CHIEF COMPLAINT: Found down in bathroom

PRESENT ILLNESS: Ms. [**Known lastname **] is a 80 yo LHW with history of 2 prior strokes who
presents with intraparechymal and intraventricular hemorrhage
after being found down in bathroom this morning.
The patient is currently living in a nursing home after recent
discharge from [**Hospital1 **] [**Hospital3 **] Rehab via [**Hospital3 **] Hospital,
where she was admitted 2 months ago for a stroke. Her recent
baseline is ambulatory with walker without assistance, mild word
finding difficulty, otherwise no residual deficits. Her friend
and son think she was at her baseline yesterday, both spoke with
her and she was laughing and making full sentences
appropriately.
Her son does mention she expressed the wish to join her deceased
husband and daughter, so he was worried about depression.
The rehab staff heard a thud at 5:30 am and found patient on
floor in bathroom, jumbled up with her walker. Her eyes were
open
and she followed commands, but her speech was garbled
and she was weak on the right side.
She was brought to [**Hospital3 **] first, NIHSS 21, BP 175/63.
She
was awake, following commands, with R sided weakness, verbal
output mostly incomprehensible except for her name and yes/no to
some questions. Head CT showed approx 5.5 x 2.5 cm left parietal
hemorrhage with some intraventricular extension. Patient was
then
transferred to [**Hospital1 18**].
In [**Hospital1 18**] ED, patient did not require any antihypertensives, she
remained with SBP 150-160s. Her mental status and exam remained
stable through her stay in the ED. She slept for some time but
was awake with eyes open when examiner entered the room. She did
vomit once, bright yellow bile, and did not cough or desat. She
received antiemetics for this. Hip X-ray was done for complaint
of hip pain, but showed no fracture or dislocation.

MEDICAL HISTORY: - 2 prior strokes, 12 years ago p/w R weakness that completely
recovered, 2 months ago p/w aphasia which recovered except for
word finding difficulties, family unclear of stroke etiology or
what was done for treatment, not on ASA per paperwork we have
here
- HTN
- cataract surgery (L) done week before her stroke
- legally blind in R eye
- ?venous thrombosis (seen in OSH list of ICD9 codes but family
not aware of this)

MEDICATION ON ADMISSION: atenolol 50 mg [**Hospital1 **]
hydralazine 10 mg PO QID
ofloxacin eye drops OS [**Hospital1 **]

ALLERGIES: hydrochlorothiazide / Penicillins / Sulfa(Sulfonamide
Antibiotics) / Macrolide Antibiotics

PHYSICAL EXAM: On Admission:
VS T 96.8  HR 87   BP 150s-180s/60-70s  RR 18   02 99/RA
GEN: eyes open, awake, regards examiner. NAD. In C-collar.
HEENT: R eye closed at baseline, scarred over, no pupillary
response.
CV: RRR, no m/r/g
PULM: CTAB anteriorly
AB: NT/ND soft
EXT: no edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: was living independently at home until stroke 2 months ago,
now residing in nursing home ([**Hospital3 **] rehab in [**Location (un) 10072**]).
Widowed few years ago. Has 1 adopted son who lives in FL. Her
adopted daughter was killed by drunk driver in her 20s. Patient
was a talented singer and pianist. No tobacco, EtoH.
Intracerebral hemorrhage,Pneumonitis due to inhalation of food or vomitus,Other amyloidosis,Atrial fibrillation,Flaccid hemiplegia and hemiparesis affecting nondominant side,Other fluid overload,Aphasia,Unspecified essential hypertension,Do not resuscitate status,Unspecified cerebrovascular disease,Late effects of cerebrovascular disease, fluency disorder,Profound impairment, one eye, impairment level not further specified,Personal history of venous thrombosis and embolism
Intracerebral hemorrhage,Food/vomit pneumonitis,Amyloidosis NEC,Atrial fibrillation,Flccd hmiplg nondmnt sde,Fluid overload NEC,Aphasia,Hypertension NOS,Do not resusctate status,Cerebrovasc disease NOS,Late eff CV-fluency dis,Blindness, one eye,Hx-ven thrombosis/embols
Admission Date:  [**2101-3-11**]              Discharge Date:   [**2101-3-18**]

Date of Birth:  [**2020-12-18**]             Sex:   F

Service: NEUROLOGY

Allergies:
hydrochlorothiazide / Penicillins / Sulfa(Sulfonamide
Antibiotics) / Macrolide Antibiotics

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Found down in bathroom

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms. [**Known lastname **] is a 80 yo LHW with history of 2 prior strokes who
presents with intraparechymal and intraventricular hemorrhage
after being found down in bathroom this morning.
The patient is currently living in a nursing home after recent
discharge from [**Hospital1 **] [**Hospital3 **] Rehab via [**Hospital3 **] Hospital,
where she was admitted 2 months ago for a stroke. Her recent
baseline is ambulatory with walker without assistance, mild word
finding difficulty, otherwise no residual deficits. Her friend
and son think she was at her baseline yesterday, both spoke with
her and she was laughing and making full sentences
appropriately.
Her son does mention she expressed the wish to join her deceased
husband and daughter, so he was worried about depression.
The rehab staff heard a thud at 5:30 am and found patient on
floor in bathroom, jumbled up with her walker. Her eyes were
open
and she followed commands, but her speech was garbled
and she was weak on the right side.
She was brought to [**Hospital3 **] first, NIHSS 21, BP 175/63.
She
was awake, following commands, with R sided weakness, verbal
output mostly incomprehensible except for her name and yes/no to
some questions. Head CT showed approx 5.5 x 2.5 cm left parietal
hemorrhage with some intraventricular extension. Patient was
then
transferred to [**Hospital1 18**].
In [**Hospital1 18**] ED, patient did not require any antihypertensives, she
remained with SBP 150-160s. Her mental status and exam remained
stable through her stay in the ED. She slept for some time but
was awake with eyes open when examiner entered the room. She did
vomit once, bright yellow bile, and did not cough or desat. She
received antiemetics for this. Hip X-ray was done for complaint
of hip pain, but showed no fracture or dislocation.

On ROS (obtained from son and friend) no recent fever, SOB, CP,
abdominal pain, N/V/D, headaches, vision changes, vertigo.


Past Medical History:
- 2 prior strokes, 12 years ago p/w R weakness that completely
recovered, 2 months ago p/w aphasia which recovered except for
word finding difficulties, family unclear of stroke etiology or
what was done for treatment, not on ASA per paperwork we have
here
- HTN
- cataract surgery (L) done week before her stroke
- legally blind in R eye
- ?venous thrombosis (seen in OSH list of ICD9 codes but family
not aware of this)


Social History:
was living independently at home until stroke 2 months ago,
now residing in nursing home ([**Hospital3 **] rehab in [**Location (un) 10072**]).
Widowed few years ago. Has 1 adopted son who lives in FL. Her
adopted daughter was killed by drunk driver in her 20s. Patient
was a talented singer and pianist. No tobacco, EtoH.


Family History:
Noncontributory

Physical Exam:
On Admission:
VS T 96.8  HR 87   BP 150s-180s/60-70s  RR 18   02 99/RA
GEN: eyes open, awake, regards examiner. NAD. In C-collar.
HEENT: R eye closed at baseline, scarred over, no pupillary
response.
CV: RRR, no m/r/g
PULM: CTAB anteriorly
AB: NT/ND soft
EXT: no edema

NEURO:
MSE: Awake, eyes open spontaneously. Not able to answer
orientation questions- answers yes/no questions correctly about
her name and location of hospital, but not which specific
hospital. Inconsistent responses about date. Unable to state
name
or age. Spoken phrases limited to "I don't know" and "Oh g-d."
Cannot name or repeat. Able to follow some commands (open/close
eyes, can perform formal testing of LUE muscles, can show 2
fingers on left hand only after the action is shown to her for
imitation).

CN: R eye blind with nonreactive pupil at baseline. L pupil 2 to
1mm. Eyes midline with difficulty looking far right, otherwise
EOMI. No blink to threat on R. R lower facial weakness.

MOTOR: Normal bulk.
RUE- flaccid, 0/5
RLE- externally rotated, slightly flaccid, small amount of
spontaneous flexion at hip and knee, no distal movement.
LUE- [**4-30**] deltoid, tricep, bicep, grip
LLE- antigravity at IP, wiggles toes

SENSATION: absent to pinch on R arm with no withdrawal, RLE
withdraws small amount to nailbed pressure. Intact light touch
and pin on L side.

DTR: 2+ biceps, 1+ triceps, brachiorad, patellars. Symmetric
bilaterally. Positive Babinkski bilaterally, more so on R.


Pertinent Results:
Admission Labs:
[**2101-3-11**] 11:00AM BLOOD WBC-9.7 RBC-3.96* Hgb-11.8* Hct-35.2*
MCV-89 MCH-29.8 MCHC-33.5 RDW-12.7 Plt Ct-205
[**2101-3-11**] 11:00AM BLOOD Neuts-85.8* Lymphs-10.9* Monos-3.0
Eos-0.1 Baso-0.2
[**2101-3-11**] 11:00AM BLOOD PT-11.0 PTT-33.4 INR(PT)-1.0
[**2101-3-11**] 11:00AM BLOOD Glucose-128* UreaN-20 Creat-0.8 Na-140
K-4.2 Cl-102 HCO3-26 AnGap-16
[**2101-3-15**] 03:20PM BLOOD ALT-32 AST-45* LD(LDH)-356* AlkPhos-62
TotBili-1.0
[**2101-3-14**] 08:45AM BLOOD TotBili-0.9 DirBili-0.3 IndBili-0.6
[**2101-3-12**] 02:37AM BLOOD Calcium-8.8 Phos-3.1 Mg-1.9
[**2101-3-14**] 08:45AM BLOOD Hapto-323*
[**2101-3-11**] 11:00AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2101-3-11**] 11:06AM BLOOD Lactate-3.3*
[**2101-3-11**] 10:35AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.5 Leuks-NEG
[**2101-3-11**] 10:35AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.008
[**2101-3-13**] 10:28PM URINE RBC-25* WBC-3 Bacteri-FEW Yeast-NONE
Epi-0

Cultures:
[**2101-3-16**] STOOL CLOSTRIDIUM DIFFICILE TOXIN A & B
NEGATIVE
[**2101-3-15**] BLOOD CULTURE Blood Culture,
Routine-PRELIMINARY {STAPHYLOCOCCUS, COAGULASE NEGATIVE};
Anaerobic Bottle Gram Stain-FINAL INPATIENT
[**2101-3-15**] BLOOD CULTURE Blood Culture, NEGATIVE
[**2101-3-14**] BLOOD CULTURE Blood Culture, NEGATIVE
[**2101-3-14**] BLOOD CULTURE Blood Culture, NEGATIVE
[**2101-3-13**] URINE URINE CULTURE-FINAL NEGATIVE
[**2101-3-12**] URINE URINE CULTURE-FINAL NEGATIVE
[**2101-3-11**] BLOOD CULTURE Blood Culture, NEGATIVE
[**2101-3-11**] BLOOD CULTURE Blood Culture, NEGATIVE
[**2101-3-11**] URINE URINE CULTURE- NEGATIVE

REPORTS:
EKG Sinus rhythm. Mild non-specific inferior T wave
abnormalities, likely
not clinically significant. No previous tracing available for
comparison.
Rate PR QRS QT/QTc P QRS T
83 168 80 [**Telephone/Fax (2) 110201**] 16

Hip Film: No evidence of right hip fracture.

NCHCT [**2101-3-11**]: Large intraparenchymal hemorrhage extending
into the left lateral
ventricle with surrounding edema appears to be slightly
increased in size with probable new component at its posterior
aspect and interval extension of hemorrhage into the right
lateral ventricle. Stable ventricular size.  Evidence of prior
bilateral infarcts.

Portable Abdomen Film: The patient has received a Dobbhoff
catheter. The course of the catheter appears normal, the tip of
the catheter is not visible on the image.  No pneumothorax.
Normal size of the cardiac silhouette.

Chest Film [**2101-3-12**]: Normal appearance of the lung parenchyma.
Borderline size of the cardiac silhouette without pulmonary
edema. Normal course of the nasogastric tube, the tip of the
Dobbhoff catheter projects over the middle parts of the stomach.
No evidence of complications.

NCHCT [**2101-3-12**]: Compared to the most recent study from [**3-11**]
at 1237H, there is interval increase in the amount of
intraventricular hemorrhage and increase of the right parietal
subarachnoid hemorrhage, and compared to the study from [**3-11**]
at 0719H, there is interval increased size of the right
frontoparietal parenchymal hemorrhage and surrounding edema.

Shoulder Film: The periarticular soft tissues are unremarkable,
no pathological calcifications. The cortical surfaces are
intact, there is no evidence of cortical disruption suggesting
fracture. No dislocation.

Chest [**2101-3-14**]: Mild, but worsening heart failure. Pneumonia is
less likely.



Brief Hospital Course:
Ms. [**Known lastname **] was admitted initially to the Neurointensive care unit
for the management of her relatively large left sided
intraparenchymal hemorrhage. She remained hemodynamically stable
and neurologically stable while in the ICU, and given this, she
was transferred to the floor.

While on the floor (Step-down unit), the patient unfortunately
developed several complications. She developed fevers and
hypoxia with a new RML infiltrate, for which she was initiated
on vancomycin/ciprofloxacin/clindamycin therapy. She developed
atrial fibrillation with a very rapid ventricular response
(130-160s), for which she was initiated on scheduled diltiazem
therapy and required frequent IV boluses of diltiazem. In the
setting of these metabolic disturbances, her mental status
worsened to the point where she was not able to follow commands
reliably and remained stuporous for most of the day. She failed
her swallow evaluation on two successive occasions and remained
dependent on her NG tube for delivering enteral medications and
nutrition.

We discussed her case with her family on numerous occasions, who
all were in agreement that [**Known firstname **] would not want her life to be
artificially continued in this way. She had already previously
signed a DNR/DNI authorization and had previously expressed
wishes that she not receive a PEG or feeding tube. Ultimately,
the decision was made to switch over to comfort care measures in
conjunction with both health care proxies (her long time friend
[**Name (NI) **] [**Name (NI) 1007**] and her son [**Name (NI) **] [**Name (NI) **]). Her antibiotics and
cardioactive medications were discontinued and she was started
on a morphine drip. She passed away peacefully on the morning of
[**2101-3-18**]. All necessary paperwork was completed and the
family was informed.


Medications on Admission:
atenolol 50 mg [**Hospital1 **]
hydralazine 10 mg PO QID
ofloxacin eye drops OS [**Hospital1 **]


Discharge Medications:
N/a Deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
Large feft intraparenchymal hemorrhage with ventricular
extension
Hypertension
History of prior strokes

Discharge Condition:
N/a Deceased

Discharge Instructions:
N/a Deceased

Followup Instructions:
N/a Deceased

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2101-3-18**]
{'Intracerebral hemorrhage,Pneumonitis due to inhalation of food or vomitus,Other amyloidosis,Atrial fibrillation,Flaccid hemiplegia and hemiparesis affecting nondominant side,Other fluid overload,Aphasia,Unspecified essential hypertension,Do not resuscitate status,Unspecified cerebrovascular disease,Late effects of cerebrovascular disease, fluency disorder,Profound impairment, one eye, impairment level not further specified,Personal history of venous thrombosis and embolism'}


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: Found down in bathroom

PRESENT ILLNESS: Ms. [**Known lastname **] is a 80 yo LHW with history of 2 prior strokes who
presents with intraparechymal and intraventricular hemorrhage
after being found down in bathroom this morning.
The patient is currently living in a nursing home after recent
discharge from [**Hospital1 **] [**Hospital3 **] Rehab via [**Hospital3 **] Hospital,
where she was admitted 2 months ago for a stroke. Her recent
baseline is ambulatory with walker without assistance, mild word
finding difficulty, otherwise no residual deficits. Her friend
and son think she was at her baseline yesterday, both spoke with
her and she was laughing and making full sentences
appropriately.
Her son does mention she expressed the wish to join her deceased
husband and daughter, so he was worried about depression.
The rehab staff heard a thud at 5:30 am and found patient on
floor in bathroom, jumbled up with her walker. Her eyes were
open
and she followed commands, but her speech was garbled
and she was weak on the right side.
She was brought to [**Hospital3 **] first, NIHSS 21, BP 175/63.
She
was awake, following commands, with R sided weakness, verbal
output mostly incomprehensible except for her name and yes/no to
some questions. Head CT showed approx 5.5 x 2.5 cm left parietal
hemorrhage with some intraventricular extension. Patient was
then
transferred to [**Hospital1 18**].
In [**Hospital1 18**] ED, patient did not require any antihypertensives, she
remained with SBP 150-160s. Her mental status and exam remained
stable through her stay in the ED. She slept for some time but
was awake with eyes open when examiner entered the room. She did
vomit once, bright yellow bile, and did not cough or desat. She
received antiemetics for this. Hip X-ray was done for complaint
of hip pain, but showed no fracture or dislocation.

MEDICAL HISTORY: - 2 prior strokes, 12 years ago p/w R weakness that completely
recovered, 2 months ago p/w aphasia which recovered except for
word finding difficulties, family unclear of stroke etiology or
what was done for treatment, not on ASA per paperwork we have
here
- HTN
- cataract surgery (L) done week before her stroke
- legally blind in R eye
- ?venous thrombosis (seen in OSH list of ICD9 codes but family
not aware of this)

MEDICATION ON ADMISSION: atenolol 50 mg [**Hospital1 **]
hydralazine 10 mg PO QID
ofloxacin eye drops OS [**Hospital1 **]

ALLERGIES: hydrochlorothiazide / Penicillins / Sulfa(Sulfonamide
Antibiotics) / Macrolide Antibiotics

PHYSICAL EXAM: On Admission:
VS T 96.8  HR 87   BP 150s-180s/60-70s  RR 18   02 99/RA
GEN: eyes open, awake, regards examiner. NAD. In C-collar.
HEENT: R eye closed at baseline, scarred over, no pupillary
response.
CV: RRR, no m/r/g
PULM: CTAB anteriorly
AB: NT/ND soft
EXT: no edema

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: was living independently at home until stroke 2 months ago,
now residing in nursing home ([**Hospital3 **] rehab in [**Location (un) 10072**]).
Widowed few years ago. Has 1 adopted son who lives in FL. Her
adopted daughter was killed by drunk driver in her 20s. Patient
was a talented singer and pianist. No tobacco, EtoH. 

### Response:
{'Intracerebral hemorrhage,Pneumonitis due to inhalation of food or vomitus,Other amyloidosis,Atrial fibrillation,Flaccid hemiplegia and hemiparesis affecting nondominant side,Other fluid overload,Aphasia,Unspecified essential hypertension,Do not resuscitate status,Unspecified cerebrovascular disease,Late effects of cerebrovascular disease, fluency disorder,Profound impairment, one eye, impairment level not further specified,Personal history of venous thrombosis and embolism'}
