CHIEF COMPLAINT: left arm weakness, slurred speech

PRESENT ILLNESS: 41 year old right handed male with history of crack cocaine use,
prior strokes, presents with sudden onset left arm weakness,
left nasolabial flattening and dysarthria. Pt reports last
smoking a marijuana and crack cocaine cigarette at 7pm this
evening. At 10:30pm while he was playing pool in a bar he
noticed the sudden onset of left arm "weakness." He was lining
up to take a shot and could not manipulate his left arm to
steady the cue. At the same time his left face felt droopy and
he was slurring his speech. He did not have any trouble thinking
of the right words to say, or any difficulty comprehending
speech. This was not preceded or followed by any headache,
diplopia or visual loss. He was concerned this could be a
stroke, as he has had two in the past, and he drove himself
towards the hospital, however he had to stop at a gas station
because he was finding it difficult to use the wheel with his
left arm. A woman at the gas station who saw him driving said
that he should not be driving (he also had 4 shots of Hennesey
whiskey and a beer), but he reports that he was not
intoxicated. They called EMS and he was brought to [**Hospital1 2519**] for evaluation.

MEDICAL HISTORY: Stroke
Hypertension
Motor Vehicle Accident (3months ago)- sustained laceration to
forehead requiring sutures, he was noted to have elevated blood
pressure by Dr. [**Last Name (STitle) 2520**] at [**Hospital 1474**] Hospital and started on a
blood
pressure medicine.

MEDICATION ON ADMISSION: Aspirin 81mg Daily- started taking following last stroke ~1 year
ago.
"Blood pressure medication"- wife and pt are unsure of the name.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 99 P: 89 R:16 BP: 185/90 SaO2: 97% RA
General: slouched to L side in bed, Awake, cooperative, but
visibly anxious, looking around the room.
HEENT: NC/AT, bilateral scleral injection. no icterus noted,
MMM,
no lesions noted in oropharynx
Neck: Supple, no JVD or carotid bruits appreciated. No nuchal
rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Mother had a stroke at age 60.
Father has diabetes.
Paternal Grandfather has diabetes.

SOCIAL HISTORY: Has domestic partner x18years (female). He runs a chiropractic
practice. active marijuana smoker, active crack cocaine user,
denies tobacco use. Drinks 5-8 drinks 3-4 nights per week.
Intracerebral hemorrhage,Malignant essential hypertension,Cocaine abuse, continuous,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Intracerebral hemorrhage,Malignant hypertension,Cocaine abuse-continuous,Hx TIA/stroke w/o resid
Admission Date:  [**2118-11-12**]              Discharge Date:   [**2118-11-16**]

Date of Birth:  [**2077-11-7**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2518**]
Chief Complaint:
left arm weakness, slurred speech


Major Surgical or Invasive Procedure:
none

History of Present Illness:
41 year old right handed male with history of crack cocaine use,
prior strokes, presents with sudden onset left arm weakness,
left nasolabial flattening and dysarthria. Pt reports last
smoking a marijuana and crack cocaine cigarette at 7pm this
evening. At 10:30pm while he was playing pool in a bar he
noticed the sudden onset of left arm "weakness." He was lining
up to take a shot and could not manipulate his left arm to
steady the cue. At the same time his left face felt droopy and
he was slurring his speech. He did not have any trouble thinking
of the right words to say, or any difficulty comprehending
speech. This was not preceded or followed by any headache,
diplopia or visual loss. He was concerned this could be a
stroke, as he has had two in the past, and he drove himself
towards the hospital, however he had to stop at a gas station
because he was finding it difficult to use the wheel with his
left arm. A woman at the gas station who saw him driving said
that he should not be driving (he also had 4 shots of Hennesey
whiskey and a beer), but he reports that he was not
intoxicated. They called EMS and he was brought to [**Hospital1 2519**] for evaluation.

At [**Hospital1 **], urine positive for cocaine, blood ETOH level was 76
and his blood pressure on arrival was 230/120. Noted to have
Left internal capsule hemorrhage by CT. He was given Labetalol
IV and transferred to [**Hospital1 18**] for further management.

He had a stroke last year when he was at a carribean carnival
and he was drinking heavily and smoking marijuana. He noted
right facial droop this time accompanied by right hand/arm
weakness. He went to [**Hospital3 417**] Hospital where he was told
he had a "blood clot." His symptoms resolved completely within
24hours. He was prescribed aspirin, and possibly plavix, but he
no longer takes this. He also has not been taking his blood
pressure medication
(unsure of the name) regularly.

He had another stroke about four years ago, which he
characterizes as left facial droop and dysarthria. He was
admitted to [**Hospital3 417**] and his symptoms resolved within an
hour.

At present the pt denieds headache, loss of vision, blurred
vision, diplopia, lightheadedness, vertigo, tinnitus or hearing
difficulty. Denied difficulties comprehending speech.  He denies
numbness, parasthesiae. No bowel or bladder incontinence or
retention. He reporst feeling somewhat unsteady while walking.

On review of systems, the pt denied recent fever or chills.  No
night sweats or recent weight loss or gain. Denied cough,
shortness of breath.  Denied chest pain or tightness,
palpitations.  Denied nausea, vomiting, diarrhea, constipation
or abdominal pain.  No recent change in bowel or bladder habits.
 No dysuria.  Denied arthralgias or myalgias. Denied rash.


Past Medical History:
Stroke
Hypertension
Motor Vehicle Accident (3months ago)- sustained laceration to
forehead requiring sutures, he was noted to have elevated blood
pressure by Dr. [**Last Name (STitle) 2520**] at [**Hospital 1474**] Hospital and started on a
blood
pressure medicine.


Social History:
Has domestic partner x18years (female). He runs a chiropractic
practice. active marijuana smoker, active crack cocaine user,
denies tobacco use. Drinks 5-8 drinks 3-4 nights per week.


Family History:
Mother had a stroke at age 60.
Father has diabetes.
Paternal Grandfather has diabetes.


Physical Exam:
Vitals: T: 99 P: 89 R:16 BP: 185/90 SaO2: 97% RA
General: slouched to L side in bed, Awake, cooperative, but
visibly anxious, looking around the room.
HEENT: NC/AT, bilateral scleral injection. no icterus noted,
MMM,
no lesions noted in oropharynx
Neck: Supple, no JVD or carotid bruits appreciated. No nuchal
rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.  Attentive, able to spell WORLD backwards
without difficulty. He does however appear somewhat anxious and
is looking about the room.  Language is fluent with intact
repetition and comprehension. He is however dysarthric. Normal
prosody.  There were no paraphasic errors. Pt. was able to name
both high and low frequency objects.  Able to read without
difficulty.  He interprets cookie theft picture appropriately.
Able to follow both midline and appendicular commands. Pt. was
able to register 3 objects and recall [**3-12**] at 5 minutes.  No
apraxia or neglect.


-Cranial Nerves: Olfaction not tested.  Pupils were large ERRL
brisk 6-->4mm. VFF to confrontation.  Left UMN facial droop/NL
flattening. Pt would not cooperate with funduscopic examination.
EOMI without nystagmus.  Normal saccades. Facial sensation
intact
to pinprick. No facial droop, facial musculature symmetric.
Hearing intact to finger-rub bilaterally.  Palate elevates
symmetrically.  5/5 strength in trapezii and SCM bilaterally.
Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No adventitious movements
noted. No asterixis noted.

The patient has a left pronator drift.

  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5    5  4-   5  5  4- 5   5   5  5    5     5    5
R  5    5    5  5    5  5  5  5   5   5  5    5     5    5

-Sensory: Reduced light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout on left hemibody with
arm > leg. + extinction to DSS.

-Coordination: No intention tremor, slight dysdiadochokinesia
noted on left hand. he has difficulty performing FNF on left.

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2   2   2    2   2
R  2   2   2    2   2

Plantar response was muted on the left. Downgoing on the right.

-Gait: ataxic gait with circumduction of the left leg, left arm
flexion, decreased left arm swing.


Pertinent Results:
[**2118-11-11**] 11:55p
Urine Cocaine Pos
Urine Benzos, Barbs, Opiates, Amphet, Mthdne Negative
Serum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc Pending

UA- negative

141  105  16 AGap=16
-------------<98
3.8  24  1.1

CK: Pnd  MB: Pnd  Trop-T: Pnd

Ca: 9.1 Mg: 2.5 P: 3.1

MCV 92
WBC 12.5, Hgb 15.5, Hct 46.4, Platelet 325

N:79.1 L:15.9 M:3.2 E:1.4 Bas:0.4

PT: 11.7  PTT: 24.8  INR: 1.0

[**2118-11-15**] 06:00AM BLOOD %HbA1c-5.4
[**2118-11-15**] 06:00AM BLOOD Triglyc-130 HDL-90 CHOL/HD-1.9 LDLcalc-58

Radiologic Data:
NCHCT [**2118-11-11**]: right internal capsule genu and anterior limb
4.2x1.7cm
hemorrhage. Small ~2mm midline shift.

NCHCT [**2118-11-12**] 2:39 am:  Slight increase to right external
capsule intracranial hemorrhage.  Additional history provided by
neurology team reveals that the patient has been using cocaine.
ATTENDING NOTE: The change in size of hematoma is subtle and can
also be due to differences in slice selection. Continued follow
up recommended.

NCHCT [**2118-11-12**] 12:20 pm: No significant interval change in size
or mass effect of right lentiform nucleus intraparenchymal
hemorrhage.

ECHO [**2118-11-16**]: The left atrium is mildly dilated. A left-to-right
shunt across the interatrial septum is seen at rest. A secundum
type atrial septal defect is present. There is mild symmetric
left ventricular hypertrophy with normal cavity size. Left
ventricular systolic function is hyperdynamic (EF>75%). A
mid-cavitary gradient is identified. There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
regurgitation. No masses or vegetations are seen on the aortic
valve. The mitral valve leaflets are mildly thickened. There is
no mitral valve prolapse. No mass or vegetation is seen on the
mitral valve. No mitral regurgitation is seen. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion.  IMPRESSION: No echocardiographic evidence
of endocarditis. Probably small secundum ASD with left to right
shunting at rest. There is a mid-cavitary gradient seen with the
Valsalva maneuver, probably due to hyperdynamic LV function.
There is no resting gradient.
EKG: Sinus rhythm. Increased QRS voltage with ST-T wave
abnormalities.
Probable left ventricular hypertrophy but may be normal for age.

No previous tracing available for comparison.


Chest Xray- no infiltrate or acute cardiopulmonary process.


Brief Hospital Course:
Mr. [**Known lastname 2521**] is a 41 year old male with uncontrolled hypertension
and cocaine abuse who presented with left lower motor neuron
seventh cranial nerve palsy, left hemiparesis with diminished
sensation to all modalities on the left and was found to have a
right internal capsule hemorrhage.

This was likely a hypertensive hemorrhage related to cocaine
use. He was admitted to the neuro ICU and started on a
nicardipine drip for MAP's < 130, and ultimately titarated off
as his pressures came down. The patient was evaluated by the
neurosurgery service who did not deem the patient a candiate for
surgery or invasive intracranial pressure monitoring. The
patient's hemorrhage was essentially stable on serial head CTs.
Beta blockers were avoided in the setting of recent cocaine use.
 Serial cardiac enzymes were negative.  He was placed on a CIWA
scale given history of alcohol use and he was given normal
saline + thiamine, folate, and multivitamin.  His deficits
dramtically improved, such that he had only some breakable right
hand weakness in the finger extensors and interossei.  He also
had a mild left UMN facial droop.  Otherwise his neurological
exam was unremarkable, and was transferred to the floors.

On the floors, he was started on lisinopril 10 mg/d for BP
control and increased to 20 mg/d for persistent hypertension.
Risk stratification revealed a normal A1C and excellent lipid
profile.  He refused MRI for evaluation of underlying etiology,
even with the offer of medication for sedation.  Given his prior
history of cocaine use, we checked an ECHO on the day of
discharge.  The echocardiogram showed no evidence of
endocarditis.  An initial leukocytosis, likely related to the
hemorrhage resolved, and he remained afebrile.  Blood cultures
were pending.  There was suggestion of a small secundum ASD with
left to right shunting at rest.  His exam remained stable and he
was deemed stable for discharge on [**2118-11-16**].

The patient was offered substance abuse counseling, and will be
in contact by [**Name (NI) 2411**] [**Name (NI) 410**] as an outpatient.

For future communication:
Wife- [**Name (NI) 2522**] [**Name (NI) 2523**] [**Telephone/Fax (1) 2524**]
Mother- [**Telephone/Fax (1) 2525**]
Brother- [**Telephone/Fax (1) 2526**]


Medications on Admission:
Aspirin 81mg Daily- started taking following last stroke ~1 year
ago.
"Blood pressure medication"- wife and pt are unsure of the name.


Discharge Medications:
1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Hemorrhagic stroke in the right internal capsule genu and
anterior limb


Discharge Condition:
Stable, patient has only some mild weakness in the left hand,
with breakable finger extensors and interossei.  He also has a
left sided upper motor neuron facial droop.  Otherwise, normal.


Discharge Instructions:
Please take your medications as prescribed and follow up with
your appointments as scheduled.  If you experience new,
worsening, or concerning symptoms, such as weakness, slurred
speech, vision changes, or trouble swallowing, please contact
Dr.[**Name2 (NI) 2527**] office at ([**Telephone/Fax (1) 2528**] or after hours, the
neurologist on-call at ([**Telephone/Fax (1) 2529**].  If you are unable to
reach someone for any reason, please return to the nearest
emergency room.  It is vital that you refrain from the use of
any illicit substances such as cocaine ("crack").  We would also
advise that you refrain from alcohol and tobacco use.

Followup Instructions:
1) Please call Dr. [**First Name8 (NamePattern2) 2530**] [**Name (STitle) 2531**] office at ([**Telephone/Fax (1) 2532**] to
arrange a follow up visit in the next 2-4 weeks.  On this visit,
please inquire about a repeat head CT to evaluate the progress
of your stroke.  Also, please ask about a renal ultrasound to
investigate your hypertension.

2) Please expect a call from [**First Name8 (NamePattern2) 2411**] [**Last Name (NamePattern1) 2412**] from addiction
services for treatment of substance use.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2533**]
{'Intracerebral hemorrhage,Malignant essential hypertension,Cocaine abuse, continuous,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}


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 arm weakness, slurred speech

PRESENT ILLNESS: 41 year old right handed male with history of crack cocaine use,
prior strokes, presents with sudden onset left arm weakness,
left nasolabial flattening and dysarthria. Pt reports last
smoking a marijuana and crack cocaine cigarette at 7pm this
evening. At 10:30pm while he was playing pool in a bar he
noticed the sudden onset of left arm "weakness." He was lining
up to take a shot and could not manipulate his left arm to
steady the cue. At the same time his left face felt droopy and
he was slurring his speech. He did not have any trouble thinking
of the right words to say, or any difficulty comprehending
speech. This was not preceded or followed by any headache,
diplopia or visual loss. He was concerned this could be a
stroke, as he has had two in the past, and he drove himself
towards the hospital, however he had to stop at a gas station
because he was finding it difficult to use the wheel with his
left arm. A woman at the gas station who saw him driving said
that he should not be driving (he also had 4 shots of Hennesey
whiskey and a beer), but he reports that he was not
intoxicated. They called EMS and he was brought to [**Hospital1 2519**] for evaluation.

MEDICAL HISTORY: Stroke
Hypertension
Motor Vehicle Accident (3months ago)- sustained laceration to
forehead requiring sutures, he was noted to have elevated blood
pressure by Dr. [**Last Name (STitle) 2520**] at [**Hospital 1474**] Hospital and started on a
blood
pressure medicine.

MEDICATION ON ADMISSION: Aspirin 81mg Daily- started taking following last stroke ~1 year
ago.
"Blood pressure medication"- wife and pt are unsure of the name.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 99 P: 89 R:16 BP: 185/90 SaO2: 97% RA
General: slouched to L side in bed, Awake, cooperative, but
visibly anxious, looking around the room.
HEENT: NC/AT, bilateral scleral injection. no icterus noted,
MMM,
no lesions noted in oropharynx
Neck: Supple, no JVD or carotid bruits appreciated. No nuchal
rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Mother had a stroke at age 60.
Father has diabetes.
Paternal Grandfather has diabetes.

SOCIAL HISTORY: Has domestic partner x18years (female). He runs a chiropractic
practice. active marijuana smoker, active crack cocaine user,
denies tobacco use. Drinks 5-8 drinks 3-4 nights per week. 

### Response:
{'Intracerebral hemorrhage,Malignant essential hypertension,Cocaine abuse, continuous,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}
