CHIEF COMPLAINT: Right sided weakness and dysarthria

PRESENT ILLNESS: 81 M with unknown PMH was transfered from OSh for evaluation. He
was found in the car seat this pm outside an electronic store.
Police and EMTs were called and he was found to have "weakness
on
the right side" and garbled speech. He was taken to OSH where he
was found to be hypothermic (95) and drowsy. He was intubated
for
airway protection later in the am around (5) after giving
dilantin 1 gm, Etomidate 20, veceuronium 10, fentanyl 100.
Initially his BP was 133/84 when he presented at 1 pm which
later
peaked to 231/84 at 3 pm and was given labetelol IV for BP
control which was 194/79 around 5 pm before transfer. At OSH,
INR
1.1, CBC showed 6.2/13.7-42/ plt of 117. EKG showed NSR and RBBB
, No ST/T change. CT head showed 3 by 3 cm left BG bleed with
IVH, 3rd and 4th ventricle with midline shift of 3 mm. He was
transfered to [**Hospital1 18**] ED. Next, neurology and neurosurgery were
called.

MEDICAL HISTORY: Inclusion body myositis diagnosed 10 yrs ago
HTN

MEDICATION ON ADMISSION: [X]lisinopril 10 mg daily
[ ]metoprolol XL 50 mg daily
[X}allopurinol 300 daily
[X]nifedipine 30 daily
[ ]triamterene-hctz 37.5-25 daily
[X}dorzolinide w/ timolol eye drops [**Hospital1 **]
[X}Brimonidine 0.2% [**Hospital1 **]
[X}Lumigan 0.03% 1 drop QHS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:

FAMILY HISTORY: none

SOCIAL HISTORY: Lives alone. Non smoker, very rare alcohol use. No drugs
Intracerebral hemorrhage,Encephalopathy, unspecified,Pneumonia, organism unspecified,Pulmonary collapse,Unspecified essential hypertension,Inclusion body myositis,Unspecified glaucoma,Dehydration
Intracerebral hemorrhage,Encephalopathy NOS,Pneumonia, organism NOS,Pulmonary collapse,Hypertension NOS,Inclusion body myositis,Glaucoma NOS,Dehydration
Admission Date:  [**2145-1-25**]              Discharge Date:   [**2145-2-2**]


Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
Right sided weakness and dysarthria

Major Surgical or Invasive Procedure:
none

History of Present Illness:
81 M with unknown PMH was transfered from OSh for evaluation. He
was found in the car seat this pm outside an electronic store.
Police and EMTs were called and he was found to have "weakness
on
the right side" and garbled speech. He was taken to OSH where he
was found to be hypothermic (95) and drowsy. He was intubated
for
airway protection later in the am around (5) after giving
dilantin 1 gm, Etomidate 20, veceuronium 10, fentanyl 100.
Initially his BP was 133/84 when he presented at 1 pm which
later
peaked to 231/84 at 3 pm and was given labetelol IV for BP
control which was 194/79 around 5 pm before transfer. At OSH,
INR
1.1, CBC showed 6.2/13.7-42/ plt of 117. EKG showed NSR and RBBB
, No ST/T change. CT head showed 3 by 3 cm left BG bleed with
IVH, 3rd and 4th ventricle with midline shift of 3 mm. He was
transfered to [**Hospital1 18**] ED. Next, neurology and neurosurgery were
called.


Past Medical History:
Inclusion body myositis diagnosed 10 yrs ago
HTN


Social History:
Lives alone. Non smoker, very rare alcohol use. No drugs


Family History:
none

Physical Exam:
ADMISSION EXAM:

Vitals: HR:90 BP:183/100 O(2)Sat:100 Normal
General: Elderly, Intubated, not following commands
HEENT: NC/AT
Neck: No mass. bruit.
Chest: Posterior and anterior exam clear to auscultation
bilaterally
Cardiac: RRR no murmurs to auscultation
Abdomen: +BS, soft, non-tender, non-distended, ecchymosis
Extremities: warm, no edema

Neurological
Intubated, eyes open intermittently, not following any commands
Pupils 2 Bl symmetric, very minimally reactive
has left gaze preference, doesnt look towards right
face looks symmetric but exam difficult owing to intubated state
doesnt Move any limb spontaneously
minimal posturing to painful stimuli on left UE, no response to
painful stimuli on other limbs
DTRS; 1 plus and symmetric
BL plantars up

DISCHARGE EXAM
Lungs rhonchorous upper more than lower lobes bilaterally.
Neuro exam: AOx1-2. language intact. 4/5 strength in the upper
arms and forearms, only 3/5 strength in wrist flexion, wrist
extension, finger flexion, and finger extension bilaterally,
lower extremities antigravity strength secondary to inclusion
body myositits.


Pertinent Results:
ADMISSION LABS:
[**2145-1-27**] 03:46AM BLOOD WBC-7.0 RBC-3.73* Hgb-12.8* Hct-37.4*
MCV-100* MCH-34.3* MCHC-34.2 RDW-15.1 Plt Ct-109*
[**2145-1-26**] 03:00AM BLOOD PT-13.0 PTT-26.0 INR(PT)-1.1
[**2145-1-25**] 06:15PM BLOOD Fibrino-400
[**2145-1-27**] 03:46AM BLOOD Glucose-122* UreaN-31* Creat-0.8 Na-144
K-3.6 Cl-112* HCO3-24 AnGap-12
[**2145-1-29**] 12:45PM BLOOD CK(CPK)-266
[**2145-1-25**] 06:15PM BLOOD Lipase-45
[**2145-1-27**] 05:15PM BLOOD CK-MB-11* MB Indx-1.4 cTropnT-0.08*
[**2145-1-27**] 03:46AM BLOOD Calcium-8.3* Phos-2.5* Mg-2.2
[**2145-1-26**] 03:00AM BLOOD %HbA1c-5.6 eAG-114
[**2145-1-26**] 03:00AM BLOOD Triglyc-131 HDL-36 CHOL/HD-3.7 LDLcalc-72
[**2145-1-25**] 06:15PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

DISCHARGE LABS:

[**2145-2-2**] 06:10AM BLOOD WBC-7.0 RBC-3.22* Hgb-10.6* Hct-32.4*
MCV-101* MCH-32.8* MCHC-32.5 RDW-15.1 Plt Ct-109*
[**2145-2-2**] 06:10AM BLOOD Glucose-135* UreaN-38* Creat-1.1 Na-152*
K-3.2* Cl-119* HCO3-24 AnGap-12

NCHCT [**2145-1-28**]:
(prelim)
1. No evidence of new bleed. Unchanged size of hematoma in the
left basal
ganglia.
2. Resolution of blood in the right lateral ventricle, fourth
ventricle and third ventricle.
3. Slight increase in extent of subarachnoid hemorrhage likely
secondary to redistribution from the original bleed. There is no
evidence of new
hemorrhage.

NCHCT [**2145-1-25**]:
IMPRESSION:
1. Overall stable appearance of left basal ganglia
intraparenchymal
hemorrhage with surrounding edema, but no significant midline
shift. No
herniation or definite evidence of hydrocephalus.
2. Intraventricular hemorrhage involving nearly all the left
lateral
ventricle with extension in the right lateral ventricle and
third and fourth  ventricles; slight increase in third, fourth,
and left occipital [**Doctor Last Name 534**] intraventricular hemorrhage, most likely
reflects redistribution.
3. Opacification of the left frontal sinus and ethmoid mucosal
thickening may represent sinusitis.

CXR [**2145-1-25**]:
IMPRESSION:
1. Left costophrenic angle not fully included on the image.
2. Endotracheal and nasogastric tubes in appropriate position.
3. Low lung volumes with possible left base retrocardiac
atelectasis.

CXR [**1-30**]
 Increased patchy bibasilar density suspicious for pneumonia

CXR [**2-1**]
There has been no significant change since the prior chest
x-ray.
Increased retrocardiac density is again noted and atelectasis is
also seen at the right base. Underlying pneumonia, particularly
at the left may be
present.


Brief Hospital Course:
# Intracerebral hemorrhage:
Pt was admitted with a left basal ganglia bleed with significant
intraventricular extension. Neurosurgery was consulted, but they
felt there was no neurosurgical intervention needed, including
an EVD. He was initially intubated and monitored in the ICU
where his SBP was kept < 160. He was extubated and transferred
to the stroke floor. His neurological exam on discharge was
notable for inattention, fluent language, but with some element
of anomia with circumlocution. He continues to have contracted
and weak distal extremities B/L (likely realted to his [**Company 378**]), but
no clear asymmetry in the UE proximally. In the LE, the right IP
and Ham are somewhat weaker (~[**3-20**]) than the left, and he has
poor effort/ROM with ankle dorsiflexion B/L.

There was felt to be an element of overlying encephalopathy from
medications/sedatives/intubation/ICU delirium, that gradually
was improving during course. A repeat head CT showed no evidence
of hydrocephalus, which was a concern given the amount of
intraventricular blood. His mental status did take a mild turn
toward decline when he was diagnosed with PNA, but this is
expected to resolve with continued antibiotics.

The patient's prognosis remains guarded, as his ICH score was 2
or 3. His family was informed of his risk for developing
complications and not fully recovering to baseline within the
next 30 days.

All anticoagulants were held except subcutaneous heparin ppx.

HTN:
Patient has baseline severe hypertension, and was on many home
meds to control this. HCTZ/triamterene was stopped, lisinopril
was increased, and clonidine was added. Metoprolol, nifedipine
were continued.

# Inclusion body myositis:
Patient has atrophy and weakness at baseline due to [**Company 378**]. He was
walking with walker and mostly independent prior to ICH. CK and
troponin was elevated on admission, and this was likely due to
his myositis in setting of paralytics used for intubation,
rather than cardiac source. Both CK and trop trended down to
normal range.

# PNA:
Patient developed fever on [**1-30**]. CXR showed bilateral lower lobe
L>R and retrocardiac opacities c/w atelectasis plus PNA. He was
treated with vanco/zosyn for hospital-acquired PNA. He remained
afebrile, WBC trended down, and he was stable on room air.

# ELECTROLYTES:
Prior to day of discharge, sodium began to trend up. Creatinine
also began to rise, which was most c/w free water deficit and
dehydration. patient was given LR to replete K and bicarb, and
increased his free water intake. Lytes should be followed and
repleted prn, along with LR maintanence fluid and encouraging
free water intake.

Medications on Admission:
[X]lisinopril 10 mg daily
[ ]metoprolol XL 50 mg daily
[X}allopurinol 300 daily
[X]nifedipine 30 daily
[ ]triamterene-hctz 37.5-25 daily
[X}dorzolinide w/ timolol eye drops [**Hospital1 **]
[X}Brimonidine 0.2% [**Hospital1 **]
[X}Lumigan 0.03% 1 drop QHS


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
3. nifedipine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
4. allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. dorzolamide-timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic [**Hospital1 **] (2 times a day).
6. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic [**Hospital1 **] (2
times a day).
7. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
8. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
9. metoprolol succinate 50 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
10. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for SOB.
11. ipratropium bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for SOB wheezing.
12. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
13. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
14. piperacillin-tazobactam-dextrs 4.5 gram/100 mL Piggyback
Sig: 4.5 g Intravenous Q8H (every 8 hours) for 7 days.
15. vancomycin in D5W 1 gram/200 mL Piggyback Sig: One (1) g
Intravenous Q 12H (Every 12 Hours) for 7 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 **] Hospital at [**Location (un) 4047**]

Discharge Diagnosis:
Basal Ganglia hemorrhage
hypertension
hospital acquired pneumonia


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.

Neuro exam: AOx1-2. language intact. Upper extremities full
strength, lower extremities antigravity [**4-20**] secondary to
inclusion body myositits.


Discharge Instructions:
You were admitted with a bleed in your brain, likely related to
high blood pressure. Please continue to monitor your blood
pressure regularly. Please return to the ER if you appreciate
any new focal weakness, sensory changes, facial droop, trouble
with language, headache, or anything else that concerns you
seriously.

You were also treated for pneumonia with antibiotics. You will
complete your course of antibiotics at rehab.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 640**] [**Last Name (NamePattern4) 3445**], MD Phone:[**Telephone/Fax (1) 2574**]
Date/Time:[**2145-3-15**] 1:30
{'Intracerebral hemorrhage,Encephalopathy, unspecified,Pneumonia, organism unspecified,Pulmonary collapse,Unspecified essential hypertension,Inclusion body myositis,Unspecified glaucoma,Dehydration'}


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: Right sided weakness and dysarthria

PRESENT ILLNESS: 81 M with unknown PMH was transfered from OSh for evaluation. He
was found in the car seat this pm outside an electronic store.
Police and EMTs were called and he was found to have "weakness
on
the right side" and garbled speech. He was taken to OSH where he
was found to be hypothermic (95) and drowsy. He was intubated
for
airway protection later in the am around (5) after giving
dilantin 1 gm, Etomidate 20, veceuronium 10, fentanyl 100.
Initially his BP was 133/84 when he presented at 1 pm which
later
peaked to 231/84 at 3 pm and was given labetelol IV for BP
control which was 194/79 around 5 pm before transfer. At OSH,
INR
1.1, CBC showed 6.2/13.7-42/ plt of 117. EKG showed NSR and RBBB
, No ST/T change. CT head showed 3 by 3 cm left BG bleed with
IVH, 3rd and 4th ventricle with midline shift of 3 mm. He was
transfered to [**Hospital1 18**] ED. Next, neurology and neurosurgery were
called.

MEDICAL HISTORY: Inclusion body myositis diagnosed 10 yrs ago
HTN

MEDICATION ON ADMISSION: [X]lisinopril 10 mg daily
[ ]metoprolol XL 50 mg daily
[X}allopurinol 300 daily
[X]nifedipine 30 daily
[ ]triamterene-hctz 37.5-25 daily
[X}dorzolinide w/ timolol eye drops [**Hospital1 **]
[X}Brimonidine 0.2% [**Hospital1 **]
[X}Lumigan 0.03% 1 drop QHS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:

FAMILY HISTORY: none

SOCIAL HISTORY: Lives alone. Non smoker, very rare alcohol use. No drugs 

### Response:
{'Intracerebral hemorrhage,Encephalopathy, unspecified,Pneumonia, organism unspecified,Pulmonary collapse,Unspecified essential hypertension,Inclusion body myositis,Unspecified glaucoma,Dehydration'}
