CHIEF COMPLAINT: Headache and unsteady gait.

PRESENT ILLNESS: Patient is a 75 year old right handed man with a history of
prostate cancer who presents with headaches since Monday,
lethargy since Tuesday and unsteady gait. According to his wife
[**Name (NI) **] and his son [**Name (NI) **] who were with him in the ER, he has been
progressively getting worse. Today, his PCP had organized an MRI
of his brain at [**Hospital 246**] Hospital, which showed a right
intraparenchymal hemorrhage, so he was sent in for further
evaluation. Of note the patient takes ASA 81 mg at home, and he
has had some higher SBP readings at home and in the doctor's
office.

MEDICAL HISTORY: 1. HTN
2. Prostate cancer - transrectal ultrasound-guided biopsy on [**7-6**], [**2164**], revealing [**3-30**] cores positive for [**Doctor Last Name **] 3+3=6
disease with up to 40% of core length involved - there is a
question of starting brachytherapy
3. GERD
4. OSA on BiPAP
5. fungal infection on the toe nails

MEDICATION ON ADMISSION: ASA 81mg daily
MVI daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T-98.8 HR-74 BP-180/80 RR-16 SpO2-99%

FAMILY HISTORY: He reports a family history of oral cancer in his father
diagnosed at the age of 70.

SOCIAL HISTORY: He is married and has two grown children.  He retired ten years
ago after working as an electrical engineer. He never smoked and
only rarely drinks alcohol. He has never used recreational
drugs. His wife who has breast ca is his HCP, her name is [**Name (NI) **]
cell: [**Telephone/Fax (1) 53150**].
Intracerebral hemorrhage,Compression of brain,Muscle weakness (generalized),Facial weakness,Other speech disturbance,Malignant neoplasm of prostate,Unspecified essential hypertension,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)
Intracerebral hemorrhage,Compression of brain,Muscle weakness-general,Facial weakness,Speech disturbance NEC,Malign neopl prostate,Hypertension NOS,Esophageal reflux,Obstructive sleep apnea
Admission Date:  [**2164-12-21**]              Discharge Date:   [**2164-12-25**]

Date of Birth:  [**2089-8-4**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Headache and unsteady gait.

Major Surgical or Invasive Procedure:
None.

History of Present Illness:
Patient is a 75 year old right handed man with a history of
prostate cancer who presents with headaches since Monday,
lethargy since Tuesday and unsteady gait. According to his wife
[**Name (NI) **] and his son [**Name (NI) **] who were with him in the ER, he has been
progressively getting worse. Today, his PCP had organized an MRI
of his brain at [**Hospital 246**] Hospital, which showed a right
intraparenchymal hemorrhage, so he was sent in for further
evaluation. Of note the patient takes ASA 81 mg at home, and he
has had some higher SBP readings at home and in the doctor's
office.

The headache started on Monday night, it came on gradually [**11-25**]
intensity, and has been constant since then. When the patient
was requested to localize the headache, he stated that it was
"all over my head", and then he pointed to his forehead on the
left and right. He said that coughing exacerbated the headache,
however, positional factors did not change the character of the
headache. On Monday night when the headache started, his wife
gave him a total of 4 baby aspirins (2 and then another 2, 4h
later). He normally never gets headaches. He has managed to
sleep through the pain. Both the patient's wife and his son
mentioned that the patient is not as sharp as he normally is,
and has been lethargic since Tuesday. In the ER, he continued to
have a [**11-25**] headache, so he was given morphine prior to the
neurology consult, and he was placed on a labetalol drip as his
systolic BPs kept going as high as the 200 mmHg range.

ROS: the patient and the patient's family, have not noticed any
weakness such as hemiparetic symptoms, word finding
difficulties, seizures, dysphagia, nausea, vomiting,
photophobia, tinnitus, phonophobia, dyspnea, although he does
have a cough, no palpitations, no chest pain, no abdominal pain
or dysuria.

Past Medical History:
1. HTN
2. Prostate cancer - transrectal ultrasound-guided biopsy on [**7-6**], [**2164**], revealing [**3-30**] cores positive for [**Doctor Last Name **] 3+3=6
disease with up to 40% of core length involved - there is a
question of starting brachytherapy
3. GERD
4. OSA on BiPAP
5. fungal infection on the toe nails


Social History:
He is married and has two grown children.  He retired ten years
ago after working as an electrical engineer. He never smoked and
only rarely drinks alcohol. He has never used recreational
drugs. His wife who has breast ca is his HCP, her name is [**Name (NI) **]
cell: [**Telephone/Fax (1) 53150**].

Family History:
He reports a family history of oral cancer in his father
diagnosed at the age of 70.

Physical Exam:
T-98.8 HR-74 BP-180/80 RR-16 SpO2-99%

Gen: Lying in bed, no bruising noted over the head
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
Abd: +BS, soft, nontender
Ext: No edema

Neurologic examination:
Mental status:
General:  alert, awake, lethargic (received morphine)
Orientation:  oriented to person, place, but not date, keeps
saying 11, 11, 11.
Attention:Able to go backwards with DOW until Tuesday, then
keeps
on repeating Tuesday, and falling asleep

Executivefunction:
*Follows simple axial and appendicular commands: closes and
opens
his eyes, shows me his tongue.

Memory:
*Cannot register [**4-18**], therefore recall not checked.

Speech/Language: Extremely hypophonic but non-dysarthric speech.
Fluent w/o paraphasic (phonemic or semantic) errors;
comprehension, repetition, naming (high frequency objects):
normal. He found low frequency words difficult, but according to
his son, this may be his baseline because his main language in
Armenian. Prosody: normal. Able to read.

Cranial Nerves:
II: Pupils 2 mm bilaterally but reactive. Visual fields are full
to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V1-3: Sensation intact V1-V3.
VII: Mild L facial droop with slightly large palpebral fissure
on the L.
VIII: Hearing intact to finger rub bilaterally.
IX & X: Palate elevation symmetric. Uvula is midline. Gives a
good cough.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius full strength bilaterally.

XII: Good bulk. No fasciculations. Tongue midline, movements
intact.

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor
His left arm drifts down slightly with possible pronation. He
appears to have full strength in his arms and legs - possible 4s
in FEs but bilateral.

Sensation: Intact to light touch. No extinction to DSS. Rest of
the exam not attempted due to inattention

Reflexes:
2 and symmetric throughout. Toes downgoing bilaterally

Coordination: finger-nose-finger normal, heel to shin normal,
RAMs slower with the left hand than the right.

Gait: Wide-based and unsteady.

Pertinent Results:
[**2164-12-23**] 02:37AM BLOOD WBC-12.3* RBC-4.55* Hgb-13.2* Hct-38.3*
MCV-84 MCH-29.1 MCHC-34.5 RDW-13.2 Plt Ct-215
[**2164-12-21**] 03:15PM BLOOD Neuts-77.8* Lymphs-14.8* Monos-6.0
Eos-0.9 Baso-0.5
[**2164-12-23**] 02:37AM BLOOD PT-13.5* PTT-25.7 INR(PT)-1.2*
[**2164-12-20**] 04:15PM BLOOD ESR-17*
[**2164-12-23**] 02:37AM BLOOD Glucose-101* UreaN-23* Creat-1.1 Na-136
K-3.7 Cl-104 HCO3-23 AnGap-13
[**2164-12-22**] 02:12AM BLOOD ALT-20 AST-25 AlkPhos-74
[**2164-12-23**] 02:37AM BLOOD Calcium-8.5 Phos-3.7 Mg-2.0

EKG
Sinus rhythm. Leftward axis. Voltage criteria for left
ventricular
hypertrophy. No previous tracing available for comparison.
Rate PR QRS QT/QTc P QRS T
74 194 86 366/390 31 -26 21

CT head and CTA neck [**2164-12-21**]
CT head demonstrates right basal ganglia hemorrhage with
extension to the lateral ventricles without hydrocephalus. CT
angiography of the head and neck are normal.

CXR
Cardiac size is top normal. The aorta is tortuous. The right
hilum is prominent. This finding should be evaluated with a
regular PA and lateral views of the chest when possible to
exclude hilar or lung abnormality.  Otherwise, the lungs are
clear. There is no pneumothorax or pleural effusion.

Repeat NCHCT [**2164-12-22**]
Similar appearance of right basal ganglia hemorrhage with
intraventricular extension, but increased lateral ventricle
caliber as compared to eight hours ago, suggestive of a
developing mild hydrocephalus.

MRI Head (with and without contrast:
1. Somewhat limited study due to motion. Right-sided basal
ganglia hemorrhage identified with surrounding edema and
extension to the ventricle.
2. There is some enhancement surrounding the hematoma on the
post gadolinium images.


Brief Hospital Course:
Patient is a 75yo RHM with a h/o HTN, OSA on BiPAP and prostate
cancer hx on ASA daily who started to have a HA that was
refractory to Tylenol.  He had no prior hx of headaches and he
also felt more fatigued.  He denied any other associated
symptoms but given the worsening headache, he went to an outside
hospital where he was found to have R IPH hence transferred here
for further care.

There is no report of any trauma but he does report that he has
had elevated BP in the past but has been under good control for
the past few years.  He was hypertensive in the ED.  Given the
hemorrhage, he was initially admitted to the ICU but given
stable imaging and exam, he was transferred to the floor.

He underwent repeat head CT and MRI with and without contrast to
further evaluate for possible underlying pathology.  However,
there was no evidence of tumor or aneurysm/AVM.  Given the
location and the risk factors (hypertension), this was felt to
be likely hypertensive in etiology.

Patient's exam is reassuring.  He has extremely hypophonic
speech with some L facial droop and possible, mild L arm
weakness.  He still suffers from HA that is mostly frontal.
Most likely secondary to hemorrhage but may be exacerbated by
the fact that he was not using BiPAP during this admission.

1. R caudate hemorrhage - likely hypertensive in origin.  BP
control and HCTZ started during this admission.  Will need
follow-up with PCP once discharged from rehab and [**First Name8 (NamePattern2) **] [**Last Name (un) 6550**] 2nd
[**Doctor Last Name 360**] such as ACEI if BP not well controlled.  We have
discontinued to ASA 81mg daily during this admission and we do
not recommend restarting the ASA.

2. OSA - patient needs to use BiPAP at bedtime.

Patient has follow-up appointments scheduled with both Dr.
[**First Name8 (NamePattern2) 2530**] [**Name (STitle) **] (neurologist who oversaw his care during this
admission) and Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] who follows up with him for his
sleep apnea.  Patient needs to schedule follow-up with Dr.
[**Last Name (STitle) 838**] as outpatient once discharged from the rehab facility.

Medications on Admission:
ASA 81mg daily
MVI daily

Discharge Medications:
1. multivitamin with minerals     Capsule Sig: One (1) Capsule
PO once a day.
2. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

Discharge Diagnosis:
Primary
Intracerebral hemorrhage likely due to hypertension

Secondary
Ostructive Sleep Apnea

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.  Very soft speech
with mild L facial droop and slight L arm weakness.  Complains
of bifrontal headache which is likely multifactorial including
not being on BiPAP during this admission and the brain
hemorrhage.

Discharge Instructions:
You came to the hospital after bleeding in your brain. You were
admitted to the hospital for evaluation of the cause and
management of this intracerebral hemorrhage. We think that your
bleed was a consequence of mild hypertension and aging of small
vessels of your brain given that no underlying lesion was noted
on MRI scan of your brain. It will be important to have this
imaging repeated in about six weeks to evaluate this further.

You were started on hydrochlorothiazide for blood pressure
control.  You will need close follow-up with your blood pressure
and likely titration of this med and possible addition of
another medication (i.e. ACE inhibitor) if needed.

Please be sure to use BiPAP at bedtime for your sleep apnea.

Followup Instructions:
Please follow-up with your medical care providers as scheduled
below.  Additionally, please scheduled follow-up with Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 838**] for follow-up within two weeks of discharge from the
rehab:

Dr. [**First Name (STitle) **] was the neurologist/attending you oversaw your care
during this admission:
Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 2574**]
Date/Time:[**2165-1-15**] 8:00
[**Hospital Ward Name 23**] Building, [**Location (un) **]

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6855**], M.D. Phone:[**Telephone/Fax (1) 6856**]
Date/Time:[**2165-11-18**] 9:00

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]

Completed by:[**2164-12-25**]
{'Intracerebral hemorrhage,Compression of brain,Muscle weakness (generalized),Facial weakness,Other speech disturbance,Malignant neoplasm of prostate,Unspecified essential hypertension,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)'}


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 and unsteady gait.

PRESENT ILLNESS: Patient is a 75 year old right handed man with a history of
prostate cancer who presents with headaches since Monday,
lethargy since Tuesday and unsteady gait. According to his wife
[**Name (NI) **] and his son [**Name (NI) **] who were with him in the ER, he has been
progressively getting worse. Today, his PCP had organized an MRI
of his brain at [**Hospital 246**] Hospital, which showed a right
intraparenchymal hemorrhage, so he was sent in for further
evaluation. Of note the patient takes ASA 81 mg at home, and he
has had some higher SBP readings at home and in the doctor's
office.

MEDICAL HISTORY: 1. HTN
2. Prostate cancer - transrectal ultrasound-guided biopsy on [**7-6**], [**2164**], revealing [**3-30**] cores positive for [**Doctor Last Name **] 3+3=6
disease with up to 40% of core length involved - there is a
question of starting brachytherapy
3. GERD
4. OSA on BiPAP
5. fungal infection on the toe nails

MEDICATION ON ADMISSION: ASA 81mg daily
MVI daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T-98.8 HR-74 BP-180/80 RR-16 SpO2-99%

FAMILY HISTORY: He reports a family history of oral cancer in his father
diagnosed at the age of 70.

SOCIAL HISTORY: He is married and has two grown children.  He retired ten years
ago after working as an electrical engineer. He never smoked and
only rarely drinks alcohol. He has never used recreational
drugs. His wife who has breast ca is his HCP, her name is [**Name (NI) **]
cell: [**Telephone/Fax (1) 53150**]. 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Muscle weakness (generalized),Facial weakness,Other speech disturbance,Malignant neoplasm of prostate,Unspecified essential hypertension,Esophageal reflux,Obstructive sleep apnea (adult)(pediatric)'}
