CHIEF COMPLAINT: Left sided weakness

PRESENT ILLNESS: 56yo M with HTN, afib, pacer implantation, CAD s/p CABG x 2,
presents with headache L sided weakness found to have R ICH on
OSH CT. Found by son on ground this am after hearing a thud
upstairs. Pt was conversant according to EMS records complaining
of severe headache and Left sided weakness. At OSH he was
intubated for ? reasons. Head CT revealed large R basal ganglia
hemorrhage with extensive intraventricular spread, + blood in
4th ventricle, 1cm midline shift. INR at OSH was 3.4. He was
given Vit K, FFP x 3 units, loaded with dilantin, nitroprusside
for BP control. Transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: Paroxysmal Atrial Fibrillation [**2159**]
Tachybrady Syndrome s/p PPM [**11-4**]
Stroke [**1-4**]
Upper GI bleed
Hepatitis C in the setting of IV drug use
Diabetes
Hpertension
Oesity

MEDICATION ON ADMISSION: Medications (per chart review):
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 10 mg
Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] -  (Prescribed by Other Provider) -
100
unit/mL Solution - 40 units by injection once a day
INSULIN LISPRO [HUMALOG] -  (Prescribed by Other Provider) -
Dosage uncertain
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 100 mg
Tablet - 1 Tablet(s) by mouth twice a day
SOTALOL -  (Prescribed by Other Provider) - 80 mg Tablet - 1.5
Tablet(s) by mouth twice a day
WARFARIN -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth as directed 5 mg M,T,TH,F,Sat and 7.5 mg (1
[**1-30**]) tabs Sun, Wed

ALLERGIES: Fentanyl

PHYSICAL EXAM: T 98, HR 100, BP 190/90, R 18, 100% intubated
Gen- critically ill, intubated, off propfol x 15 minutes prior
to
exam.
HEENT: NCAT, anicteric sclera
Neck: no carotid bruits, no nuchal rigidity.
CV- RRR, no MRG
Pulm- soft crackles bilat,
Adb- soft, nd, BS+
Extrem- 1+ bilat LE edema

FAMILY HISTORY: There is a family history of diabetes and early stroke in his
mother.

SOCIAL HISTORY: He is a prior smoker.  He is currently self-employed as an
exterminator.  He used to use IV drugs but does not use them
anymore.
Intracerebral hemorrhage,Cerebral edema,Obstructive hydrocephalus,Flaccid hemiplegia and hemiparesis affecting unspecified side,Acquired coagulation factor deficiency,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Hypotension, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Obesity, unspecified
Intracerebral hemorrhage,Cerebral edema,Obstructiv hydrocephalus,Flccd hmiplga unspf side,Acq coagul factor defic,Adv eff anticoagulants,Atrial fibrillation,Chrnc hpt C wo hpat coma,Hypotension NOS,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hypertension NOS,Obesity NOS
Admission Date:  [**2167-6-1**]              Discharge Date:   [**2167-6-2**]

Date of Birth:  [**2110-8-10**]             Sex:   M

Service: NEUROLOGY

Allergies:
Fentanyl

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Left sided weakness

Major Surgical or Invasive Procedure:
None

History of Present Illness:
56yo M with HTN, afib, pacer implantation, CAD s/p CABG x 2,
presents with headache L sided weakness found to have R ICH on
OSH CT. Found by son on ground this am after hearing a thud
upstairs. Pt was conversant according to EMS records complaining
of severe headache and Left sided weakness. At OSH he was
intubated for ? reasons. Head CT revealed large R basal ganglia
hemorrhage with extensive intraventricular spread, + blood in
4th ventricle, 1cm midline shift. INR at OSH was 3.4. He was
given Vit K, FFP x 3 units, loaded with dilantin, nitroprusside
for BP control. Transferred to [**Hospital1 18**] for further care.


Past Medical History:
Paroxysmal Atrial Fibrillation [**2159**]
Tachybrady Syndrome s/p PPM [**11-4**]
Stroke [**1-4**]
Upper GI bleed
Hepatitis C in the setting of IV drug use
Diabetes
Hpertension
Oesity

Social History:
He is a prior smoker.  He is currently self-employed as an
exterminator.  He used to use IV drugs but does not use them
anymore.


Family History:
There is a family history of diabetes and early stroke in his
mother.

Physical Exam:
T 98, HR 100, BP 190/90, R 18, 100% intubated
Gen- critically ill, intubated, off propfol x 15 minutes prior
to
exam.
HEENT: NCAT, anicteric sclera
Neck: no carotid bruits, no nuchal rigidity.
CV- RRR, no MRG
Pulm- soft crackles bilat,
Adb- soft, nd, BS+
Extrem- 1+ bilat LE edema

Neurologic exam:
MS- no response to deep noxious stimuli.

CN- pupils 6mm and unreactive to light bilaterally, absent
oculocephalic reflex laterally and vertically, no blink to
threat, absent corneal response, + gag.

Motor/Sensory- no arm movement to noxious, activates quads
bilaterally to deep noxious in legs but otherwise no actual leg
movement.

Reflexes- absent throughout

Plantar response- upgoing on left, mute on right.


Pertinent Results:
CT head [**2167-6-1**]
1. Massive right temporoparietal hemorrhage, centered within the
right basal ganglia, with intraventricular extension and
subfalcine, uncal, transtentorial and tonsillar herniation.

2. Diffuse subarachnoid hemorrhage and diffuse brain edema.

3. Entrapment of the left lateral ventricle with hydrocephalus.

CXR [**2167-6-1**]
IMPRESSION:
1. Bibasilar ill-defined patchy opacities, right greater than
left, which
could represent areas of infection or atelectasis.
2. Small amount of fluid within the right minor fissure.
3. Appropriate positioning of lines and tubes.

[**2167-6-1**] 06:33PM   TYPE-ART RATES-/14 TIDAL VOL-700 PEEP-5
O2-100 PO2-348* PCO2-43 PH-7.41 TOTAL CO2-28 BASE XS-2 AADO2-342
REQ O2-60 INTUBATED-INTUBATED
[**2167-6-1**] 05:34PM   GLUCOSE-221* UREA N-13 CREAT-0.9 SODIUM-140
POTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-26 ANION GAP-15
[**2167-6-1**] 05:34PM   CK(CPK)-159
[**2167-6-1**] 05:34PM   cTropnT-<0.01
[**2167-6-1**] 05:34PM   CALCIUM-9.6 PHOSPHATE-2.7 MAGNESIUM-1.9
[**2167-6-1**] 05:34PM   ASA-NEG ETHANOL-NEG ACETMNPHN-9.6
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2167-6-1**] 05:34PM   WBC-12.4* RBC-5.25# HGB-13.6*# HCT-41.5#
MCV-79*# MCH-25.9*# MCHC-32.8 RDW-15.0
[**2167-6-1**] 05:34PM   NEUTS-74.9* LYMPHS-18.2 MONOS-5.9 EOS-0.5
BASOS-0.5
[**2167-6-1**] 05:34PM   PLT COUNT-236
[**2167-6-1**] 05:34PM   PT-21.3* PTT-33.8 INR(PT)-2.0*

Brief Hospital Course:
56yo male with mult vascular risk factors, CAD, HTN, afib on
coumadin presents with a large R putaminal hemorrhage. His exam
off sedation at present is very poor with loss of brainstem
reflexes except for gag. Motor exam only notable for vague
activation of quadriceps bilaterally. CT from outside hospital
with extensive intraventricular spread of hemorrhage with
dissection of the brainstem and blood in the 4th. Given his
examination and imaging this is a grade IV intraventricular
hemorrhage with very poor prognosis.

He had serial brain stem examinations, and in his second
brainstem exam, he met the criteria for brain death. His family
were aware of the situation and his family agreed to an organ
donation on [**2167-6-2**].


Medications on Admission:
Medications (per chart review):
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 10 mg
Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] -  (Prescribed by Other Provider) -
100
unit/mL Solution - 40 units by injection once a day
INSULIN LISPRO [HUMALOG] -  (Prescribed by Other Provider) -
Dosage uncertain
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 100 mg
Tablet - 1 Tablet(s) by mouth twice a day
SOTALOL -  (Prescribed by Other Provider) - 80 mg Tablet - 1.5
Tablet(s) by mouth twice a day
WARFARIN -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth as directed 5 mg M,T,TH,F,Sat and 7.5 mg (1
[**1-30**]) tabs Sun, Wed

Medications - OTC
ASCORBIC ACID [VITAMIN C] -  (Prescribed by Other Provider) -
500
mg Tablet - 1 Tablet(s) by mouth twice a day
ASPIRIN [ENTERIC COATED ASPIRIN] -  (Prescribed by Other
Provider) - 81 mg Tablet, Delayed Release (E.C.) - one Tablet(s)
by mouth daily
OMEPRAZOLE MAGNESIUM [PRILOSEC OTC] -  (Prescribed by Other
Provider) - 20 mg Tablet, Delayed Release (E.C.) - 1 (One)
Tablet(s) by mouth once a day


Discharge Medications:
None

Discharge Disposition:
Expired

Discharge Diagnosis:
Stroke (large right putaminal hemorrhage with extensive
intraventricular spread)


Discharge Condition:
Not applicable


Discharge Instructions:
None

Followup Instructions:
None


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

Completed by:[**2167-6-3**]
{'Intracerebral hemorrhage,Cerebral edema,Obstructive hydrocephalus,Flaccid hemiplegia and hemiparesis affecting unspecified side,Acquired coagulation factor deficiency,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Hypotension, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Obesity, unspecified'}


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

PRESENT ILLNESS: 56yo M with HTN, afib, pacer implantation, CAD s/p CABG x 2,
presents with headache L sided weakness found to have R ICH on
OSH CT. Found by son on ground this am after hearing a thud
upstairs. Pt was conversant according to EMS records complaining
of severe headache and Left sided weakness. At OSH he was
intubated for ? reasons. Head CT revealed large R basal ganglia
hemorrhage with extensive intraventricular spread, + blood in
4th ventricle, 1cm midline shift. INR at OSH was 3.4. He was
given Vit K, FFP x 3 units, loaded with dilantin, nitroprusside
for BP control. Transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: Paroxysmal Atrial Fibrillation [**2159**]
Tachybrady Syndrome s/p PPM [**11-4**]
Stroke [**1-4**]
Upper GI bleed
Hepatitis C in the setting of IV drug use
Diabetes
Hpertension
Oesity

MEDICATION ON ADMISSION: Medications (per chart review):
ATORVASTATIN [LIPITOR] -  (Prescribed by Other Provider) - 10 mg
Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] -  (Prescribed by Other Provider) -
100
unit/mL Solution - 40 units by injection once a day
INSULIN LISPRO [HUMALOG] -  (Prescribed by Other Provider) -
Dosage uncertain
LISINOPRIL -  (Prescribed by Other Provider) - 40 mg Tablet - 1
Tablet(s) by mouth once a day
METOPROLOL TARTRATE -  (Prescribed by Other Provider) - 100 mg
Tablet - 1 Tablet(s) by mouth twice a day
SOTALOL -  (Prescribed by Other Provider) - 80 mg Tablet - 1.5
Tablet(s) by mouth twice a day
WARFARIN -  (Prescribed by Other Provider) - 5 mg Tablet - 1
Tablet(s) by mouth as directed 5 mg M,T,TH,F,Sat and 7.5 mg (1
[**1-30**]) tabs Sun, Wed

ALLERGIES: Fentanyl

PHYSICAL EXAM: T 98, HR 100, BP 190/90, R 18, 100% intubated
Gen- critically ill, intubated, off propfol x 15 minutes prior
to
exam.
HEENT: NCAT, anicteric sclera
Neck: no carotid bruits, no nuchal rigidity.
CV- RRR, no MRG
Pulm- soft crackles bilat,
Adb- soft, nd, BS+
Extrem- 1+ bilat LE edema

FAMILY HISTORY: There is a family history of diabetes and early stroke in his
mother.

SOCIAL HISTORY: He is a prior smoker.  He is currently self-employed as an
exterminator.  He used to use IV drugs but does not use them
anymore. 

### Response:
{'Intracerebral hemorrhage,Cerebral edema,Obstructive hydrocephalus,Flaccid hemiplegia and hemiparesis affecting unspecified side,Acquired coagulation factor deficiency,Anticoagulants causing adverse effects in therapeutic use,Atrial fibrillation,Chronic hepatitis C without mention of hepatic coma,Hypotension, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Unspecified essential hypertension,Obesity, unspecified'}
