CHIEF COMPLAINT: Vertigo and severe hypertension.

PRESENT ILLNESS: This is a 73 year old right
handed man with a history of hypertension, insulin dependent
diabetes mellitus, hypercholesterolemia and a chronic ataxia
not otherwise specified, who presents following an episode of
lightheadedness, headache, and vertigo, on [**2199-10-22**].  He
woke up with a feeling of vertigo with the sensation of room
spinning and had a mild bifrontal headache.  At this time he
also experienced nausea and had one bout of vomiting.  The
lightheadedness was worse on standing and in fact, he slumped
over to the floor because of lightheadedness but did not lose
consciousness and did not hit his head.  A neighbor called
EMS and he was brought to the Emergency Room.

MEDICAL HISTORY: 1.  Hypertension.
2.  Insulin dependent diabetes mellitus.
3.  Chronic ataxia.
4.  Hypothyroidism.
5.  Anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: None known.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not drink and was an old
smoker but currently does not smoke.
Malignant essential hypertension,Unspecified acquired hypothyroidism,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Displacement of cervical intervertebral disc without myelopathy,Other persistent mental disorders due to conditions classified elsewhere
Malignant hypertension,Hypothyroidism NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Cervical disc displacmnt,Mental disor NEC oth dis
Admission Date:  [**2199-10-22**]       Discharge Date:  [**2199-10-26**]

Date of Birth:   [**2126-2-9**]       Sex:  M

Service:  NEURO MED

NOTE:  The following is an admission history and physical as
noted by [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 10447**], M.D., Ph.D.

CHIEF COMPLAINT:   Vertigo and severe hypertension.

HISTORY OF PRESENT ILLNESS:   This is a 73 year old right
handed man with a history of hypertension, insulin dependent
diabetes mellitus, hypercholesterolemia and a chronic ataxia
not otherwise specified, who presents following an episode of
lightheadedness, headache, and vertigo, on [**2199-10-22**].  He
woke up with a feeling of vertigo with the sensation of room
spinning and had a mild bifrontal headache.  At this time he
also experienced nausea and had one bout of vomiting.  The
lightheadedness was worse on standing and in fact, he slumped
over to the floor because of lightheadedness but did not lose
consciousness and did not hit his head.  A neighbor called
EMS and he was brought to the Emergency Room.

In the Emergency Room, he was found to be hypertensive with a
systolic blood pressure in the 220's and diastolics in the
100's.  He also had nystagmus on primary gaze.  There he also
had two more bouts of vomiting.  He was admitted to the
Medical Intensive Care Unit for more close monitoring and
control of his blood pressure using a Nitroglycerin drip.

On review of systems, the patient did not have any fever or
chills, weakness, numbness, double vision or any other visual
changes, difficulty swallowing, difficulty with speech,
shortness of breath, chest pain, palpitations, diaphoresis,
bowel or bladder function change.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Insulin dependent diabetes mellitus.
3.  Chronic ataxia.
4.  Hypothyroidism.
5.  Anemia.

MEDICATIONS:
1.  NPH, regimen unclear but may be 20 and 4 twice a day.
2.  Lisinopril 20 mg p.o. twice a day.
3.  Aspirin 325 mg p.o. q. day.
4.  Midodrine 10 mg p.o. three times a day.
5.  Synthroid 25 mcg q. day.

ALLERGIES:   None known.

SOCIAL HISTORY:  The patient does not drink and was an old
smoker but currently does not smoke.

PHYSICAL EXAMINATION:   Vital signs were blood pressure 220
to 230 over 90's; heart rate in the sixties; respiratory rate
18; temperature 96.5 F.  In general, well developed, but does
have some wasting of the legs.  No acute distress.  Head and
Neck:  Unremarkable.  Cardiovascular:  Regular rhythm, normal
rate.  No murmurs, no jugular venous distention.  Pulmonary:
clear to auscultation bilaterally.  Abdomen positive bowel
sounds, soft, nontender, nondistended, no hepatosplenomegaly.
Extremities with one plus edema in the feet.  They are warm,
dry and with palpable pulses.  Neurological:  Awake, alert
and oriented to place and date.  Fluent speech.  Can span
seven days of the week and months of the year forwards and
backwards without problems.  Repetition and naming are
intact.  Comprehension is intact.  Registration was three of
three objects, but recall is zero of three at five minutes.
Cranial nerves:  Were intact to space bilaterally. Pupils are
equal and trace reactive.  Visual fields are full by
confrontation.  Extraocular muscles are full.  There is a
primary gaze nystagmus with slow drift to the right and lag
component to the left.  This is exacerbated by gaze to the
right and does not habituate.  Withdraw is strong.  The face
is symmetric.  Hearing is equal bilaterally.  Palate rises
evenly.  Sternocleidomastoid and trapezius are full strength.
Tongue protrudes midline.  He has no vertigo lying or
sitting.

Motor:  Very mild weakness throughout five minus over five.
The right upper extremity is a touch weaker than the left
upper extremity.  There is no pronator drift.  Rapid
alternating movement is intact.

Reflexes:  Three plus in the upper extremity and patella.
One plus at the ankle.  Plantar on the left is flexor and on
the right is equivocal but possibly extensor.

Sensory:  Intact to light touch and pinprick.  Attenuated
vibration at both feet.

Coordination:  Truncal ataxia when sitting upright, leans to
the right.  Dysmetria on finger-to-nose on the left.

STUDIES:  No bleeds, no obvious mass or edema.

LABORATORY:  White count is 8.0, hematocrit 34.1, platelets
213, potassium 3.2.  SMA-7 otherwise normal.  Urinalysis is
unremarkable.

INITIAL IMPRESSION:  Dr. [**Last Name (STitle) 10447**] felt that this was a man
with poorly controlled hypertension and chronic ataxia with
vertigo and primary gaze nystagmus in the setting of poorly
controlled hypertension because of poor compliance.  He was
admitted to the Intensive Care Unit for better blood pressure
management.

HOSPITAL COURSE:   Mr. [**Known lastname **] was started on a Nitroglycerin
and Hydralazine drip for control of his blood pressure and
had an unremarkable course during his stay in the Intensive
Care Unit.  His blood pressure was controlled and he was
weaned off the drips.  He was continued on intravenous blood
pressure medications and transferred to the [**Known lastname 878**] floor.

There, his medications were changed from intravenous to p.o.
formulations.  His blood pressure is currently adequately
controlled.

Work-up while in-house have included an MR imaging study of
the brain which revealed some old periventricular disease but
no evidence of acute ischemic disease as evidenced by changes
on diffusion imaging.  MR angiography done in [**Month (only) 205**] was also
normal.

Cardiac echocardiogram revealed low normal ejection fraction
of 50 to 55%.  Taken together, these studies revealed no
evidence of acute vascular insults.  The MR imaging study is
consistent with old microvascular disease.

We note that Mr. [**Known lastname **] has a presentation that is complicated.
Clearly, he had a component of poor medication compliance
with poorly controlled hypertension and diabetes mellitus.
His gait and visual disturbances are most consistent with a
central etiology coupled with peripheral neuropathy from
diabetes mellitus.  The central processes involved in his
disease may be both in the brain and spinal cord as he has
some evidence of cervical neck disease.

He has a spastic gait and is unable to walk unaided.  The
clinical presentation is somewhat concerning for a
multi-system atrophy and therefore he was started on a trial
of Sinemet.  This will take some time to manifest itself as
to whether useful or not.

Finally, he has an orthostatic hypotension and that had been
attributed to autonomic dysfunction secondary to diabetes
mellitus.  We have chosen to take a conservative approach
with regard to his treatment as he does clearly have poorly
controlled hypertension and we would prefer not to exacerbate
the situation with the addition of medications that could
compromise his blood pressure.  We have therefore recommended
that he use a TEDS stocking when he ambulates as well as keep
himself volume repleted.

At the time of this dictation, Mr. [**Known lastname **] is clinically stable
and appropriate for transfer to a rehabilitation facility
where the focus would be on gait improvement and mobility.

CONDITION ON DISCHARGE:   Improved.

DISCHARGE STATUS:   Discharged to [**Hospital3 2558**].

DISCHARGE DIAGNOSES:
1.  Poorly controlled hypertension.
2.  Diabetes mellitus.
3.  Vertigo, likely central.
4.  Spastic gait, likely from both cervical neck disease and
microvascular disease within the brain.

SECONDARY DIAGNOSES:  Dementia, likely secondary to vascular
insults in the past.

DISCHARGE MEDICATIONS:
1.  Atenolol 100 mg p.o. q. day.
2.  Aspirin 325 mg p.o. q. day.
3.  Lisinopril 40 mg p.o. q. day.
4.  Norvasc 7.5 mg p.o. q. day.
5.  Sinemet 25/100 [**12-5**] tablet p.o. three times a day.
6.  NPH insulin 12 units q. a.m. and 5 units q. p.m.  This
regimen will likely need to be adjusted.
7.  Insulin sliding scale.
8.  Pantoprazole 40 mg p.o. q. day.
9.  Levothyroxine 25 micrograms p.o. q. day; TSH checked
in-house was 3.2, within the normal limits.
10. Heparin 5000 units subcutaneously twice a day while not
mobile.
11. Magnesium oxide 400 mg p.o. three times a day for three
days.

DISCHARGE INSTRUCTIONS:
1.  Mr. [**Known lastname **] should follow-up with his primary physician.
2.  He should also follow-up with me in [**Hospital 878**] Clinic at
[**Telephone/Fax (1) 541**].  He can make an appointment in a couple of
months.

                            [**Doctor Last Name **] [**Name8 (MD) 8346**], M.D., Ph.D.
                            Assistant Professor [**First Name (Titles) **] [**Last Name (Titles) 878**]

Dictated By:[**Last Name (NamePattern4) 10448**]
MEDQUIST36

D:  [**2199-10-25**]  18:38
T:  [**2199-10-25**]  21:37
JOB#:  [**Job Number 10449**]
{'Malignant essential hypertension,Unspecified acquired hypothyroidism,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Displacement of cervical intervertebral disc without myelopathy,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: Vertigo and severe hypertension.

PRESENT ILLNESS: This is a 73 year old right
handed man with a history of hypertension, insulin dependent
diabetes mellitus, hypercholesterolemia and a chronic ataxia
not otherwise specified, who presents following an episode of
lightheadedness, headache, and vertigo, on [**2199-10-22**].  He
woke up with a feeling of vertigo with the sensation of room
spinning and had a mild bifrontal headache.  At this time he
also experienced nausea and had one bout of vomiting.  The
lightheadedness was worse on standing and in fact, he slumped
over to the floor because of lightheadedness but did not lose
consciousness and did not hit his head.  A neighbor called
EMS and he was brought to the Emergency Room.

MEDICAL HISTORY: 1.  Hypertension.
2.  Insulin dependent diabetes mellitus.
3.  Chronic ataxia.
4.  Hypothyroidism.
5.  Anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: None known.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not drink and was an old
smoker but currently does not smoke. 

### Response:
{'Malignant essential hypertension,Unspecified acquired hypothyroidism,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Displacement of cervical intervertebral disc without myelopathy,Other persistent mental disorders due to conditions classified elsewhere'}
