CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 57-year-old man who
vasculitis on [**2182-9-6**].  Mr. [**Known lastname 2093**] has had history of numerous
strokes on presentation.  In 4/98 he had a right sided
hemorrhagic stroke in basal ganglia with extension to the
ventricles.  Then in 9/00 he presented with right sided
ataxic hemiparesis and was found to have a left internal
capsule basal ganglia infarct on MRI.  Per old hospital
record the patient recovered from a motor standpoint but was
was placed on antihypertensives and Aggrenox at some point in
his past history.  The patient subsequently presented on [**8-27**]
with an acute onset of right sided weakness.  On history
patient apparently had stopped taking his antihypertensives
and Aggrenox for about a month duration.  Neurologic work-up
for stroke back then included an echocardiogram on [**8-30**]
showing EF of 45-50%, aortic sclerosis, trace aortic
insufficiency, trace tricuspid regurgitation.  MRA and MRI
showed moderate global atrophy with diffuse extensive small
vessel disease.  Acute infarct seen on DWI in the left pons.
His neck vessels were intact with question of mild stenosis
of left carotid.  Based on the study results, differential
diagnosis was made to include small vessel disease vs
vasculitis.  An LP was recommended.  This was reported to be
a moderately traumatic tap with only one out of four tubes
sent where there were 110 red blood cells, 30 monocytes, no
polys with a glucose of 69, protein 167.  Gram stain was
negative and culture showed question of coag negative staph
aureus which was thought to be a contaminant.  Fungal AFB and
cryptococcal antigens were negative in the CSF.  Based on
this result the patient was transferred to [**Hospital1 346**] for positive angiography and biopsy
for work-up of possible CNS vasculitis.

MEDICAL HISTORY: Hypertension, GI bleed, retinal
emboli, glaucoma, hyperbilirubinemia, [**Doctor Last Name 9376**], history of
hypokalemia, history of low platelets on Heparin, history of
mild ITP, no history of diabetes or MI.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has no history of nicotine or
etoh use.  He was a salesman.
Cerebral arteritis,Urinary tract infection, site not specified,Personal history of other diseases of circulatory system
Cerebral arteritis,Urin tract infection NOS,Hx-circulatory dis NEC
Admission Date:  [**2182-9-6**]       Discharge Date:

Date of Birth:   [**2114-9-30**]       Sex:  M

Service:
IDENTITY:  67-year-old right handed man.

DISCHARGE DIAGNOSIS:  Primary CNS angiitis.

HISTORY OF PRESENT ILLNESS:  This is a 57-year-old man who
vasculitis on [**2182-9-6**].  Mr. [**Known lastname 2093**] has had history of numerous
strokes on presentation.  In 4/98 he had a right sided
hemorrhagic stroke in basal ganglia with extension to the
ventricles.  Then in 9/00 he presented with right sided
ataxic hemiparesis and was found to have a left internal
capsule basal ganglia infarct on MRI.  Per old hospital
record the patient recovered from a motor standpoint but was
was placed on antihypertensives and Aggrenox at some point in
his past history.  The patient subsequently presented on [**8-27**]
with an acute onset of right sided weakness.  On history
patient apparently had stopped taking his antihypertensives
and Aggrenox for about a month duration.  Neurologic work-up
for stroke back then included an echocardiogram on [**8-30**]
showing EF of 45-50%, aortic sclerosis, trace aortic
insufficiency, trace tricuspid regurgitation.  MRA and MRI
showed moderate global atrophy with diffuse extensive small
vessel disease.  Acute infarct seen on DWI in the left pons.
His neck vessels were intact with question of mild stenosis
of left carotid.  Based on the study results, differential
diagnosis was made to include small vessel disease vs
vasculitis.  An LP was recommended.  This was reported to be
a moderately traumatic tap with only one out of four tubes
sent where there were 110 red blood cells, 30 monocytes, no
polys with a glucose of 69, protein 167.  Gram stain was
negative and culture showed question of coag negative staph
aureus which was thought to be a contaminant.  Fungal AFB and
cryptococcal antigens were negative in the CSF.  Based on
this result the patient was transferred to [**Hospital1 346**] for positive angiography and biopsy
for work-up of possible CNS vasculitis.

PAST MEDICAL HISTORY:  Hypertension, GI bleed, retinal
emboli, glaucoma, hyperbilirubinemia, [**Doctor Last Name 9376**], history of
hypokalemia, history of low platelets on Heparin, history of
mild ITP, no history of diabetes or MI.

ALLERGIES:  None.

MEDICATIONS:  On admission, Lopressor 50 mg [**Hospital1 **], K-Dur,
Gemfibrozil, Folic Acid, Vitamin E, Vitamin C, Labetalol and
Aggrenox.

SOCIAL HISTORY:  The patient has no history of nicotine or
etoh use.  He was a salesman.

PHYSICAL EXAMINATION:  On admission blood pressure 140/80.
General exam, head, eyes, ENT is unremarkable.  Neck supple
without bruit.  Cardiovascular exam showed regular rate and
rhythm.  Lungs were clear to auscultation.  Abdomen benign.
Extremities were warm and well perfused.  Neurological exam,
patient was alert, awake, oriented to [**Hospital1 190**], [**Location (un) 86**], [**Month (only) 216**] and [**2182**].  The patient showed
slight perseveration.  The patient was slow to respond to
questions and his speech was general, thought was tangential.
There was mild degree of echolalia.  The patient recalled [**1-30**]
objects in three minutes.  His word generation was very poor.
Language is fluent with intact [**Location (un) 1131**] and repetition.  He
had difficulty following multi-step commands, mild grasp
glabellar bilaterally.  Claw construction is atrocious and he
did not attempt 3D object.  On cranial nerve exam pupils were
equal and reactive.  Visual fields were not reliably tested.
Extraocular movements show no nystagmus nor diplopia.  His
tongue and palate were midline.  On motor exam there is
increased tone in the lower extremities.  On upper extremity
exam there is questionable deltoid weakness on the left,
otherwise full strength on the left upper extremity.  Over
the right extremity there is more proximal than distal upper
extremity weakness.  Reflexes were brisk and toes were
upgoing.  Sensation was grossly intact to pinch.

LABORATORY DATA:  On admission RPR negative, [**Doctor First Name **] negative,
ESR 20, platelet count 115,000, cholesterol 186,
triglycerides 173, LDL 123, Lyme titers were negative.

HOSPITAL COURSE:  The patient was admitted to neurology
service.  A lumbar puncture was repeated to verify the
abnormal [**Location (un) 1131**] in the CSF.  On repeat lumbar puncture the
patient still was found to have an elevated protein of 133 in
his cerebrospinal fluid.  Cerebral angiogram showed narrowing
of the P1 segment in his posterior circulation which was
uncommon for atherosclerotic disease.  Based on these
results, the patient underwent diagnostic brain biopsy of the
right frontal region on [**2182-9-12**].  The patient tolerated this
procedure well.  Results of the brain biopsy were consistent
with a microangiopathic vasculitis.  Meeting with the
patient's wife and brother was held to discuss this diagnosis
of CNS vasculitis as well as treatment options and future
prognosis.  The patient's family were in agreement with a
trial of treatment with Cytoxan and Prednisone.  The patient
was started on Cytoxan 100 mg and Prednisone 60 mg q day on
[**9-21**].  The patient was hydrated with IV fluids at 100 cc per
hour while on Cytoxan therapy with regular urine dipstick to
monitor for hematuria.  The patient had microscopic hematuria
noted two days after starting Cytoxan therapy with 6-10 red
blood cells per high power field.  On [**9-25**] the patient had
one transient episode of [**Known lastname **] hematuria which was thought to
be traumatic as it was noted during movement and the Foley
catheter might have been pulled.  His urine cleared soon
after.  The patient received regular fingersticks to monitor
for blood glucose level while on Prednisone.  The patient
showed no sign of hyperglycemia on Prednisone and this was
stopped.

During his hospital admission the patient had a waxing and
[**Doctor Last Name 688**] of mental status.  On [**9-21**] the patient had one episode
of tremor of left extremity with eye deviation to the right
side times five minutes per report.  This was controlled with
2 mg of IV Ativan administration.  The patient was loaded on
Dilantin and CT of head was immediately obtained to evaluate
intracranial status and ruled out any postoperative bleeding.
CT head was normal.  The patient had no more episodes of
seizure during this hospitalization and remained therapeutic
on Dilantin.  Of note, during his hospitalization the patient
was also treated for one bout of urinary tract infection with
Ciprofloxacin.  EKG obtained also suggested the diagnosis of
left ventricular hypertrophy with ST changes that are
chronic.

The patient showed marked mental status improvement since
starting on Dilantin.  On [**9-25**] the patient was alert, awake,
oriented to place and person and month of the year.  The
patient was tolerating Cytoxan and Prednisone well.  Decision
was made to discharge the patient to rehabilitation center as
soon as a bed becomes available.  The patient will require
weekly CBC to monitor his white blood cell count while on
Cytoxan therapy.  The patient will also need to be
aggressively hydrated while on Cytoxan therapy to prevent
potential toxicity including hemorrhagic cystitis.  The
patient will require regular urine dipsticks to monitor for
any microscopic hematuria while on Cytoxan.  Recommended
frequency is 2-3 times per week.  The patient will remain on
Cytoxan therapy with a follow-up with Dr. [**Last Name (STitle) **] at the
neurology clinic at the [**Hospital1 69**]
on [**10-23**] when the effect of Cytoxan and Prednisone therapy
will be reevaluated and treatments tailored.

DISCHARGE MEDICATIONS:  IV fluid D5 ?????? NS plus 20 mEq of KCL
at 120 cc per hour, Dilantin 100 mg IV tid, Cytoxan 100 mg po
q d, Prednisone 60 mg po q d, Protonix 40 mg IV q d,
Hydralazine 50 mg po qid, Lopressor 100 mg po bid, potassium
chloride 10 mEq po q d, Milk of Magnesia 30 cc po q d prn
constipation, Dulcolax suppository one pr q d prn
constipation, Tylenol 325 mg to 650 mg po q 4 hours prn.


                    DR.[**Last Name (STitle) 726**],[**First Name3 (LF) 725**] 13-268



Dictated By:[**Doctor Last Name 35271**]
MEDQUIST36

D:  [**2182-9-25**]  14:28
T:  [**2182-9-25**]  14:58
JOB#:  [**Job Number 35272**]
{'Cerebral arteritis,Urinary tract infection, site not specified,Personal history of other diseases of circulatory system'}


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: 

PRESENT ILLNESS: This is a 57-year-old man who
vasculitis on [**2182-9-6**].  Mr. [**Known lastname 2093**] has had history of numerous
strokes on presentation.  In 4/98 he had a right sided
hemorrhagic stroke in basal ganglia with extension to the
ventricles.  Then in 9/00 he presented with right sided
ataxic hemiparesis and was found to have a left internal
capsule basal ganglia infarct on MRI.  Per old hospital
record the patient recovered from a motor standpoint but was
was placed on antihypertensives and Aggrenox at some point in
his past history.  The patient subsequently presented on [**8-27**]
with an acute onset of right sided weakness.  On history
patient apparently had stopped taking his antihypertensives
and Aggrenox for about a month duration.  Neurologic work-up
for stroke back then included an echocardiogram on [**8-30**]
showing EF of 45-50%, aortic sclerosis, trace aortic
insufficiency, trace tricuspid regurgitation.  MRA and MRI
showed moderate global atrophy with diffuse extensive small
vessel disease.  Acute infarct seen on DWI in the left pons.
His neck vessels were intact with question of mild stenosis
of left carotid.  Based on the study results, differential
diagnosis was made to include small vessel disease vs
vasculitis.  An LP was recommended.  This was reported to be
a moderately traumatic tap with only one out of four tubes
sent where there were 110 red blood cells, 30 monocytes, no
polys with a glucose of 69, protein 167.  Gram stain was
negative and culture showed question of coag negative staph
aureus which was thought to be a contaminant.  Fungal AFB and
cryptococcal antigens were negative in the CSF.  Based on
this result the patient was transferred to [**Hospital1 346**] for positive angiography and biopsy
for work-up of possible CNS vasculitis.

MEDICAL HISTORY: Hypertension, GI bleed, retinal
emboli, glaucoma, hyperbilirubinemia, [**Doctor Last Name 9376**], history of
hypokalemia, history of low platelets on Heparin, history of
mild ITP, no history of diabetes or MI.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient has no history of nicotine or
etoh use.  He was a salesman. 

### Response:
{'Cerebral arteritis,Urinary tract infection, site not specified,Personal history of other diseases of circulatory system'}
