocardial infarction, initial episode of care,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Mitral valve disorders,Diseases of tricuspid valve,Congestive heart failure, unspecified,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere'}


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 85 year-old
woman with a history of progressive dementia who was admitted
to [**Hospital1 **] Hospital on [**2153-9-16**] with
a chief complaint of a change in mental status as per her
daughter with right side weakness.  The patient had a history
been on Coumadin.  She also was being treated for a urinary
tract infection for which Levofloxacin was started on
[**9-10**].  The Levofloxacin was changed to Bactrim
Flagyl, because of culture resistance.  At that same time the
Coumadin had been switched to Lovenox, because of
interactions with the antibiotics.

MEDICAL HISTORY: Small vessel dementia, hypertension,
coronary artery bypass graft [**2137**], right arm fracture, deep
venous thrombosis in [**Month (only) 216**], transient ischemic attack,
cerebrovascular accident in [**2153-4-17**] with a residual right
hemiparesis.

MEDICATION ON ADMISSION: Procardia, aspirin, multi
vitamins, Senna, Colace, Lipitor, Lovenox, Lescol.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Intracerebral hemorrhage,Subendocardial infarction, initial episode of care,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Mitral valve disorders,Diseases of tricuspid valve,Congestive heart failure, unspecified,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere'}
