CHIEF COMPLAINT: acute left-sided weakness

PRESENT ILLNESS: This is a 79 year old man with a history of hypertension and
hypercholesterolemia, who was well until 8am this morning when
he tried to get out of bed and noticed his right leg felt a bit
numb and weak. He has a hard time distinguishing for certain if
it was numb, weak or both. He thought he had gotten his foot
caught in between the covers. He got up to go to the bathroom
and as he did he fell because his right side completely gave out
on him, including his arm and leg. He thinks both of these were
affected simultaneously. He is still not certain if they were
numb. He remained on the floor, unable to push himself up, when
his daughter came in and helped prop him up with pillows. He had
to urinate very badly and by this time because he was still
unable to reach the bathroom, he did urinate on himself. He was
trying
to say to his wife, "get me a towel" but what came out was
"gibberish." It seemed to his wife that mainly he was quiet but
when he talked, words flowed freely. The patient comprehended
everything that was spoken to him during this time. He did not
say much and actually his language started to improve shortly
thereafter. While he was weak, his wife noticed that he was
trying to move his right arm up and down as if he were doing an
exercise, but this was completely volitional. He was then able
to get back up on his bed and his right arm and leg were
completely back to normal again. He estimates that the deficit
lasted about 5-10 minutes.

MEDICAL HISTORY: 1. hypertension
2. hypercholesterolemia
3. s/p prostate resection in [**2159**] for prostate CA
4. hernia repair x 2
5. appendicitis
6. colitis [**6-5**]
7. bilateral cataracts surgery

MEDICATION ON ADMISSION: [unsure of dosages]
norvasc
lipitor
protonix
vitamin E

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.8 BP 165/44 HR 70 RR 12 O2 sat 98% RA
General appearance: well appearing man in no distress
Heart: regular rate and rhythm without murmurs, rubs or gallops
Lungs: clear to auscultation bilaterally.
Abdomen: soft, NT
Extremities: no clubbing, cyanosis or edema
Skull & Spine: Neck movements are full and not painful to
palpation in the paraspinal soft tissues.

FAMILY HISTORY: His mother died young of an unknown cancer, his father died from
"arteriosclerosis" in his 50s.

SOCIAL HISTORY: Pt is a retired former executive vice president of a finance
company. He lives in [**Location 620**] with his wife and daughter.
Occlusion and stenosis of carotid artery with cerebral infarction,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Contusion of hip,Unspecified fall,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate
Ocl crtd art w infrct,Surg compl-urinary tract,Urin tract infection NOS,Contusion of hip,Fall NOS,Hypertension NOS,Esophageal reflux,Pure hypercholesterolem,Hx-prostatic malignancy
Admission Date:  [**2169-2-2**]              Discharge Date:   [**2169-2-9**]

Date of Birth:  [**2089-5-23**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
acute left-sided weakness

Major Surgical or Invasive Procedure:
Right carotid stent placement, Brain MRI/MRA, Carotid
ultrasound, CT Abdomen/Pelvis, Abdominal & Chest XRay

History of Present Illness:
This is a 79 year old man with a history of hypertension and
hypercholesterolemia, who was well until 8am this morning when
he tried to get out of bed and noticed his right leg felt a bit
numb and weak. He has a hard time distinguishing for certain if
it was numb, weak or both. He thought he had gotten his foot
caught in between the covers. He got up to go to the bathroom
and as he did he fell because his right side completely gave out
on him, including his arm and leg. He thinks both of these were
affected simultaneously. He is still not certain if they were
numb. He remained on the floor, unable to push himself up, when
his daughter came in and helped prop him up with pillows. He had
to urinate very badly and by this time because he was still
unable to reach the bathroom, he did urinate on himself. He was
trying
to say to his wife, "get me a towel" but what came out was
"gibberish." It seemed to his wife that mainly he was quiet but
when he talked, words flowed freely. The patient comprehended
everything that was spoken to him during this time. He did not
say much and actually his language started to improve shortly
thereafter. While he was weak, his wife noticed that he was
trying to move his right arm up and down as if he were doing an
exercise, but this was completely volitional. He was then able
to get back up on his bed and his right arm and leg were
completely back to normal again. He estimates that the deficit
lasted about 5-10 minutes.

He denied any headache, vertigo, double vision, trouble
swallowing or drooling. There was no facial droop seen during
this time.


Past Medical History:
1. hypertension
2. hypercholesterolemia
3. s/p prostate resection in [**2159**] for prostate CA
4. hernia repair x 2
5. appendicitis
6. colitis [**6-5**]
7. bilateral cataracts surgery

Social History:
Pt is a retired former executive vice president of a finance
company. He lives in [**Location 620**] with his wife and daughter.

He used to smoke two cigars daily for a decade but quit a decade
ago. He denies alcohol or drugs.


Family History:
His mother died young of an unknown cancer, his father died from
"arteriosclerosis" in his 50s.


Physical Exam:
T 97.8 BP 165/44 HR 70 RR 12 O2 sat 98% RA
General appearance: well appearing man in no distress
Heart: regular rate and rhythm without murmurs, rubs or gallops
Lungs: clear to auscultation bilaterally.
Abdomen: soft, NT
Extremities: no clubbing, cyanosis or edema
Skull & Spine: Neck movements are full and not painful to
palpation in the paraspinal soft tissues.

Mental Status: The patient is attentive, registered three
objects
at 30 seconds and recalled 0 out of 3 items at 3 minutes but
improved to [**2-2**] with choices. Good knowledge for current events.

Language is intact. There is no apraxia or agnosia. There is no
left/right agnosia, calculations are intact.

Cranial Nerves: Visual acuity is intact. The visual fields are
full. The optic disc on the right is normal in appearance, the
left is hard to see because of distortion from a cataracts lens.

Eye movements are normal, the pupils react normally to light,
both directly and consensually. Sensation on the face is intact
to light touch, pin prick. Facial movements are normal and
symmetrical. Hearing is intact to finger rub. There is no
nystagmus. The palate elevates in the midline. The tongue
protrudes in the midline and is of normal appearance. The
sternocleidomastoid and trapezius muscles are intact
bilaterally.

Motor System: Appearance, tone, power are normal in all 4 limbs.

There is a slight right pronator drift. There are no
adventitious
movements.

Reflexes: The tendon reflexes are present, symmetric and normal.

The plantar reflexes are flexor.

Sensory: Sensation is intact to pin prick, graphesthesia, light
touch, vibration sense, and position sense in all extremities
and
trunk.

Coordination: There is no ataxia. The finger/nose test and
heel/shin test are performed accurately.

Gait and stance: The Romberg is negative. The gait is normal.

Pertinent Results:
UA negative
WBC 5.2 Hct 42.7 MCV 88.5 Plts 215
Na 139 K 3.8 Cl 102 HCO3 24.6 Gluc 99 BUN 22 Cr 1.3 Ca 9.0
Mg 2.0 Albumin 4.2 TP 6.5 Bili 0.8 Alkphos 138 ALT 39 AST 19
CK 77 CKMB 2.9 TnI<0.2

Carotid Ultrasound IMPRESSION: Ultrasound evaluation of the
carotids with B-mode, color and spectral Doppler suggests 40-59%
stenosis of the right internal carotid artery, 80-99% stenosis
of the left internal carotid artery.

Brain MRI IMPRESSION:  There is an early infarct in the left
parietal lobe within the left MCA territory. No intracranial
occlusion is seen. There is diminished flow in the left internal
carotid artery, suggesting a nonvisualized, significant proximal
left internal carotid artery stenosis.

Chest Xray IMPRESSION: No acute cardiopulmonary disease
Abdominal Xray IMPRESSION: No evidence for megacolon or other
diagnostic abnormalities.

Abdominal/Pelvic CT: IMPRESSION: Colonic wall thickening most
prevalent in the descending colon, sigmoid, and rectum. This is
compatible with the patient's history of C-dificile. There is no
evidence of perforation or abscess. Diverticulosis. Simple liver
cyst and other low density lesions within the liver that are too
small to accurately characterize. Tiny low density lesions in
each kidney that are too small to accurately characterize.


Brief Hospital Course:
The patient was admitted to Neurology. Aspirin was started and
BP meds were held. Given the severe left carotid stenosis,
prognosis and therapeutic options were discussed with the
patient. The patient agreed to undergo left carotid stenting
after discussions of risks and benefits. The stent was placed on
[**2169-2-6**]. Post-procedure course was significant for low-grade
fever to 100.8. A UA showed probable UTI, and the patient was
started on Levaquin. The patient also was noted to have a right
hip hematoma, thought to be from his fall prior to admission. A
post-procedure carotid U/S showed approximately 40% stenosis. By
[**2169-2-9**], the pt was afebrile, stable, and asymptomatic; he was
felt to be stable for discharge. A repeat ultrasound was
scheduled for [**2-20**], with follow-up appts scheduled with Drs.
[**Last Name (STitle) 1132**], [**Name5 (PTitle) **] and [**Name5 (PTitle) **]. The patient was discharged on his outpt
regimen of medications, but without Norvasc, as his blood
pressures were low-normal without it. Plavix and ASA were
prescribed.

Medications on Admission:
[unsure of dosages]
norvasc
lipitor
protonix
vitamin E

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
3. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

4. Clopidogrel Bisulfate 75 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 5 days.
Disp:*5 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Left parietal infarct
2. Left internal carotid artery stenosis, now status post
stenting
3. Urinary tract infection


Discharge Condition:
Stable and afebrile.

Discharge Instructions:
[**Month (only) 116**] shower, do not bathe for 1 week (to keep groin dry) watch
area for redness or swelling call Dr[**Name (NI) 9224**] office for any
questions

Followup Instructions:
Provider: [**Name10 (NameIs) **] STUDY Where: CC CLINICAL CENTER RADIOLOGY
Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2169-2-20**] 11:00
Provider: [**Name10 (NameIs) **] [**Last Name (NamePattern4) **], MD Where: LM [**Hospital Unit Name 12006**] Phone:[**Telephone/Fax (1) 3666**] Date/Time:[**2169-2-24**] 10:00
Provider: [**Name10 (NameIs) 4267**] [**Last Name (NamePattern4) 4268**], MD, PHD[**MD Number(3) **]: [**Hospital6 29**]
NEUROLOGY Phone:[**Telephone/Fax (1) 657**] Date/Time:[**2169-3-21**] 2:30


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Occlusion and stenosis of carotid artery with cerebral infarction,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Contusion of hip,Unspecified fall,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate'}


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: acute left-sided weakness

PRESENT ILLNESS: This is a 79 year old man with a history of hypertension and
hypercholesterolemia, who was well until 8am this morning when
he tried to get out of bed and noticed his right leg felt a bit
numb and weak. He has a hard time distinguishing for certain if
it was numb, weak or both. He thought he had gotten his foot
caught in between the covers. He got up to go to the bathroom
and as he did he fell because his right side completely gave out
on him, including his arm and leg. He thinks both of these were
affected simultaneously. He is still not certain if they were
numb. He remained on the floor, unable to push himself up, when
his daughter came in and helped prop him up with pillows. He had
to urinate very badly and by this time because he was still
unable to reach the bathroom, he did urinate on himself. He was
trying
to say to his wife, "get me a towel" but what came out was
"gibberish." It seemed to his wife that mainly he was quiet but
when he talked, words flowed freely. The patient comprehended
everything that was spoken to him during this time. He did not
say much and actually his language started to improve shortly
thereafter. While he was weak, his wife noticed that he was
trying to move his right arm up and down as if he were doing an
exercise, but this was completely volitional. He was then able
to get back up on his bed and his right arm and leg were
completely back to normal again. He estimates that the deficit
lasted about 5-10 minutes.

MEDICAL HISTORY: 1. hypertension
2. hypercholesterolemia
3. s/p prostate resection in [**2159**] for prostate CA
4. hernia repair x 2
5. appendicitis
6. colitis [**6-5**]
7. bilateral cataracts surgery

MEDICATION ON ADMISSION: [unsure of dosages]
norvasc
lipitor
protonix
vitamin E

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 97.8 BP 165/44 HR 70 RR 12 O2 sat 98% RA
General appearance: well appearing man in no distress
Heart: regular rate and rhythm without murmurs, rubs or gallops
Lungs: clear to auscultation bilaterally.
Abdomen: soft, NT
Extremities: no clubbing, cyanosis or edema
Skull & Spine: Neck movements are full and not painful to
palpation in the paraspinal soft tissues.

FAMILY HISTORY: His mother died young of an unknown cancer, his father died from
"arteriosclerosis" in his 50s.

SOCIAL HISTORY: Pt is a retired former executive vice president of a finance
company. He lives in [**Location 620**] with his wife and daughter. 

### Response:
{'Occlusion and stenosis of carotid artery with cerebral infarction,Urinary complications, not elsewhere classified,Urinary tract infection, site not specified,Contusion of hip,Unspecified fall,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Personal history of malignant neoplasm of prostate'}
