CHIEF COMPLAINT: Pt complaining of worst headache of his life.

PRESENT ILLNESS: 50yo previously healthy RHM experienced 'worst HA of life'
after coitus during the evening of [**2122-1-4**].  Went to [**Hospital3 2568**]
ED where NCHCT showed SAH. Loaded with dilantin 1gm and xferred
to [**Hospital1 18**] for further eval. No numbess, weakness, visual or
mental
status changes.  No recent trauma or illness. BP 113/69 on
arrival to [**Hospital1 18**] with c/o  HA.

MEDICAL HISTORY: R hip replacement

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On arrival:
VS:  t99.1  bp113/69  hr68   rr12  98%ra	
General: WNWD, NAD
HEENT:  anicteric, MMM without lesions, OP clear
Neck:	Supple, no LAD, no carotid bruits, no thyromegaly
CV:	RRR  s1s2     no m/r/g
Resp:	CTAB   no r/w/r
Abd:	+BS    Soft/NT/ND    no HSM/masses
Ext:	No c/c/e, distal pulses intact
Skin:	No rashes, petechiae

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies ETOH
Denies illicit drug use
Subarachnoid hemorrhage,Hip joint replacement
Subarachnoid hemorrhage,Joint replaced hip
Admission Date:  [**2122-1-6**]              Discharge Date:   [**2122-1-14**]

Date of Birth:  [**2071-6-16**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Pt complaining of worst headache of his life.

Major Surgical or Invasive Procedure:
Cerebral angiogram X2


History of Present Illness:
50yo previously healthy RHM experienced 'worst HA of life'
after coitus during the evening of [**2122-1-4**].  Went to [**Hospital3 2568**]
ED where NCHCT showed SAH. Loaded with dilantin 1gm and xferred
to [**Hospital1 18**] for further eval. No numbess, weakness, visual or
mental
status changes.  No recent trauma or illness. BP 113/69 on
arrival to [**Hospital1 18**] with c/o  HA.


Past Medical History:
R hip replacement


Social History:
Denies ETOH
Denies illicit drug use

Pt works as a ballet dancer.

Family History:
Non-contributory

Physical Exam:
On arrival:
VS:  t99.1  bp113/69  hr68   rr12  98%ra	
General: WNWD, NAD
HEENT:  anicteric, MMM without lesions, OP clear
Neck:	Supple, no LAD, no carotid bruits, no thyromegaly
CV:	RRR  s1s2     no m/r/g
Resp:	CTAB   no r/w/r
Abd:	+BS    Soft/NT/ND    no HSM/masses
Ext:	No c/c/e, distal pulses intact
Skin:	No rashes, petechiae

MS:	A&O x 3, interactive, appropriate, following all commands
Speech fluent w/o paraphasic errors
CN:	I ?????? not tested, II,III ?????? PERRL, VFF by confrontation, optic
discs sharp; III,IV,VI ?????? EOMI, no ptosis, no nystagmus;  V-
sensation intact to LT, masseters strong symmetrically; VII ?????? no
facial weakness/asymmetry; VIII ?????? hears finger rub B; IX,X ??????
voice normal, palate elevates symmetrically; [**Doctor First Name 81**] ?????? SCM/Trapezii
[**4-6**] B; XII ?????? tongue protrudes midline, no atrophy or
fasciculations
Motor:	nl bulk and tone, full power throughout
DTRs:	[**Name2 (NI) **] (C56)	BR (C6)	Tri (C7)	Pa (L34)	Ac (S12)  Plantar	
        L	2	2	2	2	2	  down
        R	2	2	2	2	2	  down
Sensory:	LT intact throughout
Coord:	finger tap rapid & symm
Gait:	deferred

EKG ([**Hospital3 2568**]): NSR

CT head (1740 at [**Hospital3 2568**] ED): extensive SAH; no hydrocephalus.

CT head (2214 [**Hospital1 18**]):  Known extensive SAH looks same as [**Hospital3 26611**] study on CD performed at 1740 [**1-5**]. No apparent aneurysm
or
malformation. No hydrocephalus/ventriculomegaly.

On discharge:
N/MS:  Pt A/A/O x3, PERRLA [**2-1**]/brisk, EOMI, face symmetric,
tongue midline, facial sensation intact, MAE [**4-6**] equal strength,
no dysmetria, no pronator drift.
Pt conversant, following all commands.
Pt conts with c/o headache-improving on current pain regimen of
MScontin with Percocet for breakthrough pain.


Pertinent Results:
[**2122-1-14**] 05:25AM BLOOD WBC-5.8 RBC-4.71 Hgb-15.0 Hct-42.7 MCV-91
MCH-31.8 MCHC-35.1* RDW-12.5 Plt Ct-126*
[**2122-1-12**] 05:40PM BLOOD Neuts-78.0* Lymphs-10.2* Monos-8.8
Eos-2.7 Baso-0.3
[**2122-1-14**] 05:25AM BLOOD Glucose-91 UreaN-24* Creat-1.0 Na-140
K-4.4 Cl-103 HCO3-28 AnGap-13
[**2122-1-14**] 05:25AM BLOOD Calcium-9.0 Phos-3.9 Mg-2.2
[**2122-1-14**] 05:25AM BLOOD Phenyto-8.0*

REASON FOR THIS EXAMINATION:
SAH- eval for aneyrusm
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: Subarachnoid hemorrhage, evaluate for aneurysm.

TECHNIQUE: Contiguous axial images were obtained through the
brain without contrast. Subsequent rapid axial imaging was
performed from the aortic arch through the brain during infusion
of IV contrast. Images were processed on a separate workstation
with display curved reformats and volume-rendered images, and
maximum intensity projection images.
The outside CT is not available for comparison at this time.
HEAD CT: There is diffuse subarachnoid hemorrhage within the
basal cisterns and the left quadrigeminal and suprasellar
cisterns. The ventricles are normal in caliber and
configuration. There are no fractures identified. Minimal
midline shift, no hydrocephalus.
HEAD CTA: The carotid and vertebral arteries and their major
branches are patent with no evidence of stenosis. No aneurysms
or vascular malformations are seen. The proximal basilar artery
is fenestrated. There is a duplicate superior cerebral artery on
the right.
IMPRESSION: Diffuse subarachnoid blood within the basal,
quadrigeminal and suprasellar cisterns. Normal CT angiogram. No
evidence of aneurysm or vascular malformation.

CAROT/CEREB [**Hospital1 **]

Reason: r/o aneurysm
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
50 year old man with non-traumatic SAH
REASON FOR THIS EXAMINATION:
r/o aneurysm
HISTORY: 50-year-old man with nontraumatic subarachnoid
hemorrhage, to rule out aneurysm.

TECHNIQUE: Informed consent was obtained from the patient after
explaining the risks, indication, and alternative management.
Risks explained include stroke, loss of vision and speech,
temporary or permanent, with possible treatment with stent and
coils if needed.

STAFF: Dr. [**Last Name (STitle) **], Dr. [**First Name (STitle) **] and Dr. [**Last Name (STitle) 1611**].

The patient was brought to the interventional neuroradiology
theater and placed on the biplane table in the supine position.
Two patient identifiers performed, a timeout on the patient.
Both groins were prepped and draped in the usual fashion. Access
to the right common femoral artery was obtained using a 19-gauge
single wall needle, under local anesthesia using 1% lidocaine
mixed with sodium bicarbonate and with aseptic precautions.
Through the needle, a 0.35 [**Last Name (un) 7648**] wire was introduced and the
needle taken out. Over the wire, a 5 French vascular sheath was
placed and connected to a saline infusion (mixed with heparin
500 units and 500 cc of saline) with a continuous drip. Through
the sheath, a 4 French Berenstein catheter was introduced and
connected to continuous saline infusion (with heparin mixture:
1000 units of heparin and 1000 cc of saline). The following
vessels were selectively catheterized and arteriograms were
performed from these locations. After review of films, the
catheter and the sheath were withdrawn and pressure was applied
on the groin until hemostasis was obtained. The procedure was
uneventful and the patient tolerated the procedure well without
complications. The patient was sent to the floor with orders.
The following vessels were selectively catheterized and
arteriograms were obtained in the AP and lateral projections:
1. Right internal carotid artery.
2. Right external carotid artery.
3. Right internal carotid artery.
4. Left external carotid artery.
5. Right vertebral artery.
6. Left vertebral artery.
There was no evidence of any aneurysm, filling defect or
stenosis in all the above-mentioned vessels.
Mr. [**Known firstname 449**] [**Known lastname 76579**] cerebral angiogram demonstrated no evidence of
any aneurysm, AV malformation, filling defect or fistula.
Evaluation of the above vessels demonstrated no evidence of any
aneurysm, vascular malformation, fistula or filling defect.
IMPRESSION:
Successful cerebral angiogram of Mr. [**Known firstname 449**] [**Known lastname **] with no
evidence of any aneurysm, vascular malformation, fistula or
filling defect.

CTA HEAD W&W/O C & RECONS; CT BRAIN PERFUSION

Reason: with perfusion also, aneurysm vs AVM

[**Hospital 93**] MEDICAL CONDITION:
50 year old man with SAH
REASON FOR THIS EXAMINATION:
with perfusion also, aneurysm vs AVM
CONTRAINDICATIONS for IV CONTRAST: None.

CTA OF THE HEAD
CLINICAL INFORMATION: Patient with subarachnoid hemorrhage, rule
out spasm or perfusion abnormalities.
TECHNIQUE: Axial images of the head were obtained without
contrast. Following this, using departmental protocol CT
perfusion images of the head were obtained. Reformatted CT
images were also acquired. Comparison was made with the previous
CTA examination of [**2122-1-5**].
FINDINGS:
CT HEAD:
Again, subarachnoid hemorrhage is identified with considerable
decrease in amount of blood in the basal cisterns. There is no
hydrocephalus seen.
CT PERFUSION STUDY:
The CT perfusion study demonstrates no evidence of focal
perfusion abnormalities on transit time or blood volume or blood
flow images.
CT ANGIOGRAPHY:
CT angiography demonstrates no evidence of vasospasm. No
definite aneurysm is identified.
IMPRESSION:
1. Evolution of blood products in the basal cistern since the
previous CT.
2. No perfusion abnormalities are identified.
3. No evidence of vasospasm or aneurysm identified.

MRI SOFT TISUUE NECK, W/O CONTRAST  [**2122-1-8**] 10:17 AM
MRA NECK W&W/O CONTRAST; MRI SOFT TISUUE NECK, W/O CONT
Reason: aneurysm vs AVM
Contrast: MAGNEVIST
[**Hospital 93**] MEDICAL CONDITION:
50 year old man with SAH
REASON FOR THIS EXAMINATION:
aneurysm vs AVM
CONTRAINDICATIONS for IV CONTRAST: None.
EXAM: MRI of the neck.
CLINICAL INFORMATION: Rule out dissection.
TECHNIQUE: Axial T2 and T1 fat suppressed images were acquired
through the neck. 2D time-of-flight MRA of the neck was
obtained. Following this gadolinium-enhanced 3D time-of-flight
MRA of the neck was acquired.
FINDINGS: Fat suppressed images demonstrate no evidence of
dissection. 3D time-of-flight MRA and gadolinium-enhanced MRA
demonstrate normal vascular structures in the neck without
evidence of dissection or stenosis.
IMPRESSION: Normal MRA of the neck.


Brief Hospital Course:
This 50yo male admitted with sudden onset of worst headache of
his life.  Pt originally went to OSH with CT showing SAH. Pt
transferred to [**Hospital1 18**] with repeat imaging of CT/CTA negative,
MRI/MRA of head/neck negative, cerebral angio x2 negative. Pt
originally loaded with Dilantin at OSH, continued on Dilantin
100mg TID, started Nimodipine at [**Hospital1 18**]. Pt continued to have
mild to moderate headaches controlled with MS contin and
percocet.  Pt continued to have nausea with no vomiting,
controlled with Zofran.

Pt's neurological exam maintained stable without deficits noted.

Medications on Admission:
None

Discharge Medications:
1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*1*
2. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 12 days.
Disp:*144 Capsule(s)* Refills:*0*
3. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day) for 21 days.
Disp:*63 Capsule(s)* Refills:*0*
4. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**12-3**]
Tablets PO Q6H (every 6 hours) as needed for headache for 14
days.
Disp:*56 Tablet(s)* Refills:*0*
5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
6. Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours) as needed for
headache for 1 weeks.
Disp:*14 Tablet Sustained Release(s)* Refills:*0*
7. Zofran 4 mg Tablet Sig: One (1) Tablet PO twice a day for 1
weeks.
Disp:*14 Tablet(s)* Refills:*0*
8. Outpatient Lab Work
dilantin level to be drawn the week of [**2122-1-19**]
please fax results to patients primary care physician.


Discharge Disposition:
Home

Discharge Diagnosis:
SAH


Discharge Condition:
STABLE


Discharge Instructions:
DISCHARGE INSTRUCTIONS SUBARACHNOID HEMORRHAGE

??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.

- No excessive physical activity for one month. No lifting
greater than 10 lbs, no running/dancing/sexual intercourse for
one month
No bathing for 5 days due to incision in leg, showering is okay

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication


Followup Instructions:
PLEASE CALL [**Telephone/Fax (1) **] IF YOU NEED TO CANCEL YOUR SCHEDULED
APPOINTMENT WITH DR.[**First Name (STitle) **] TO BE SEEN [**2122-2-12**] AT 1:30PM.

YOU NEED TO FOLLOW UP WITH A PRIMARY CARE PHYSICIAN/ MEDICAL
DOCTOR FOR YOUR DILANTIN LEVELS AND YOUR PAIN MANAGEMENT.  IF
YOU DO NOT HAVE ONE - YOU [**Month (only) **] CALL [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Hospital **]
[**Hospital3 249**] AT ([**Telephone/Fax (1) 1300**].  THEY CAN HELP YOU IN
FINDING A DOCTOR.

YOU WILL NEED AN MRI/MRA OF THE BRAIN/NECK WITHOUT CONTRAST
WHICH IS SCHEDULED FOR [**2122-2-12**] AT 11:45 AM



Completed by:[**2122-1-14**]
{'Subarachnoid hemorrhage,Hip joint replacement'}


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: Pt complaining of worst headache of his life.

PRESENT ILLNESS: 50yo previously healthy RHM experienced 'worst HA of life'
after coitus during the evening of [**2122-1-4**].  Went to [**Hospital3 2568**]
ED where NCHCT showed SAH. Loaded with dilantin 1gm and xferred
to [**Hospital1 18**] for further eval. No numbess, weakness, visual or
mental
status changes.  No recent trauma or illness. BP 113/69 on
arrival to [**Hospital1 18**] with c/o  HA.

MEDICAL HISTORY: R hip replacement

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On arrival:
VS:  t99.1  bp113/69  hr68   rr12  98%ra	
General: WNWD, NAD
HEENT:  anicteric, MMM without lesions, OP clear
Neck:	Supple, no LAD, no carotid bruits, no thyromegaly
CV:	RRR  s1s2     no m/r/g
Resp:	CTAB   no r/w/r
Abd:	+BS    Soft/NT/ND    no HSM/masses
Ext:	No c/c/e, distal pulses intact
Skin:	No rashes, petechiae

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Denies ETOH
Denies illicit drug use 

### Response:
{'Subarachnoid hemorrhage,Hip joint replacement'}
