CHIEF COMPLAINT: L acute on chronic SDH

PRESENT ILLNESS: 79 yo russian speaking only male c hx of CAD, COPD, asthma,
afib with 7 day hx of increasing right sided weakness with acute
worsening 2-3 hours ago.  Patient states that he has felt
unsteady over this time period and daughter states that he fell
approximately 3 days ago and has been dragging his R leg over
the
last 1-2 days.  Slurred speech per daughter tonight and he had
difficulty holding on to a cup of water with his right hand.
Patient has had no visual changes and denies headache.

MEDICAL HISTORY: 1) h/o CHF but no EF
2) CAD s/p MI x 2 and angioplasty, ? stent in L iliac. On
coumadin and plavix but stopped for steroid injection planned
for [**1-3**]
3) PVD
4) Afib
5) PUD/GERD
6) s/p cataract removal
7) s/p CCY (gallstones, porcelin gallbladder)
8) hernia repair
9) COPD/ Asthma
10)Nephrolithiasis
11) colonic polyps
12) DVT in L lower extr.
13) DCMP, CHF
14) L spine disc herniation

MEDICATION ON ADMISSION: Medications prior to admission:

ALLERGIES: Aspirin

PHYSICAL EXAM: PHYSICAL EXAM (upon admission)
O: T:97.3  BP: 108/66         HR:60    R 18       O2Sats 98% 2L
NC
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:PERRL 3mm bilat  EOMs intact
Lungs: CTA bilaterally.
Cardiac: reg irregular.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused, multiple soft mobile lipomas
throughout extremities and torso.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. A&Ox3
Orientation: Oriented to person, place, and date.
Language: good comprehension and repetition, difficult to assess
dysarthria [**2-21**] russian language. Naming intact.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives in [**Location 583**] with wife, denies tobacco, etoh and IVDU
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Compression of brain,Other primary cardiomyopathies,Hemiplegia, unspecified, affecting dominant side,Unspecified fall,Chronic obstructive asthma, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Esophageal reflux,Peripheral vascular disease, unspecified,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Displacement of lumbar intervertebral disc without myelopathy,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Other states following surgery of eye and adnexa
Subdural hem w/o coma,Compression of brain,Prim cardiomyopathy NEC,Unsp hemiplga domnt side,Fall NOS,Chronic obst asthma NOS,Atrial fibrillation,CHF NOS,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Old myocardial infarct,Status-post ptca,Esophageal reflux,Periph vascular dis NOS,Peptic ulcer NOS,Lumbar disc displacement,Pure hypercholesterolem,Long-term use anticoagul,Post-proc st eye/adn NEC
Admission Date:  [**2192-11-26**]              Discharge Date:   [**2192-12-5**]

Date of Birth:  [**2113-3-13**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Aspirin

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
L acute on chronic SDH


Major Surgical or Invasive Procedure:
Left frontoparietal craniotomy and evacuation of subdural
hematoma.


History of Present Illness:
79 yo russian speaking only male c hx of CAD, COPD, asthma,
afib with 7 day hx of increasing right sided weakness with acute
worsening 2-3 hours ago.  Patient states that he has felt
unsteady over this time period and daughter states that he fell
approximately 3 days ago and has been dragging his R leg over
the
last 1-2 days.  Slurred speech per daughter tonight and he had
difficulty holding on to a cup of water with his right hand.
Patient has had no visual changes and denies headache.


Past Medical History:
1) h/o CHF but no EF
2) CAD s/p MI x 2 and angioplasty, ? stent in L iliac. On
coumadin and plavix but stopped for steroid injection planned
for [**1-3**]
3) PVD
4) Afib
5) PUD/GERD
6) s/p cataract removal
7) s/p CCY (gallstones, porcelin gallbladder)
8) hernia repair
9) COPD/ Asthma
10)Nephrolithiasis
11) colonic polyps
12) DVT in L lower extr.
13) DCMP, CHF
14) L spine disc herniation


Social History:
Lives in [**Location 583**] with wife, denies tobacco, etoh and IVDU


Family History:
Noncontributory

Physical Exam:
PHYSICAL EXAM (upon admission)
O: T:97.3  BP: 108/66         HR:60    R 18       O2Sats 98% 2L
NC
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:PERRL 3mm bilat  EOMs intact
Lungs: CTA bilaterally.
Cardiac: reg irregular.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused, multiple soft mobile lipomas
throughout extremities and torso.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. A&Ox3
Orientation: Oriented to person, place, and date.
Language: good comprehension and repetition, difficult to assess
dysarthria [**2-21**] russian language. Naming intact.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to
2 mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally
V, VII: slight R facial droop and sensation intact and
symmetric.
VIII: decreased on R side
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**5-23**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Reflexes: B T Br Pa Ac
Right     2 2  2  2  2
Left      2 2  2  2  2

  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  4    4+   4+  4   5  4  5  4   5    5  5     5     5   5

Toes downgoing bilaterally

Coordination: difficulty with finger-nose-finger on the right,
slow rapid alternating movements on the right


Pertinent Results:
ADMISSION LABS:

[**2192-11-25**] 11:40PM   PT-27.9* PTT-26.4 INR(PT)-2.7*
[**2192-11-25**] 11:40PM   WBC-8.7 RBC-4.39* HGB-13.9* HCT-39.0* MCV-89
MCH-31.7 MCHC-35.7* RDW-13.9
[**2192-11-25**] 11:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2192-11-25**] 11:40PM   cTropnT-<0.01
[**2192-11-25**] 11:40PM   GLUCOSE-119* UREA N-24* CREAT-1.2 SODIUM-130*
POTASSIUM-4.8 CHLORIDE-99 TOTAL CO2-25 ANION GAP-11

DISCHARGE LABS:

IMAGING:
CTA HEAD W/O CONTRAST [**2192-11-26**]:
1. Large left chronic subdural hematoma, heterogeneous in
attenuation but
containing acute blood products, measuring 3.3 cm in maximum
depth. There is
resultant rightward subfalcine herniation and shift of midline
structures to
the right, by 1.5 cm at the level of foramen of [**Last Name (un) 2044**] and 1 cm
at the septal
level.

2. CTA demonstrates a soft plaque at the right proximal ICA
without evidence
of flow-limiting imaging stenosis. CTA head demonstrates no
focus of active
bleeding ("spot sign"), dural AVF, AVM or aneurysm larger than
2mm.

3. Stable appearance of likely right-sided Zenker's diverticulum
in the
superior mediastinum, at the thoraic inlet.

4. Multilevel cervical spondylosis.


Brief Hospital Course:
Mr. [**Known lastname 10816**] was admitted to the neurosurgery service to the
ICU. He was started on Keppra due to question of subclincal
seizures given his transient right arm weakness. His INR was
reversed, surgery was delayed while the subdural became more
chronic in nature. A speech and swallow was completed and was
approved for a regular diet. He underwent a left sided
craniotomy on [**2192-11-30**] with Dr. [**First Name (STitle) **]. Post-operative course
was uneventful. Patient was written for transfer to the SDU from
the ICU on [**12-1**] but remained in the ICU due to no beds in the
SDU. On [**11-1**] the patient was transfered to the floor without a
stepdown bed given his stable examination and neurologic status.
On [**11-1**] his Foley catheter was discontinued and his oxygen was
weaned. The patient was cleared for home with physical therapy
on [**12-5**] and he was discharged stable without issue.

Medications on Admission:
Medications prior to admission:

Singulair 10 mg Tab
1 Tablet(s) by mouth once a day

Plavix 75 mg Tab
1 Tablet(s) by mouth DAILY (Daily)

Hydrocodone-Acetaminophen 5 mg-500 mg Tab
1 Tablet(s) by mouth once or twice daily as needed for for
severe
pain only

Xopenex HFA 45 mcg/Actuation Aerosol Inhaler
1 puff inhaled every 6 hours as needed for shortness of
breath/wheeze

Furosemide 20 mg Tab
1 Tablet(s) by mouth once a day

Alprazolam 0.25 mg Tab
1 Tablet(s) by mouth daily

Lisinopril 10 mg Tab
1 Tablet(s) by mouth once a day

Simvastatin 80 mg Tab
1 Tablet(s) by mouth daily at bedtime

Omeprazole 20 mg Cap, Delayed Release
Capsule(s) by mouth once a day

Isosorbide Mononitrate SR 30 mg 24 hr Tab
1 Tablet(s) by mouth once a day dose change. to replace 60 mg
tabs

Prednisone 10 mg Tab
1 Tablet(s) by mouth once a day

Amitriptyline 25 mg Tab
1 Tablet(s) by mouth daily at bedtime

Docusate Sodium 100 mg Cap
3 Capsule(s) by mouth daily

Trazodone 50 mg Tab
1 Tablet(s) by mouth once a day

Warfarin 5 mg Tab
Take 1 Tablet(s) by mouth daily or as directed by [**Hospital 197**]
Clinic

Warfarin 7.5 mg Tab
Take 1 Tablet(s) by mouth daily or as directed by coumadin
clinic

metoprolol succinate ER 25 mg 24 hr Tab Oral
1 Tablet Sustained Release 24 hr(s) Once Daily

nitroglycerin 0.3 mg Sublingual Tab Sublingual as needed


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day). Capsule(s)
2. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily): ** RESTART THIS MEDICATION on [**2192-12-7**] **.
3. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4H (every
4 hours) as needed for pain.
6. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).


Discharge Disposition:
Home With Service

Facility:
[**Hospital6 1952**], [**Location (un) 86**]

Discharge Diagnosis:
Acute on Chronic SDH


Discharge Condition:
Activity Status: Ambulatory - Independent.
Level of Consciousness: Alert and interactive.
Mental Status: Clear and coherent.


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.
?????? Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, or
Ibuprofen etc.
?????? You were on a medication called Coumadin (Warfarin) which was
held during your hospitalization. Please restart this medication
IF/WHEN your primary care physician deems appropriate. ** Please
RESTART your home Plavix dose on [**2192-12-7**] **

?????? If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring. Please continue Keppra dose
until follow-up appointment

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.
[**First Name (STitle) **], to be seen in 4 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.

Please have your STAPLES REMOVED in 5 days after discharge at
your primary care physician's office.
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Compression of brain,Other primary cardiomyopathies,Hemiplegia, unspecified, affecting dominant side,Unspecified fall,Chronic obstructive asthma, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Esophageal reflux,Peripheral vascular disease, unspecified,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Displacement of lumbar intervertebral disc without myelopathy,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Other states following surgery of eye and adnexa'}


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: L acute on chronic SDH

PRESENT ILLNESS: 79 yo russian speaking only male c hx of CAD, COPD, asthma,
afib with 7 day hx of increasing right sided weakness with acute
worsening 2-3 hours ago.  Patient states that he has felt
unsteady over this time period and daughter states that he fell
approximately 3 days ago and has been dragging his R leg over
the
last 1-2 days.  Slurred speech per daughter tonight and he had
difficulty holding on to a cup of water with his right hand.
Patient has had no visual changes and denies headache.

MEDICAL HISTORY: 1) h/o CHF but no EF
2) CAD s/p MI x 2 and angioplasty, ? stent in L iliac. On
coumadin and plavix but stopped for steroid injection planned
for [**1-3**]
3) PVD
4) Afib
5) PUD/GERD
6) s/p cataract removal
7) s/p CCY (gallstones, porcelin gallbladder)
8) hernia repair
9) COPD/ Asthma
10)Nephrolithiasis
11) colonic polyps
12) DVT in L lower extr.
13) DCMP, CHF
14) L spine disc herniation

MEDICATION ON ADMISSION: Medications prior to admission:

ALLERGIES: Aspirin

PHYSICAL EXAM: PHYSICAL EXAM (upon admission)
O: T:97.3  BP: 108/66         HR:60    R 18       O2Sats 98% 2L
NC
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:PERRL 3mm bilat  EOMs intact
Lungs: CTA bilaterally.
Cardiac: reg irregular.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused, multiple soft mobile lipomas
throughout extremities and torso.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. A&Ox3
Orientation: Oriented to person, place, and date.
Language: good comprehension and repetition, difficult to assess
dysarthria [**2-21**] russian language. Naming intact.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives in [**Location 583**] with wife, denies tobacco, etoh and IVDU 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Compression of brain,Other primary cardiomyopathies,Hemiplegia, unspecified, affecting dominant side,Unspecified fall,Chronic obstructive asthma, unspecified,Atrial fibrillation,Congestive heart failure, unspecified,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Old myocardial infarction,Percutaneous transluminal coronary angioplasty status,Esophageal reflux,Peripheral vascular disease, unspecified,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Displacement of lumbar intervertebral disc without myelopathy,Pure hypercholesterolemia,Long-term (current) use of anticoagulants,Other states following surgery of eye and adnexa'}
