CHIEF COMPLAINT: unresponsive, R sided weakness

PRESENT ILLNESS: 56y RHM with no previous stroke, presented with
unresponsiveness, ?L MCA stroke.
Patient was last seen normal at yesterday 9:30PM, however, his
wife saw him taling, rolling (from R to L) around 6:15AM. His
nephew heard that he was walking toward to bathroom and came
back to living room. Then he heard thud and found that patient
was on the floor. EMS activated around 6:30AM, arrived at 9:38,
saw him awake, alert, oriented, with L gaze preference, R
neglect. He was brought to [**Hospital **] Hospital, there his NIHSS was
31 with dense R weakness, poor responsiveness. He was contact[**Name (NI) **]
to our Stroke fellow, initiated transfer. He was intubated to
secure airway with Saccinylcholine, Vecuronium and Ativan. Head
CT showed L-M1 clot and low density area at L-MCA territory. He
arrived at [**Hospital1 18**] ED at 10AM and code stroke was initiated.
.
ROS:
No recent febrile episodes. No cough, SOB, chest pain,
palpitation. No abdominal pain, vomiting, diarrhea. No recent
trauma

MEDICAL HISTORY: Depression
No hx of HTN, DM and HL. No hx of stroke, seizure

MEDICATION ON ADMISSION: Bupropion 150mg SR [**Hospital1 **]
Klonopin 1mg QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T   HR 55, reg  BP 97/72 RR 18  SO2 100% intubated
Gen:NAD. Intubated, unresponsive.
Skin: No rash
HEENT:MMM. Sclera clear. OP clear. Extra ear canals, ear drums
clear. On C-collar.
Neck: No Carotid bruits
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: Soft, flat, no tenderness
Ext: No deformities, no edema
.
Neurologic examination:
Mental status: No grimacing, eye opening to noxious stimuli. No
following command.
Cranial Nerves: No blink to threat. Pupils 5mm to non-reactive,
equal. Eyes at midline, no gaze deviation, no nystagmus. OCR not
tested due to cervical collar.
Motor:
Normal bulk. External rotation of right leg (subtle hypotonic
sign). No spasticity. No tremor. No withdrawal to pain.
Sensation: No withdrawal to pain x 4 limbs.
Reflexes: B T Br Pa Ankle
Right       2 2 2  2   2
Left         2 2 2  2   2
Toes were mute.
.
Coordination: Unable to study.
Gait: Unable to study.
Meningeal sign: Unable to study.

FAMILY HISTORY: No FH of stroke or seizure

SOCIAL HISTORY: Works as a painter, 40 PY tobacco
Cerebral artery occlusion, unspecified with cerebral infarction,Dissection of carotid artery,Hematoma complicating a procedure,Encounter for palliative care
Crbl art ocl NOS w infrc,Dissect carotid artery,Hematoma complic proc,Encountr palliative care
Admission Date:  [**2170-5-14**]              Discharge Date:   [**2170-5-17**]

Date of Birth:  [**2113-6-27**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
unresponsive, R sided weakness

Major Surgical or Invasive Procedure:
cerebral angiogram

History of Present Illness:
56y RHM with no previous stroke, presented with
unresponsiveness, ?L MCA stroke.
Patient was last seen normal at yesterday 9:30PM, however, his
wife saw him taling, rolling (from R to L) around 6:15AM. His
nephew heard that he was walking toward to bathroom and came
back to living room. Then he heard thud and found that patient
was on the floor. EMS activated around 6:30AM, arrived at 9:38,
saw him awake, alert, oriented, with L gaze preference, R
neglect. He was brought to [**Hospital **] Hospital, there his NIHSS was
31 with dense R weakness, poor responsiveness. He was contact[**Name (NI) **]
to our Stroke fellow, initiated transfer. He was intubated to
secure airway with Saccinylcholine, Vecuronium and Ativan. Head
CT showed L-M1 clot and low density area at L-MCA territory. He
arrived at [**Hospital1 18**] ED at 10AM and code stroke was initiated.
.
ROS:
No recent febrile episodes. No cough, SOB, chest pain,
palpitation. No abdominal pain, vomiting, diarrhea. No recent
trauma

Past Medical History:
Depression
No hx of HTN, DM and HL. No hx of stroke, seizure

Social History:
Works as a painter, 40 PY tobacco

Family History:
No FH of stroke or seizure

Physical Exam:
Vitals: T   HR 55, reg  BP 97/72 RR 18  SO2 100% intubated
Gen:NAD. Intubated, unresponsive.
Skin: No rash
HEENT:MMM. Sclera clear. OP clear. Extra ear canals, ear drums
clear. On C-collar.
Neck: No Carotid bruits
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: Soft, flat, no tenderness
Ext: No deformities, no edema
.
Neurologic examination:
Mental status: No grimacing, eye opening to noxious stimuli. No
following command.
Cranial Nerves: No blink to threat. Pupils 5mm to non-reactive,
equal. Eyes at midline, no gaze deviation, no nystagmus. OCR not
tested due to cervical collar.
Motor:
Normal bulk. External rotation of right leg (subtle hypotonic
sign). No spasticity. No tremor. No withdrawal to pain.
Sensation: No withdrawal to pain x 4 limbs.
Reflexes: B T Br Pa Ankle
Right       2 2 2  2   2
Left         2 2 2  2   2
Toes were mute.
.
Coordination: Unable to study.
Gait: Unable to study.
Meningeal sign: Unable to study.


Pertinent Results:
Admission Labs:

[**2170-5-14**] 04:46PM   TYPE-ART PO2-187* PCO2-42 PH-7.39 TOTAL
CO2-26 BASE XS-0
[**2170-5-14**] 04:35PM   GLUCOSE-89 UREA N-9 CREAT-0.8 SODIUM-138
POTASSIUM-3.9 CHLORIDE-110* TOTAL CO2-21* ANION GAP-11
[**2170-5-14**] 04:35PM   CK(CPK)-171  CK-MB-6 cTropnT-<0.01
[**2170-5-14**] 04:35PM   CALCIUM-7.7* PHOSPHATE-2.4* MAGNESIUM-1.8
[**2170-5-14**] 04:35PM URINE  HOURS-RANDOM CREAT-43 SODIUM-156
[**2170-5-14**] 04:35PM   WBC-11.6* RBC-4.00* HGB-13.0* HCT-34.8*
MCV-87 MCH-32.4* MCHC-37.3* RDW-13.6  PLT COUNT-269
[**2170-5-14**] 02:24PM   TYPE-ART TEMP-35.7 PO2-419* PCO2-40 PH-7.38
TOTAL CO2-25 BASE XS-0 INTUBATED-INTUBATED VENT-CONTROLLED
[**2170-5-14**] 02:24PM   GLUCOSE-100 LACTATE-1.3 K+-4.0
[**2170-5-14**] 02:24PM   freeCa-1.11*
[**2170-5-14**] 10:15AM   GLUCOSE-135* UREA N-15 CREAT-1.0 SODIUM-140
POTASSIUM-4.3 CHLORIDE-109* TOTAL CO2-25 ANION GAP-10
[**2170-5-14**] 10:15AM   CK(CPK)-149  CK-MB-5 cTropnT-<0.01
[**2170-5-14**] 10:15AM   OSMOLAL-292
[**2170-5-14**] 10:15AM   WBC-10.2 RBC-4.19* HGB-13.4* HCT-36.9* MCV-88
MCH-32.0 MCHC-36.3* RDW-13.5   PLT COUNT-222
[**2170-5-14**] 10:15AM   PT-11.6 PTT-24.7 INR(PT)-1.0
[**2170-5-14**] 10:15AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.020
[**2170-5-14**] 10:15AM URINE  BLOOD-SM NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0
LEUK-NEG
[**2170-5-14**] 10:15AM URINE  RBC-[**1-29**]* WBC-<1 BACTERIA-NONE YEAST-NONE
EPI-0-2
.
CTA Head and Neck:
There appears to be dissection of the left internal carotid
artery starting from at least its petrous segment and into the
cavernous
internal carotid artery.  There appears to be thrombus in the
left middle
cerebral artery and supraclinoid internal carotid artery.
.
No opacification of middle cerebral artery territory branches.
.
Based upon the CT perfusion data (CBF, CBV and MTT), there is a
large
irreversible infarct in the middle cerebral artery territory.
.
Cerebral ANgiogram:
Dissection of almost the entire cervical portion of the left
internal carotid artery with a smaller area of dissection in the
cavernous portion.  In addition, there is a large thrombus at
the level of the left ICA bifurcation with no opacification of
the left M1 or A1 segments as above
.
CT Head [**5-15**]:
Evolving total left MCA distribution infarction, with
significant
mass effect, midline shift, and subfalcine herniation.  No
evidence of
hemorrhagic transformation
.
CT C Spine: No acute fracture or malalignment of the cervical
spine.  Mild
degenerative change
.
CT Head [**5-16**]:
1.  Concerning increase in the amount of cerebral edema within
the left
hemisphere with increasing right-[**Hospital1 **] midline shift and new
uncal herniation.
2.  Possible new midbrain infarction
.
Repeat CT Head [**5-16**]:
Interval progression of left cerebral hemispheric edema and
associated subfalcine and uncal herniation compared to
examination from eight hours prior.


Brief Hospital Course:
Pt. was taken to the angiography suite for possible tPA from the
ED.  Angiography was performed and unfortunately showed a large
dissection of the left ICA, with thrombus extending from the ICA
into the MCA.  He was therefore not a tPA candidate.  He was
transferred to the NeuroICU for close monitoring.  Heparin was
not started because it was felt to be risky given the size of
the infarct.  The team had extensive discussions with the family
as it was felt that he was at high risk for swelling and
herniation given the size of the infarct.  We felt that he would
likely need decompressive hemicraniectomy to survive the
infarct, and discussed with him what his deficits would likely
be afterwards (including dense hemiparesis, expressive and
receptive aphasia).  They felt that he would not want to live
with that degree of deficit and would not want the
hemicraniectomy.  He did show evidence of herniation on repeat
CTs.  He was made DNR, and on [**5-17**] he was taken to the OR for
organ donation.

Medications on Admission:
Bupropion 150mg SR [**Hospital1 **]
Klonopin 1mg QHS


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
L ICA dissection
L MCA thrombus
total L MCA ischemic stroke

Discharge Condition:
Expired

Discharge Instructions:
None

Followup Instructions:
None

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2170-6-25**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Dissection of carotid artery,Hematoma complicating a procedure,Encounter for palliative care'}


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: unresponsive, R sided weakness

PRESENT ILLNESS: 56y RHM with no previous stroke, presented with
unresponsiveness, ?L MCA stroke.
Patient was last seen normal at yesterday 9:30PM, however, his
wife saw him taling, rolling (from R to L) around 6:15AM. His
nephew heard that he was walking toward to bathroom and came
back to living room. Then he heard thud and found that patient
was on the floor. EMS activated around 6:30AM, arrived at 9:38,
saw him awake, alert, oriented, with L gaze preference, R
neglect. He was brought to [**Hospital **] Hospital, there his NIHSS was
31 with dense R weakness, poor responsiveness. He was contact[**Name (NI) **]
to our Stroke fellow, initiated transfer. He was intubated to
secure airway with Saccinylcholine, Vecuronium and Ativan. Head
CT showed L-M1 clot and low density area at L-MCA territory. He
arrived at [**Hospital1 18**] ED at 10AM and code stroke was initiated.
.
ROS:
No recent febrile episodes. No cough, SOB, chest pain,
palpitation. No abdominal pain, vomiting, diarrhea. No recent
trauma

MEDICAL HISTORY: Depression
No hx of HTN, DM and HL. No hx of stroke, seizure

MEDICATION ON ADMISSION: Bupropion 150mg SR [**Hospital1 **]
Klonopin 1mg QHS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T   HR 55, reg  BP 97/72 RR 18  SO2 100% intubated
Gen:NAD. Intubated, unresponsive.
Skin: No rash
HEENT:MMM. Sclera clear. OP clear. Extra ear canals, ear drums
clear. On C-collar.
Neck: No Carotid bruits
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: Soft, flat, no tenderness
Ext: No deformities, no edema
.
Neurologic examination:
Mental status: No grimacing, eye opening to noxious stimuli. No
following command.
Cranial Nerves: No blink to threat. Pupils 5mm to non-reactive,
equal. Eyes at midline, no gaze deviation, no nystagmus. OCR not
tested due to cervical collar.
Motor:
Normal bulk. External rotation of right leg (subtle hypotonic
sign). No spasticity. No tremor. No withdrawal to pain.
Sensation: No withdrawal to pain x 4 limbs.
Reflexes: B T Br Pa Ankle
Right       2 2 2  2   2
Left         2 2 2  2   2
Toes were mute.
.
Coordination: Unable to study.
Gait: Unable to study.
Meningeal sign: Unable to study.

FAMILY HISTORY: No FH of stroke or seizure

SOCIAL HISTORY: Works as a painter, 40 PY tobacco 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Dissection of carotid artery,Hematoma complicating a procedure,Encounter for palliative care'}
