CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: Pt is a 50 yo male w/ PMHx sig for HTN and lip cancer s/p
resection who presented to [**Hospital 1474**] hospital after episode of
loss of consciousness found to have a reported SAH.  Earlier in
the afternoon, he went to speak with a neighbor who was building
a fence and took down a portion of the patient's fence.  Pt was
angry and confronted neighbor and apparently lost consciousness.
 The next thing he remembers is waking up at an OSH with a large
headache.  A head CT revealed SAH blood in the suprasellar
cistern, Sylvian fissure, and intra hemispheric fissure.  Pt was
hypertensive to the 180s/115s.  He was given IV Labetolol and
transferred to [**Hospital1 18**] for further management

MEDICAL HISTORY: 1. Lip Cancer s/p resection
2. Hypertension

MEDICATION ON ADMISSION: 1.Lisinopril 40 mg q day
2.HCTZ 25 mg q day
3.Amlodipine 10 mg q day
4.Labetolol HCL 200 mg q 12
5.Clonidine HCL 0.1 mg [**Hospital1 **]
6.Benicar 40 mg q day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
Vitals: T 98.6; BP 180/113; P 67; RR 17; O2 sat 96% 3L

FAMILY HISTORY: Father - CAD, HTN, CVA, DM, CPOD, CHF.  Mother -deceased
emphysema.

SOCIAL HISTORY: Lives with father.  Former 3 ppd smoker quit in [**2131**].  Rare
ETOH.
Subarachnoid hemorrhage,Unspecified chronic bronchitis,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Cerebral aneurysm, nonruptured
Subarachnoid hemorrhage,Chronic bronchitis NOS,Hypertension NOS,Hx-skin malignancy NEC,Nonrupt cerebral aneurym
Admission Date:  [**2139-7-9**]              Discharge Date:   [**2139-7-17**]

Date of Birth:  [**2089-4-21**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Syncope

Major Surgical or Invasive Procedure:
[**7-10**]: Angiogram with embolization of right ACOM aneurysm


History of Present Illness:
Pt is a 50 yo male w/ PMHx sig for HTN and lip cancer s/p
resection who presented to [**Hospital 1474**] hospital after episode of
loss of consciousness found to have a reported SAH.  Earlier in
the afternoon, he went to speak with a neighbor who was building
a fence and took down a portion of the patient's fence.  Pt was
angry and confronted neighbor and apparently lost consciousness.
 The next thing he remembers is waking up at an OSH with a large
headache.  A head CT revealed SAH blood in the suprasellar
cistern, Sylvian fissure, and intra hemispheric fissure.  Pt was
hypertensive to the 180s/115s.  He was given IV Labetolol and
transferred to [**Hospital1 18**] for further management

Past Medical History:
1. Lip Cancer s/p resection
2. Hypertension

Social History:
Lives with father.  Former 3 ppd smoker quit in [**2131**].  Rare
ETOH.

Family History:
Father - CAD, HTN, CVA, DM, CPOD, CHF.  Mother -deceased
emphysema.


Physical Exam:
On Admission:
Vitals: T 98.6; BP 180/113; P 67; RR 17; O2 sat 96% 3L

General: lying in bed NAD
HEENT: NCAT, dry mucous membranes
Neck: supple
Pulmonary: CTA b/l
Cardiac: regular rate and rhythm, with no m/r/g
Carotids: no blood flow murmur
Abdomen: soft, nontender, non distended, normal bowel sounds
Extremities: no c/c/e.

Neurological Exam:
Mental status: A & O x3, attentive - relays coherent history.
Fluent speech with no paraphasic or phonemic errors.  Adequate
comprehension.  Follows simple and multi-step commands.

Cranial Nerves:
I: Not tested
II: PERRL, 3-->2mm with light. optic discs sharp difficult to
visualize.  VFF.
III, IV, VI: EOMI. no nystagmus.
V, VII: facial sensation intact, facial strength
VIII: hearing intact b/l to finger rubbing.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: SCM [**4-6**]
XII: Tongue midline without fasciculations.

Motor: Normal bulk. Normal tone. No pronator drift.  Full
strength.
Sensation: intact to light touch.
Reflexes: 1+ in UEs, 2+ patellas.  Toes downgoing bilaterally.
Coordination: FNF intact.


Pertinent Results:
Labs on Admission:
[**2139-7-9**] 08:00PM BLOOD WBC-16.7* RBC-4.65 Hgb-14.1 Hct-42.5
MCV-91 MCH-30.4 MCHC-33.3 RDW-13.4 Plt Ct-371
[**2139-7-9**] 08:00PM BLOOD Neuts-88* Bands-0 Lymphs-9.0* Monos-2
Eos-1 Baso-0
[**2139-7-9**] 08:00PM BLOOD PT-14.3* PTT-26.8 INR(PT)-1.2*
[**2139-7-9**] 08:00PM BLOOD Glucose-121* UreaN-17 Creat-1.0 Na-139
K-4.4 Cl-101 HCO3-27 AnGap-15

CTA on Admission:
IMPRESSION: Diffuse subarachnoid hemorrhage in the basal
cisterns, sylvian
fissure, interhemispheric fissure, and in the sulci of the
frontal lobe
bilaterally. No midline shift of normally placed structures.
Aneurysm at the anterior communicating artery measuring 6 x 3
mm, pointing
inferiorly and anteriorly, with irregularity on right. No
vasospasm.

Pre-op Chest X-ray:
IMPRESSION: AP chest reviewed in the absence of prior chest
radiographs:
Lungs are fully expanded and clear and the mediastinum is
midline. There is no evidence of volume loss, or central
adenopathy. Study does not represent a reasonable assessment of
central airways, however. Lung periphery is clear. Heart size
top normal. No pleural abnormality.

Post-Embolization CT:
ATTENDING NOTE: Less apparent SAH could be due to
redistribution. No new
hemorrhage. No loss of GW differentiation. Ventricles slightly
prominent but unchanged. Decrease in extent of diffuse
subarachnoid hemorrhage, no new hemorrhage. Status post coiling
of the Acom aneurysm.

MRI of Head [**7-13**]:
TECHNIQUE: Axial T2-weighted images of the brain were obtained.
Arterial
spin-labeling MR perfusion study was performed. Dynamic
susceptibility
contrast MR perfusion study was performed during intravenous
gadolinium
administration.

FINDINGS: A complete evaluation of the brain was not performed
with this
study. Axial T2-weighted images demonstrate multiple foci of
high signal in the subcortical and deep white matter of the
cerebral hemispheres,
corresponding to hypodensities noted on the head CT of [**2139-7-11**],
which are
nonspecific. The ventricles and sulci are normal in size and
configuration.
There is a mucus retention cyst in the left maxillary sinus and
mild mucosal thickening in the left sphenoid sinus.

No perfusion abnormalities are identified on the MR perfusion
study.

IMPRESSION:
1. No evidence of perfusion abnormalities.
2. Multiple foci of high T2 signal in the white matter of the
cerebral
hemispheres, which are nonspecific in a patient of this age.
Further
evaluation may be performed by a complete brain MRI.



Brief Hospital Course:
Mr. [**Known lastname 7049**] was admitted after being transferred from an OSH with
a
spontaneous SAH. A CTA revealed an aneurysm at the anterior
communicating artery measuring 6 x 3 mm. The patient was
admitted to the ICU for hourly neuro checks and was started on
nimodipine. On [**7-10**] he had an angiogram by Dr. [**First Name (STitle) **] and the
aneurysm was coiled at that time. The procedure went well and he
felt that the vessel was secured afterwards. The patient went
back to the ICU following the angio. He was neurologically
intact throughout his whole stay in the ICU. Mr. [**Known lastname 7049**] did have
headaches and some nausea and vomiting that improved with
medication. His blood pressure was maintained at < 200 systolic
in order to profuse the brain. On [**7-15**] the patient had a CTA
which was reviewed by Dr. [**First Name (STitle) **] who felt there was no
significant vasospasm present. The patient was also treated with
dilantin to prevent seizures during his hospital course.

On [**7-15**] the patient was transferred to the stepdown unit since
he was doing well neurologically. He had Q 2 neuro checks. The
patient was given metoprolol, lisinopril, and nimodipine while
in the stepdown unit. His blood pressure was still elevated, but
< 200 systolic.

On [**7-17**] he had an episode of an acute headache and vomiting. The
headache resolved after he vomited and the patient had no
neurologic changes. He had a stat head CT which revealed no
hydrocephalus and no new hemorrhage. He was evaluated by
physical therapy who felt that he was safe to ambulate without
assistance and that he was safe to be discharged. Neurologically
he was oriented x 3, cranial nerves intact, full strength and
sensation throughout, no pronator drift. The patient was
discharged with enough nimodpine for the weekend and his
pharmacy will have the remaining portion ready on Monday
morning. He will complete a total of 21 days of therapy on
[**2139-7-29**].

Medications on Admission:
1.Lisinopril 40 mg q day
2.HCTZ 25 mg q day
3.Amlodipine 10 mg q day
4.Labetolol HCL 200 mg q 12
5.Clonidine HCL 0.1 mg [**Hospital1 **]
6.Benicar 40 mg q day.


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Albuterol 90 mcg/Actuation Aerosol Sig: 6-8 Puffs Inhalation
Q4H (every 4 hours) as needed.
4. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day) for 4 weeks.
Disp:*112 Capsule(s)* Refills:*1*
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain: No driving while on
narcotics.
Disp:*50 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 25 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day) for 1 months.
Disp:*90 Tablet(s)* Refills:*0*
7. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 9 days.
Disp:*108 Capsule(s)* Refills:*0*
8. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO every four
(4) hours for 3 days.
Disp:*36 Capsule(s)* Refills:*0*
9. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Outpatient Lab Work
Please have your dilantin level drawn prior to your appointment
with Dr. [**First Name (STitle) **].


Discharge Disposition:
Home

Discharge Diagnosis:
diffuse SAH, R ACOM aneurysm


Discharge Condition:
Neurologically Stable


Discharge Instructions:
Angiogram with Embolization
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal)
??????	After 1 week, you may resume sexual activity
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room


Followup Instructions:
Please call [**Telephone/Fax (1) 1669**] to make an appointment to be seen in 4
weeks by Dr. [**First Name (STitle) **].  You will need to have a CT scan without
contrast prior to your appointment.

You need to have a dilantin level drawn prior to seeing Dr.
[**First Name (STitle) **].

You need to follow-up with your PCP on [**Name9 (PRE) 766**] for blood pressure
management. You are taking nimodipine to prevent vasospasm for a
total of 21 days. You are on lisinopril and metoprolol. Your
other blood pressure medications were stopped in the hospital.



Completed by:[**2139-7-17**]
{'Subarachnoid hemorrhage,Unspecified chronic bronchitis,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Cerebral aneurysm, nonruptured'}


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: Pt is a 50 yo male w/ PMHx sig for HTN and lip cancer s/p
resection who presented to [**Hospital 1474**] hospital after episode of
loss of consciousness found to have a reported SAH.  Earlier in
the afternoon, he went to speak with a neighbor who was building
a fence and took down a portion of the patient's fence.  Pt was
angry and confronted neighbor and apparently lost consciousness.
 The next thing he remembers is waking up at an OSH with a large
headache.  A head CT revealed SAH blood in the suprasellar
cistern, Sylvian fissure, and intra hemispheric fissure.  Pt was
hypertensive to the 180s/115s.  He was given IV Labetolol and
transferred to [**Hospital1 18**] for further management

MEDICAL HISTORY: 1. Lip Cancer s/p resection
2. Hypertension

MEDICATION ON ADMISSION: 1.Lisinopril 40 mg q day
2.HCTZ 25 mg q day
3.Amlodipine 10 mg q day
4.Labetolol HCL 200 mg q 12
5.Clonidine HCL 0.1 mg [**Hospital1 **]
6.Benicar 40 mg q day.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
Vitals: T 98.6; BP 180/113; P 67; RR 17; O2 sat 96% 3L

FAMILY HISTORY: Father - CAD, HTN, CVA, DM, CPOD, CHF.  Mother -deceased
emphysema.

SOCIAL HISTORY: Lives with father.  Former 3 ppd smoker quit in [**2131**].  Rare
ETOH. 

### Response:
{'Subarachnoid hemorrhage,Unspecified chronic bronchitis,Unspecified essential hypertension,Personal history of other malignant neoplasm of skin,Cerebral aneurysm, nonruptured'}
