CHIEF COMPLAINT: syncope

PRESENT ILLNESS: Patient is a 68 yo woman with PMH of HTN and cataracts who
syncopized while leaving a restaurant last night.  Says she does
not actually recall passing out and does not recall any
pre-syncopal sensation.  She remembers getting ready to leave
and
then next recalls waking up with EMS present.  Did not have any
preceding HA.  Now reports slight frontal headache, but no
dizziness, nausea, weaknes, numbness or incontinence.

MEDICAL HISTORY: * Cataracts - s/p surgery on the right, scheduled for surgery on
the left in one week
* Hypertention
* s/p lumbar laminectomy [**2141**]

MEDICATION ON ADMISSION: HCTZ 12.5 daily, Verapamil 240
daily, Singulair 10 daily, Calcium supplement, MVI

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 97.5 BP: 148-195/65-80         HR:78    R 18   O2Sats 97
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 2.5-2 left and 2.5 trace reaction right
(surgical)
EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-11**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Mother - CHF

SOCIAL HISTORY: Denies tobacco or illicit drug use. EtOH use
3-4days per week.
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified fall,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Cataract extraction status
Cl skul base fx/brf coma,Ocl crtd art wo infrct,Fall NOS,Hypertension NOS,Asthma NOS,Cataract extract status
Admission Date:  [**2147-4-7**]              Discharge Date:   [**2147-4-11**]

Date of Birth:  [**2079-2-26**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
syncope

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Patient is a 68 yo woman with PMH of HTN and cataracts who
syncopized while leaving a restaurant last night.  Says she does
not actually recall passing out and does not recall any
pre-syncopal sensation.  She remembers getting ready to leave
and
then next recalls waking up with EMS present.  Did not have any
preceding HA.  Now reports slight frontal headache, but no
dizziness, nausea, weaknes, numbness or incontinence.


Past Medical History:
* Cataracts - s/p surgery on the right, scheduled for surgery on
the left in one week
* Hypertention
* s/p lumbar laminectomy [**2141**]


Social History:
Denies tobacco or illicit drug use. EtOH use
3-4days per week.


Family History:
Mother - CHF

Physical Exam:
PHYSICAL EXAM:
O: T: 97.5 BP: 148-195/65-80         HR:78    R 18   O2Sats 97
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 2.5-2 left and 2.5 trace reaction right
(surgical)
EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-11**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils 2.5-2 left and 2.5 trace reactive right (surgical) .
Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
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 [**4-15**] 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

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin


Pertinent Results:
[**2147-4-7**] 07:01PM   CK(CPK)-111
[**2147-4-7**] 07:01PM   cTropnT-<0.01
[**2147-4-7**] 02:49PM   GLUCOSE-142* POTASSIUM-3.2*
[**2147-4-7**] 02:49PM   MAGNESIUM-2.3
[**2147-4-7**] 10:05AM   CK(CPK)-143*
[**2147-4-7**] 10:05AM   CK-MB-5 cTropnT-<0.01
[**2147-4-7**] 06:55AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.008
[**2147-4-7**] 06:55AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2147-4-7**] 04:20AM   CK(CPK)-182*
[**2147-4-7**] 04:20AM   estGFR-Using this
[**2147-4-7**] 04:20AM   cTropnT-<0.01
[**2147-4-7**] 04:20AM   CK-MB-6
[**2147-4-7**] 04:20AM   CALCIUM-8.8 PHOSPHATE-2.4* MAGNESIUM-1.7
[**2147-4-7**] 04:20AM   ASA-NEG ETHANOL-196* ACETMNPHN-NEG
[**2147-4-7**] 04:20AM   WBC-13.0* RBC-3.62* HGB-13.0 HCT-36.3
MCV-100* MCH-35.9* MCHC-35.7* RDW-12.3
[**2147-4-7**] 04:20AM   NEUTS-89.1* BANDS-0 LYMPHS-8.4* MONOS-2.1
EOS-0.2 BASOS-0.2
[**2147-4-7**] 04:20AM   HYPOCHROM-NORMAL ANISOCYT-1+ POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-1+ POLYCHROM-NORMAL
[**2147-4-7**] 04:20AM   PLT SMR-NORMAL PLT COUNT-335
[**2147-4-7**] 04:20AM   PT-12.4 PTT-27.5 INR(PT)-1.1
[**2147-4-10**] 05:31PM BLOOD K-2.8*
[**2147-4-7**] 06:55AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.008
[**2147-4-7**] 06:55AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG

CTA HEAD [**4-7**]:

1. Focal stenosis of the right internal carotid within the
petrous bone could be consistent with either underlying
atherosclerotic disease, a previous traumatic injury, or acute
dissection. Close clinical correlation is recommended.

2. Extensive, severe bifrontal hemorrhagic contusions, with
multiple areas of subdural and subarachnoid hemorrhage. No mass
effect.

3. Probable longitudinal fracture of the left temporal bone with
adjacent opacification of the mastoid air cells.

4. A small foci of air within the subcutaneous tissues of the
left parietal skull could represent deep laceration.

EKG [**4-8**]:

Sinus rhythm, rate 88. Technical artifacts are seen. The Q-T
interval is
borderline prolonged. Minor ST-T wave abnormalities are present.

TRACING #1

[**4-7**] ECHO:
The left atrium is normal in size. The right atrium is
moderately dilated.
Left ventricular wall thickness, cavity size, and systolic
function are normal
(LVEF>55%). Regional left ventricular wall motion is normal.
There is no left
ventricular outflow obstruction at rest or with Valsalva. Right
ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3)
are mildly thickened but aortic stenosis is not present. Mild
(1+) aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial
mitral regurgitation is seen. The estimated pulmonary artery
systolic pressure
is normal. There is no pericardial effusion.

IMPRESSION: Normal global and regional biventricular systolic
function. Mild
aortic regurgitation.

[**4-8**] MRA Neck:
CONCLUSION: Narrowing of right internal carotid artery in its
petrous segment perhaps due to dissection. No change since the
CTA of [**2147-4-7**].

[**4-10**] Carotid US Neck:
40-50% stenosis of L ICA on wet read.  Official report P.

Brief Hospital Course:
Pt was admitted to the SICU from the ED for intracranial
hemmorrhage secondary to fall with question of syncope.  Shge
had a serum alcohol content of 196.  Patient initially had GCS
15 upon presentation and her cspine was cleared in ED by trauma
attending, Dr [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] (clinically).  Pt was maintained on
q1h neuro checks and given dilantin loading dose then 100mg tid
with monitoring after CT head was performed showing interval
developement of bifrontal hemorrhagic contusions.  No aneurysms
were visualized.  Subarachnoid blood was seen mostly within the
frontal sulci.  She underwent a syncope workup and
EKG/Echo/Carotid US results were as above.  Pt was maintained on
a regular diet since admission.  Pulmonary toilet was good and
pt remained stable on room air.  Patient was able to void on her
own throughout her course.  Pt had electrolyte repletions of
sodium, potassium, and magnesium throughout her course.  She was
maintained on a RISS for glucose control.  Her blood pressure
was initially in the 150-160s systollically and adequate control
was achieved through prn dosing of hydralazine and labetalol prn
>140.  Neurology stroke was consulted regarding the narrowing in
the petrous portion of the right ICA and recommended follow up
imaging studies since anticoagulation was not possible due to
intracranial bleeds.  She was transferred to the floor on HD 3
without event and maintained no change in mental status or
neurological exams.  PT was consulted on [**4-10**] and did not see
any need for inpt or outpt PT and cleared the patient to go
home.  Social work also saw patient and gave recommendations for
alcohol abuse treatment.  Pt had potassium repleted on [**4-10**] as
it was 2.8 and rechecked and discharged home on [**4-11**] without
complaints.

Medications on Admission:
HCTZ 12.5 daily, Verapamil 240
daily, Singulair 10 daily, Calcium supplement, MVI

Discharge Medications:
1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day) for 1 months.
Disp:*90 Capsule(s)* Refills:*0*
2. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
3. Verapamil 240 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q24H (every 24 hours).
4. Montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
8. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for prn headache.
9. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
Bifrontal subarachnoid hemorrhages
Stenosis of the right internal carotid artery


Discharge Condition:
Good


Discharge Instructions:
??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending.
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

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
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
Follow up with Dr [**Last Name (STitle) **] at [**Telephone/Fax (1) 2574**] / you will need an MRA
or CT angio of the brain at that time - please confirm this with
Dr. [**Last Name (STitle) 72850**] office.

Please follow up with your primary care physician regarding your
hypertension and hypokalemia.  Please call and make appointment.



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

Completed by:[**2147-4-18**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified fall,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Cataract extraction status'}


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: syncope

PRESENT ILLNESS: Patient is a 68 yo woman with PMH of HTN and cataracts who
syncopized while leaving a restaurant last night.  Says she does
not actually recall passing out and does not recall any
pre-syncopal sensation.  She remembers getting ready to leave
and
then next recalls waking up with EMS present.  Did not have any
preceding HA.  Now reports slight frontal headache, but no
dizziness, nausea, weaknes, numbness or incontinence.

MEDICAL HISTORY: * Cataracts - s/p surgery on the right, scheduled for surgery on
the left in one week
* Hypertention
* s/p lumbar laminectomy [**2141**]

MEDICATION ON ADMISSION: HCTZ 12.5 daily, Verapamil 240
daily, Singulair 10 daily, Calcium supplement, MVI

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 97.5 BP: 148-195/65-80         HR:78    R 18   O2Sats 97
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 2.5-2 left and 2.5 trace reaction right
(surgical)
EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-11**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Mother - CHF

SOCIAL HISTORY: Denies tobacco or illicit drug use. EtOH use
3-4days per week. 

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief [less than one hour] loss of consciousness,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Unspecified fall,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Cataract extraction status'}
