CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 49F was at home, had had a couple beers when developed severe
sudden onset headache.  Went to OSH where CT showed CT with SAH.
Neuro intact.  Transferred [**Hospital1 18**] ED for further management.

MEDICAL HISTORY: depression, inc cholesterol

MEDICATION ON ADMISSION: toprimate 100hs, sertraline 150 qday, ranitidine 150 qday,
valium 10 prn, gabapentin 100 [**Hospital1 **], cipro 500 [**Hospital1 **], seroquel 200
qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
O: T:98.4  BP: 138/76         HR:86        O2Sats 97 2l
Gen: WD/WN, NAD but eyes closed with cold cloth on head.
HEENT: Pupils: [**4-7**]        EOMs full
Neck: Supple.minimal pain with flex/ex
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: n/a

SOCIAL HISTORY: Etoh
Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Alcohol withdrawal,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Other and unspecified alcohol dependence, unspecified,Anxiety state, unspecified
Subarachnoid hemorrhage,Crbl art ocl NOS w infrc,Alcohol withdrawal,Depressive disorder NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Esophageal reflux,Alcoh dep NEC/NOS-unspec,Anxiety state NOS
Admission Date:  [**2161-6-23**]              Discharge Date:   [**2161-7-2**]

Date of Birth:  [**2111-6-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
[**2161-6-24**]: Cerebral Angiogram with coiling of left PComm Artery
Aneurysm


History of Present Illness:
49F was at home, had had a couple beers when developed severe
sudden onset headache.  Went to OSH where CT showed CT with SAH.
Neuro intact.  Transferred [**Hospital1 18**] ED for further management.

Past Medical History:
depression, inc cholesterol

Social History:
Etoh

Family History:
n/a

Physical Exam:
PHYSICAL EXAM:
O: T:98.4  BP: 138/76         HR:86        O2Sats 97 2l
Gen: WD/WN, NAD but eyes closed with cold cloth on head.
HEENT: Pupils: [**4-7**]        EOMs full
Neck: Supple.minimal pain with flex/ex
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 5 to 4
mm bilaterally. 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 [**4-8**] throughout. No pronator drift

Sensation: Intact to light touch bilaterally.

Toes downgoing bilaterally

Coordination: normal

PHYSICAL EXAM UPON DISCHARGE *******

Pertinent Results:
ADMISSION LABS:

[**2161-6-22**] 11:00PM   WBC-16.6*# RBC-4.46 HGB-13.5 HCT-40.2 MCV-90
MCH-30.4 MCHC-33.7 RDW-14.1
[**2161-6-22**] 11:00PM   PT-12.3 PTT-27.5 INR(PT)-1.0
[**2161-6-22**] 11:00PM   GLUCOSE-167* UREA N-22* CREAT-0.7 SODIUM-139
POTASSIUM-3.9 CHLORIDE-110* TOTAL CO2-18* ANION GAP-15
[**2161-6-23**] 03:42AM   PHENYTOIN-14.8

IMAGING:
CTA Neck [**6-23**]:
extensive SAH centered at the left aspect of the suprasellar
cistern.
7mm x 7 mm lobulated aneurysm at the junction of the left MCA
and carotid
artery.

[**2161-6-26**] Head CT: IMPRESSION:
1. New area of hypoattenuation in the left parietal lobe s/p
aneurysm
coiling, suspicious for acute infarction.
2. Small amount of residual subarachnoid hemorrhage.

[**2161-6-30**] Head CTA: IMPRESSION: 1. No significant change in the
hypodense area in the left parietal lobe at the vertex compared
to the recent study of [**6-26**], though it is new compared to [**6-24**]
and may represent a focus of infarction.
2. Short segment areas of stenosis, in the left posterior
cerebral artery -P2 segment, may be real/related to adjacent
artifacts from the coils. Short segment narrowing of the distal
Basilar artery is likely related o artifacts.  Atherosclerotic
calcified and non-calcified plaques in the cavernous segments on
both sides with some degree of stenosis.
Otherwise, no flow-limiting stenosis or occlusion of the major
arteries noted.

[**Date range (1) 59214**] EEG: IMPRESSION: This is a normal video EEG telemetry
in the awake and drowsy states. There was no organized
epileptiform activity or
electrographic seizures.




Brief Hospital Course:
The patient was admitted to the Surgical ICU for Q1 neuro checks
and tight blood pressure control. She was placed on nimodipine
for vasospasm prophylaxis, and dilantin for seizures. A repeat
CTA was performed, which demonstrated a 7x7mm lobular aneurysm
at the junction of the L carotid/MCA.

She was taken to the angio suite on [**6-23**] and underwent coiling
of the P Comm Artery aneurysm. Procedure was without
complication but due to a small coil protrusion in the parent
artery, she was left on a heparin drip overnight. Patient
returned to the ICU for close neurological monitoring.
The following morning the heparin was discontinued and EEG
monitoring was initiated per protocol. She was also started on a
prednisone taper for additional pain control.
On [**6-25**] dilantin level was reloaded. On [**6-26**] a CT was performed
at the discretion of the ICU team for continued headaches. This
revealed a small left parietal infarction. The patient remained
neurologically stable and asymptomatic, but hypertension and
hypervolemia were initiated.
From [**6-27**] through [**6-30**] the patient remained neurologically
intact in the ICU. Pain medications were changed frequently in
attempt to reach an acceptable comfort level. On [**6-30**] the
patient was cleared for discharge to the floor. Her IVF was
halfed to 100ml/hr. EEG monitoring was discontinued and she was
encouraged to be out of bed.
On [**7-1**] A CTA was obtained to assess for vasospasm and was
negative.
IVF was discontinued.
On [**7-2**] the patient was ambulating independently and tolerating
a PO diet. H/A was stable and current pain regimen is tolerable.
Pt was cleared for discharge home at this time.

Medications on Admission:
toprimate 100hs, sertraline 150 qday, ranitidine 150 qday,
valium 10 prn, gabapentin 100 [**Hospital1 **], cipro 500 [**Hospital1 **], seroquel 200
qhs


Discharge Medications:
1. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 13 days.
Disp:*156 Capsule(s)* Refills:*0*
2. Sertraline 50 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily). Tablet(s)
3. Quetiapine 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day).

6. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**12-6**]
Tablets PO Q4H (every 4 hours) as needed for pain: Alternate
with Florinal to decrease tylenol intake.
Disp:*60 Tablet(s)* Refills:*0*
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Butalbital-Aspirin-Caffeine 50-325-40 mg Capsule Sig: [**12-6**]
Caps PO Q4H (every 4 hours) as needed for h/a: Alternate with
Florinal to decrease tylenol intake.
Disp:*60 Cap(s)* Refills:*0*
10. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Aneurysmal Subarachnoid Hemorrhage


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


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


Followup Instructions:
You need to follow up with Dr. [**First Name (STitle) **] in 1 month. You will need
an MRI/MRA of your head before this appointment. Please call
Takesia at [**Telephone/Fax (1) 1669**] to schedule this.



Completed by:[**2161-7-2**]
{'Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Alcohol withdrawal,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Other and unspecified alcohol dependence, unspecified,Anxiety state, unspecified'}


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: Headache

PRESENT ILLNESS: 49F was at home, had had a couple beers when developed severe
sudden onset headache.  Went to OSH where CT showed CT with SAH.
Neuro intact.  Transferred [**Hospital1 18**] ED for further management.

MEDICAL HISTORY: depression, inc cholesterol

MEDICATION ON ADMISSION: toprimate 100hs, sertraline 150 qday, ranitidine 150 qday,
valium 10 prn, gabapentin 100 [**Hospital1 **], cipro 500 [**Hospital1 **], seroquel 200
qhs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
O: T:98.4  BP: 138/76         HR:86        O2Sats 97 2l
Gen: WD/WN, NAD but eyes closed with cold cloth on head.
HEENT: Pupils: [**4-7**]        EOMs full
Neck: Supple.minimal pain with flex/ex
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: n/a

SOCIAL HISTORY: Etoh 

### Response:
{'Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Alcohol withdrawal,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Esophageal reflux,Other and unspecified alcohol dependence, unspecified,Anxiety state, unspecified'}
