CHIEF COMPLAINT: Called by Emergency Department to evaluate
non-responsive patient sent by OSH for neuro eval.

PRESENT ILLNESS: The pt is a 70 year-old female of unknown handedness with
history of HTN, HLD, CAD (reportedly had MI a few years prior),
CVA in past but unknown symptoms, ?known carotid disease,
vertigo
who presented to an OSH with nausea and vomiting, and by report
possible left arm weakness.

MEDICAL HISTORY: - MI (a few years prior)
- history of vertigo tx with meclizine
- HTN
- HLD
- CVA in [**2104**] (unclear what the symptoms were)
- carotid disease
- recent hospitalization ~4 week prior for diarrhea/UTI/vertigo

MEDICATION ON ADMISSION: - Imdur 30mg qd
- ASA 325mg qd
- Metoprolol 50mg [**Hospital1 **]
- Simvastatin 40mg qd
- Lisinopril 10mg qd
- Nitro PRN
- Meclizine 12.5mg TID prn
- Omeprazole 20mg qd
- Tylenol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Awake, looks older than stated age, various areas of
mild skin breakdown
HEENT: NC/AT, no scleral icterus noted, dry mouth,
Neck: Supple, bruit on right sided of neck,  No nuchal rigidity
Pulmonary: Lungs CTA
Cardiac: RRR, nl. S1S2, systolic murmur
Abdomen: soft, NT/ND, normoactive bowel sounds
Extremities: lesion on right sole - flaky and erythematous ?
psoriatic lesion.

FAMILY HISTORY: Unknown, some cardiac disease

SOCIAL HISTORY: Lives in a low income elder housing.  Separated from
husband.  [**Name (NI) **] brother and family friend who help take care of
her, usually able to do her own daily activities.  Long smoking
history of unknown duration, no etoh or drug known
Cerebral artery occlusion, unspecified with cerebral infarction,Persistent vegetative state,Aphasia,Polymyalgia rheumatica,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Right bundle branch block
Crbl art ocl NOS w infrc,Persistent vegtv state,Aphasia,Polymyalgia rheumatica,Hypertension NOS,Crnry athrscl natve vssl,Old myocardial infarct,Hyperlipidemia NEC/NOS,Rt bundle branch block
Admission Date:  [**2108-8-22**]              Discharge Date:   [**2108-8-24**]

Date of Birth:  [**2038-1-5**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6075**]
Chief Complaint:
 Called by Emergency Department to evaluate
non-responsive patient sent by OSH for neuro eval.


Major Surgical or Invasive Procedure:
none

History of Present Illness:
The pt is a 70 year-old female of unknown handedness with
history of HTN, HLD, CAD (reportedly had MI a few years prior),
CVA in past but unknown symptoms, ?known carotid disease,
vertigo
who presented to an OSH with nausea and vomiting, and by report
possible left arm weakness.

The history on this patient is unfortunately unknown for the
most
part.  She was transferred from [**Hospital1 **] for unclear
reasons.  She came with one phone number that turned out to be
her husband, but they separated 10 years prior.  He reluctantly
gave us his daughter's number who also did not know the past
days
events, and then provided a family friend who also was unaware
of
what occurred.  She was apparently taken to the ED by her
brother
who is in his 80s and was not available to speak at this time.

This is what was available through these family members and the
staff at [**Name (NI) **] [**Name (NI) 1459**]:

What is known is the patient is usually able to speak and
interact and is usually ambulatory.  At some time over the last
week she had increased urinary frequency, and was concerned that
she had a UTI.  She was apparently seen by her PCP who started
her on Cipro.  She was seen by her estranged husband yesterday
and he said she was "fine" but just kept going to bathroom.
According to her daughter the patient was having some nausea
yesterday, unclear if there was vertigo and there was some
episodes of vomiting.  There is a report from the OSH that the
patient had complained of difficulty with her left arm, but this
is not corroborated by the family available.  She was taken in
to
[**Location (un) **] [**Location (un) 1459**] (according to the daughter) because of the
nausea.  At the OSH they did not note any left sided weakness
however they felt she was not able to lift either of her legs.
The decided to get a head CT.  At some point while at the OSH
the
patient become "incoherent" and less responsive.  Based on the
note and exam at the OSH it does not appear that she is
following
commands or interacting with the examiner enough to do a formal
exam.  Based on this she was sent to [**Hospital1 18**] for further
evaluation.  There is no record of how interactive she was prior
to coming to the hospital, but according to family, at least as
recently as yesterday she was able to interact.

Here the patient will open her eyes but will not engage the
examiner at all.  She will not speak, not follow commands, or
mimic the examiner.  She is not able to provide any history of
today's events.

Past Medical History:
- MI (a few years prior)
- history of vertigo tx with meclizine
- HTN
- HLD
- CVA in [**2104**] (unclear what the symptoms were)
- carotid disease
- recent hospitalization ~4 week prior for diarrhea/UTI/vertigo


Social History:
Lives in a low income elder housing.  Separated from
husband.  [**Name (NI) **] brother and family friend who help take care of
her, usually able to do her own daily activities.  Long smoking
history of unknown duration, no etoh or drug known


Family History:
Unknown, some cardiac disease


Physical Exam:
Awake, looks older than stated age, various areas of
mild skin breakdown
HEENT: NC/AT, no scleral icterus noted, dry mouth,
Neck: Supple, bruit on right sided of neck,  No nuchal rigidity
Pulmonary: Lungs CTA
Cardiac: RRR, nl. S1S2, systolic murmur
Abdomen: soft, NT/ND, normoactive bowel sounds
Extremities: lesion on right sole - flaky and erythematous ?
psoriatic lesion.


Pertinent Results:
[**2108-8-22**] 09:45PM   PT-12.4 PTT-46.9* INR(PT)-1.0
[**2108-8-22**] 04:30AM CEREBROSPINAL FLUID (CSF)  PROTEIN-23
GLUCOSE-103
[**2108-8-22**] 04:30AM CEREBROSPINAL FLUID (CSF)  WBC-1 RBC-0 POLYS-1
LYMPHS-78 MONOS-21
[**2108-8-22**] 01:45AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-150
GLUCOSE-NEG KETONE-TR BILIRUBIN-SM UROBILNGN-1 PH-7.0 LEUK-NEG
[**2108-8-22**] 01:15AM   LACTATE-1.7
[**2108-8-22**] 01:00AM   cTropnT-<0.01

MRI [**2108-8-22**]

FINDINGS: There is no intracranial hemorrhage. Diffusion
sequences
demonstrate bilateral and acute ACA territory infarcts extending
into the genu
of the corpus callosum and left posterior parietal parasagittal
cortex. There
is a small left posterior parietal infarct. There is para
sagittal gyral
edema. No evidence of midline shift, intracranial mass or mass
effect. The
ventricles and sulci are slightly prominent. There is no CP
angle mass.
There are scattered foci of T2 and FLAIR hyperintensities in the
subcortical
and deep white matter and pons in keeping with chronic
microangiopathic small
vessel disease.

IMPRESSION:
Bilateral acute ACA territory infarcts.



Brief Hospital Course:
Pt [**Name (NI) 4223**] was admitted for altered level of mental status. She
was found to be in a semi-comatose state. She was admitted to
the Neuro-ICU team for further evaluation. She was started on
heparin for a possible stroke while we obtained an MRI. An MRI
was completed which showed bilateral ACA infarcts resulting in
akinetic mutism. The family was made aware of the diagnosis and
decided to make the patient CMO. She was transferred to an
outside facility for this.

Medications on Admission:
- Imdur 30mg qd
- ASA 325mg qd
- Metoprolol 50mg [**Hospital1 **]
- Simvastatin 40mg qd
- Lisinopril 10mg qd
- Nitro PRN
- Meclizine 12.5mg TID prn
- Omeprazole 20mg qd
- Tylenol PRN



Discharge Medications:
n/a

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Senior Healthcare of [**Location (un) **]

Discharge Diagnosis:
Primary
- Bilateral ACA stroke


Discharge Condition:
Vegatative state.


Discharge Instructions:
You were admitted from an outside hospital for altered mental
status. You were initially admitted to the medicine team and
were then transferred to the Neuro ICU team for further care.
You had an MRI that showed a stroke on both sides of your brain.
This has led to something called akinetic mutism. You were made
comfort measures only by your family. You were discharged to an
extended care facility.

Followup Instructions:
No follow up.



Completed by:[**2108-8-24**]
{'Cerebral artery occlusion, unspecified with cerebral infarction,Persistent vegetative state,Aphasia,Polymyalgia rheumatica,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Right bundle branch block'}


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: Called by Emergency Department to evaluate
non-responsive patient sent by OSH for neuro eval.

PRESENT ILLNESS: The pt is a 70 year-old female of unknown handedness with
history of HTN, HLD, CAD (reportedly had MI a few years prior),
CVA in past but unknown symptoms, ?known carotid disease,
vertigo
who presented to an OSH with nausea and vomiting, and by report
possible left arm weakness.

MEDICAL HISTORY: - MI (a few years prior)
- history of vertigo tx with meclizine
- HTN
- HLD
- CVA in [**2104**] (unclear what the symptoms were)
- carotid disease
- recent hospitalization ~4 week prior for diarrhea/UTI/vertigo

MEDICATION ON ADMISSION: - Imdur 30mg qd
- ASA 325mg qd
- Metoprolol 50mg [**Hospital1 **]
- Simvastatin 40mg qd
- Lisinopril 10mg qd
- Nitro PRN
- Meclizine 12.5mg TID prn
- Omeprazole 20mg qd
- Tylenol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Awake, looks older than stated age, various areas of
mild skin breakdown
HEENT: NC/AT, no scleral icterus noted, dry mouth,
Neck: Supple, bruit on right sided of neck,  No nuchal rigidity
Pulmonary: Lungs CTA
Cardiac: RRR, nl. S1S2, systolic murmur
Abdomen: soft, NT/ND, normoactive bowel sounds
Extremities: lesion on right sole - flaky and erythematous ?
psoriatic lesion.

FAMILY HISTORY: Unknown, some cardiac disease

SOCIAL HISTORY: Lives in a low income elder housing.  Separated from
husband.  [**Name (NI) **] brother and family friend who help take care of
her, usually able to do her own daily activities.  Long smoking
history of unknown duration, no etoh or drug known 

### Response:
{'Cerebral artery occlusion, unspecified with cerebral infarction,Persistent vegetative state,Aphasia,Polymyalgia rheumatica,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Old myocardial infarction,Other and unspecified hyperlipidemia,Right bundle branch block'}
