CHIEF COMPLAINT: Sudden onset severe headache

PRESENT ILLNESS: 67F with HTN with h/o migraines in distant past but not for
past 10yrs p/w sudden onset worst HA of life yesterday at 4PM.
Scan revealed left SDH

MEDICAL HISTORY: PMH: arthritis, cataracts, HTN, cystitis, rhinitis

MEDICATION ON ADMISSION: Epi pen, Flonase 50 nasal, HCTZ 25', Omeprazole 20', Calcium +
Vitamin D, Glucosamine/chondroitin

ALLERGIES: Aspirin / Bee Sting

PHYSICAL EXAM: Physical Exam:
Vitals: T:97.7 P: 75  R: 13  BP: 125/75 SaO2: 95% RA
General: somnolent but easily arousable, NAD
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no 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; pt in brace on R leg from angiogram
Skin: no rashes or lesions noted.
.
Neurologic:
.
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.  Inattentive, stopped [**Doctor Last Name 1841**] after [**Month (only) 958**], when
she realized she forgot [**Month (only) 547**].  Language is fluent with intact
repetition and comprehension.  Normal prosody.  There were no
paraphasic errors.  Pt. was able to name both high and low
frequency objects.  Able to read without difficulty.  Speech was
not dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**2-9**] at 3
minutes.  Was unable to get 3rd word even with cues.  The pt.
had
good knowledge of current events.  There was no evidence of
apraxia or neglect.
.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 1.5 to 1mm and brisk.  VFF to confrontation.
Funduscopic exam was difficult due to small pupil size, but what
was seen showed no papilledema, exudates, or hemorrhages.
III, IV, VI: EOMI without nystagmus.  Normal saccades.
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.
.
-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5   5   5   5  5  5  5   5    5  5     5     5   5
R  5    5   5   5   5  5  5  5   5    5  5     5     5   5
.
-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.
.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Plantar response was flexor bilaterally.
.
-Coordination: No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF or HKS bilaterally.

FAMILY HISTORY: NC

SOCIAL HISTORY: SH
Married, 4 children,8 grandchildren
originally from [**Country 12649**]
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Cerebral edema,Acute respiratory failure,Unspecified protein-calorie malnutrition,Peripheral vascular complications, not elsewhere classified,Iatrogenic pneumothorax,Hyposmolality and/or hyponatremia,Urinary tract infection, site not specified,Osteoporosis, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Solitary pulmonary nodule,Aneurysm of artery of lower extremity,Other accident caused by striking against or being struck accidentally by objects or persons,Other convulsions
Subdural hem w/o coma,Cerebral edema,Acute respiratry failure,Protein-cal malnutr NOS,Surg comp-peri vasc syst,Iatrogenic pneumothorax,Hyposmolality,Urin tract infection NOS,Osteoporosis NOS,Hypertension NOS,Pure hypercholesterolem,Solitary pulmonry nodule,Lower extremity aneurysm,Obj w-w/o sub fall NEC,Convulsions NEC
Name:  [**Known lastname 8280**],[**Known firstname **]                     Unit No:   [**Numeric Identifier 8281**]

Admission Date:  [**2186-12-15**]              Discharge Date:   [**2187-1-2**]

Date of Birth:  [**2119-8-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Aspirin / Bee Sting

Attending:[**First Name3 (LF) 1698**]
Addendum:
Pt requests follow-up With Dr. [**First Name (STitle) **] instead of Dr.
[**Last Name (STitle) **] in 4 weeks.  Will oblige.

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 41**] - [**Location (un) 42**]

                             [**Name6 (MD) **] [**Name8 (MD) 1041**] MD [**MD Number(2) 1709**]

Completed by:[**2187-1-2**]

Admission Date:  [**2186-12-15**]              Discharge Date:   [**2187-1-2**]

Date of Birth:  [**2119-8-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Aspirin / Bee Sting

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Sudden onset severe headache

Major Surgical or Invasive Procedure:
[**2186-12-17**] Cerebral Angiogram
[**2186-12-20**] L TLC
[**2186-12-20**] L Chest tube
[**2186-12-23**] R craniotomy


History of Present Illness:
67F with HTN with h/o migraines in distant past but not for
past 10yrs p/w sudden onset worst HA of life yesterday at 4PM.
Scan revealed left SDH


Past Medical History:
PMH: arthritis, cataracts, HTN, cystitis, rhinitis

PSH: Hysterectomy, breast bx


Social History:
SH
Married, 4 children,8 grandchildren
originally from [**Country 12649**]



Family History:
NC

Physical Exam:
Physical Exam:
Vitals: T:97.7 P: 75  R: 13  BP: 125/75 SaO2: 95% RA
General: somnolent but easily arousable, NAD
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no 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; pt in brace on R leg from angiogram
Skin: no rashes or lesions noted.
.
Neurologic:
.
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.  Inattentive, stopped [**Doctor Last Name 1841**] after [**Month (only) 958**], when
she realized she forgot [**Month (only) 547**].  Language is fluent with intact
repetition and comprehension.  Normal prosody.  There were no
paraphasic errors.  Pt. was able to name both high and low
frequency objects.  Able to read without difficulty.  Speech was
not dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**2-9**] at 3
minutes.  Was unable to get 3rd word even with cues.  The pt.
had
good knowledge of current events.  There was no evidence of
apraxia or neglect.
.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 1.5 to 1mm and brisk.  VFF to confrontation.
Funduscopic exam was difficult due to small pupil size, but what
was seen showed no papilledema, exudates, or hemorrhages.
III, IV, VI: EOMI without nystagmus.  Normal saccades.
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.
.
-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5   5   5   5  5  5  5   5    5  5     5     5   5
R  5    5   5   5   5  5  5  5   5    5  5     5     5   5
.
-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.
.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Plantar response was flexor bilaterally.
.
-Coordination: No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF or HKS bilaterally.

On discharge: patient is pleasant, [**Location (un) 1131**] a book, He is AOx3,
PERRL, EOM intact face is symmetric, mild broca's aphasia, MAEs
with good strenght, no drift, sensory intact, incision is c/d/i
(staples removed [**1-2**]).


Pertinent Results:
[**12-15**] CT Head- IMPRESSION:
1. 9-mm left hemispheric subdural hematoma with trace
supratentorial
extension and minimal if any rightward shift. No intra-axial
hemorrhage.
2. Benign-appearing right frontal bone reticular lucent lesion
could
potentially represent a hemangioma.

[**12-16**] CTA Head:
IMPRESSION: Unchanged left hemispheric subdural hematoma,
measuring
approximately 9 mm in thickening with trace of blood along the
left tentorium. The vascular images, demonstrate an outpouching
adjacent to the left transverse sinus, possibly consistent with
a venous aneurysm, measuring approximately 5.6 x 7.0 mm as
described above. Grossly no arterial aneurysms larger than 3 mm
in size are detected; however, this study is limited due to lack
of 3D reconstructions.

[**12-17**] Cerebral Angio- which failed to reveal a source of
her left subdural hematoma. She will have other imaging studies
to
corroborate this.

[**12-17**] CT Head: IMPRESSION: Known left-sided subdural hematoma
with interval redistribution of blood products. No significant
shift of midline structures. A small mixed attenuation focsu in
the right parietal bone ( se 2, im 16), unchanged and needs
attention on f/u- a hemantioma or a focal lesion related to
other etiology.

[**12-17**] CT Head: IMPRESSION:
1. Stable appearance of left subdural hematoma without new
development of
mass effect or increased hemorrhage.
2. Right parietal bone lesion, recommendations are unchanged.

MR HEAD W & W/O CONTRAST Study Date of [**2186-12-18**] 5:30 PM
IMPRESSION:
1. Stable subdural collections overlying both convexities with
right and left maximal thickness of 5 or 9 mm. While there is
predominantly hygroma on the right side with some traces of
blood, the left subdural collection containts largely blood
products of early subacute origin. Mass effect is mild and
limited to effacement of the sulci.
2. No evidence of vascular malformation, underlying
space-occupying lesion, or infarct.

Neurophysiology Report EEG Study Date of [**2186-12-19**] IMPRESSION:
This is an abnormal extended routine EEG because of occasional
low amplitude left temporal sharp waves indicative of a
potential epileptogenic focus in this region. In addition, there
was intermittent slowing of background over the left temporal
region consistent with an underlying subcortical dysfunction in
this region. Also, there were intermittent brief periods of
generalized slowing of background indicative of a midline
cerebral dysfunction. Background otherwise showed a posterior
dominant alpha rhythm. No electrographic seizures were present.


PORTABLE HEAD CT W/O CONTRAST Study Date of [**2186-12-19**] 6:37 AM
IMPRESSION:
1. No marked change in size or mass effect exerted by the left
subacute
frontoparietal subdural hematoma.
2. No new major hemorrhage is seen. Assessment for subtle
cerebral edema and subtle new hemorrhage can be limited given
the lower resolution of portable study. Correlate clinically and
f/u closely.

The study and the report were reviewed by the staff radiologist.


Neurophysiology Report EEG Study Date of [**12-20**]/11IMPRESSION:
This EEG continues to show what is most likely a significant
encephalopathy. While background rhythms sometimes achieve the
alpha frequency range, they are frequently supplanted by high
voltage and fairly continuous theta activity. There are also
multifocal interictal epileptic discharges, as defined above.
Left temporal most active, right temporal second, and left
central also noted. No sustained seizures, however, were
identified.

EEG [**12-23**] - This is an abnormal continuous ICU video EEG due to
prolonged periods of background slowing most likely representing
a
moderate encephalopathy. While background rhythms sometimes
achieve the
alpha frequency range, they are frequently interrupted by high
voltage
and fairly continuous theta activity. There are also multifocal
interictal epileptic discharges, as defined above. Left temporal
most
active, right temporal second, and left central also noted
representing
areas of cortical irritability. There were four prolonged
periods of
intermittent runs of sharply contoured theta with some evolution
to
slower rhythm over time suspicious for subtle electrographic
seizure-like phenomenon. On video, there was no clinical
seizure-like
correlation during these runs.

[**12-23**]  Ct head - Interval craniotomy with evacuation of left
subdural hematoma. Slight interval increase/redistribution of
the right parafalcine subdural

[**12-25**] LENIs -
1. Right common femoral artery pseudoaneurysm, with the
flow-containing
portion measuring 1.9 x 1.2 x 1.6 cm.
2. No DVT in right or left lower extremities

[**12-25**] CT Head
1. Increased mass effect from operative site causing new
rightward shift of subfalcine herniation and effacement of left
lateral ventricle.
2. Partial fluid replacement of subdural air collection.
3. No new hemorrhage identified.

[**12-26**] CT Head

Stable appearance of partially evacuated acute-on-chronic left
subdural hematoma, with residual pneumocephalus. Continued 8-mm
rightward
subfalcine herniation, early left uncal herniation, and 5-mm
rightward shift. Mild diffuse cerebral edema.

[**12-28**] CT Head

Slight interval increase in transverse diameter of subdural
fluid
collection. No evidence of new blood within the subdural space.
Interval
slight increase of mass effect causing progression of the
subfalcine
herniation. Stable prominence of left uncus in the suprasellar
cistern.

[**12-28**] Femoral US:
Interval increase in size in the right groin pseudoaneurysm, now

2.3 cm.


Brief Hospital Course:
Ms. [**Known lastname 38513**] was admitted to the neurosurgery service, she
underwent a CTA which was negative for underlying vascular
lesion. Given a lack of trauma in the patient's history on the
morning on [**12-17**] patient underwent a formal diagnostic
angiogram.  Angiogram was negative for an underlying AVM, dural
av fistula and aneurysm.
A neurology consult was obtained for a second opinion for cause
of the spontaneous hemorrhage. They recommend obtaining an MRI.
In the evening the patient was found OOB on the floor in a pool
or urine. She was unharmed which was confirmed by CT.
On [**12-18**] she was neurologically intact. A lung lesion was noted
on CXR and it was recommended that she follow up with her PCP.
[**Name10 (NameIs) **] patient continued to complain of headache so she was started
on a 2 day course of decadron.
On [**12-19**] she was neurologically stable and she stated that her
headache pain was improved compared to admission. She was
cleared for transfer to the floor.
On [**12-20**] Patient was found to be less responsive on exam and not
protecting her airway.  She underwent a STAT head CT that showed
diffuse edema and effacement of cortical sulci concerning for
impending herniation. She was transferred to the ICU, intubated,
and had a left SC TLC which resulted in a Pneumothorax which
required a chest tube.  We started her on 3% hypertonic saline
at a rate of 30cc an hour when it was noted that her NA had
dropped from 140 to 127. Her Na elevated slowly and corrected
and 3% NA was discontinued.  She was extubated on the evening of
the 14th.  Antibiotics were changed on the 15th from Cipro to
Ceftriaxone for.....

On [**12-21**] The patient was neurologically intact.  The Chext Tube
was placed to H20 seal. A chest xray was performed and was
consistent with left-sided chest tube remains in unchanged
position terminating in the apical area.  Also, the small apical
pneumothorax persists and has now width of about 1-1.5 cm. No
new abnormalities are seen. A left-sided subclavian approach
central venous line remains in unchanged position. The patient
was out of bed with physical therapy.  The hyponatremia
resolving and the serum sodium was 140.  The patient was
tolerating a clear liquid diet.

On [**12-23**] Pt was noted to be increasingly lethargic and
disoriented. CT scan showed increased left subdural hematoma
with early subfalcine herniation. Pt was taken emergently to OR
for a mini right craniotomy with decompression of hemorrhage.
The patient was extubated in the OR and transferred back to the
ICU. Immediately post-op the patient was moving all extremities
and following commands. Subcutaneous heparin was stopped.
Post-operative CT showed post operative changes with
pneumocephalus. On [**12-24**], patient was seen to be slightly
drowsy, but following commands and MAE.
She was seen by speech therapy for swallow eval.  It was
recommended that she have an NGT placed as she was pocketing
pureed foods.  Screening lenies were performed and were
negative.  On [**12-25**], Repeat CT demonstrated persistent cerebral
edema with unchanged 5mm midline shift.  She was noted to have a
clot in her right femoral artery which vascular surgery was
consulted.

Her chest tube was placed to water seal which demonstrated no
leak. As a result, pt's Chest tube was removed in routine
fashion. Post pull x-rays showed showed no PTX. A dobhoff was
placed in routine fasion today.  Tubefeeds was initiated, she
was transferred to Step down unit in stable condition.

On [**12-26**], she was transferred to the floor, on examination, she
was more lethargic and provigil was started. In the afternoon,
she became less arousable and a head CT was ordered. This showed
increase in cerebral edema and midline shift. Her serum Na was
139 and she was started on NaCl tabs for goal Na greater than
140. She was transferred to the SDU. She was made NPO in
preparation for possible procedure on [**12-27**] pending her
neurological status.

On [**12-27**] she was seen on a.m rounds and more awake. Her eyes
were open spontaneously, she was AOx2 and month but not year.
She continued to move all extremities with full strength. Given
her significant improvement the plan for procedure was cancelled
and she was restarted on her TF. Speech and swallow was
consulted and cleared her for a mechanical soft diet. Her TF
were discontinued.

On [**12-28**] the patient had intermittent episodes of aphasia with
urinary incontinence x 1. A CT scan showed slight increase in
subdural fluid collection and mass effect. The patient was given
dexamethasone, mannitol, and hypertonic saline was continued.
Seizure prophylaxis with Keppra was increased to 1500mg [**Hospital1 **]. A
repeat ultrasound of the groin showed interval increase in size
of the right femoral artery pseudoaneurysm to 2.3cm. Vascular
surgery recommended continued observation with a repeat
ultrasound in 2 weeks.

On [**12-29**] the patient had improved alertness on exam. Mannitol
was discontinued. A dexamethosone 4-day taper was ordered, and
hypertonic saline infusion was continued. The patient's sodium
level was 144.  She remained stable trhoughout the rest of her
stay.  Dexamethasone and 35 saline was weaned off.  Now DOD, she
is afebrile, VSS, and neuro stable.  She is tolerating POs and
her pain is well controlled.  She is set for d/c to acute rehab
and will follow-up in four weeks.

Medications on Admission:
Epi pen, Flonase 50 nasal, HCTZ 25', Omeprazole 20', Calcium +
Vitamin D, Glucosamine/chondroitin


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily).
4. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: One
(1) Tablet PO Q6H (every 6 hours) as needed for headache.
5. modafinil 100 mg Tablet Sig: One (1) Tablet PO daily  ().
6. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain or fever.
7. Cepacol Sore Throat 15-2.6 mg Lozenge Sig: One (1) lozengen
Mucous membrane once a day as needed for throat irritation.
8. levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
9. sodium chloride 1 gram Tablet Sig: Two (2) Tablet PO BID (2
times a day).
10. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Left Subdural Hematoma
11 mm wide nodule in the left lower lung
Acute hyponatremia
Cerebral edema
Altered mental status
Respiratory failure
Left sided pneumothorax
malnutrition
Seizures
Right Common femoral artery pseudoaneurysm


Discharge Condition:
Mental Status: Clear and coherent with mild expressive aphasia
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
General Instructions

??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.

?????? you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy 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.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) 739**], to be seen in [**4-12**] weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.
??????       You need to follow up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1391**] of
Vascular Surgery on Wednesday [**1-10**]. You will need an
ultrasound of yor Right groin prior to your appointment. Please
call ([**Telephone/Fax (1) 4852**] to set this up.

Please call your primary care physician for an appointment to be
seen within two weeks of discharge.  During your hospital stay
is was noted that there was an 11mm nodule in the left lower
lung.  This may be a benign process.  It does however require
formal evaluation. Your primary care physician will decide how
this will best be followed.


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2187-1-2**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Cerebral edema,Acute respiratory failure,Unspecified protein-calorie malnutrition,Peripheral vascular complications, not elsewhere classified,Iatrogenic pneumothorax,Hyposmolality and/or hyponatremia,Urinary tract infection, site not specified,Osteoporosis, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Solitary pulmonary nodule,Aneurysm of artery of lower extremity,Other accident caused by striking against or being struck accidentally by objects or persons,Other convulsions'}


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: Sudden onset severe headache

PRESENT ILLNESS: 67F with HTN with h/o migraines in distant past but not for
past 10yrs p/w sudden onset worst HA of life yesterday at 4PM.
Scan revealed left SDH

MEDICAL HISTORY: PMH: arthritis, cataracts, HTN, cystitis, rhinitis

MEDICATION ON ADMISSION: Epi pen, Flonase 50 nasal, HCTZ 25', Omeprazole 20', Calcium +
Vitamin D, Glucosamine/chondroitin

ALLERGIES: Aspirin / Bee Sting

PHYSICAL EXAM: Physical Exam:
Vitals: T:97.7 P: 75  R: 13  BP: 125/75 SaO2: 95% RA
General: somnolent but easily arousable, NAD
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no 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; pt in brace on R leg from angiogram
Skin: no rashes or lesions noted.
.
Neurologic:
.
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.  Inattentive, stopped [**Doctor Last Name 1841**] after [**Month (only) 958**], when
she realized she forgot [**Month (only) 547**].  Language is fluent with intact
repetition and comprehension.  Normal prosody.  There were no
paraphasic errors.  Pt. was able to name both high and low
frequency objects.  Able to read without difficulty.  Speech was
not dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**2-9**] at 3
minutes.  Was unable to get 3rd word even with cues.  The pt.
had
good knowledge of current events.  There was no evidence of
apraxia or neglect.
.
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 1.5 to 1mm and brisk.  VFF to confrontation.
Funduscopic exam was difficult due to small pupil size, but what
was seen showed no papilledema, exudates, or hemorrhages.
III, IV, VI: EOMI without nystagmus.  Normal saccades.
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.
.
-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5   5   5   5  5  5  5   5    5  5     5     5   5
R  5    5   5   5   5  5  5  5   5    5  5     5     5   5
.
-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.
.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Plantar response was flexor bilaterally.
.
-Coordination: No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF or HKS bilaterally.

FAMILY HISTORY: NC

SOCIAL HISTORY: SH
Married, 4 children,8 grandchildren
originally from [**Country 12649**] 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Cerebral edema,Acute respiratory failure,Unspecified protein-calorie malnutrition,Peripheral vascular complications, not elsewhere classified,Iatrogenic pneumothorax,Hyposmolality and/or hyponatremia,Urinary tract infection, site not specified,Osteoporosis, unspecified,Unspecified essential hypertension,Pure hypercholesterolemia,Solitary pulmonary nodule,Aneurysm of artery of lower extremity,Other accident caused by striking against or being struck accidentally by objects or persons,Other convulsions'}
