CHIEF COMPLAINT: Headache and vomiting

PRESENT ILLNESS: 38 y/o female with no past medical history, was showering
this morning and developed a sudden sharp headache in the
occipital area which radiated down her neck. Her husband was
home
and helped out of the shower and she began to vomit. They then
called EMS. She was transferred to [**Hospital 8**] Hospital and was
found to have a SAH.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]:  Grade 3 (drowsy)  [**Doctor Last Name **]: 3  GCS  E: 2     V:5
Motor 6
O: T:  BP:101/53     HR: 78   R   16    O2Sats 95%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**1-23**]        EOMs full
Neck: pain with flexion

FAMILY HISTORY: NC

SOCIAL HISTORY: Married and lives with husband. Non [**Name2 (NI) 1818**]
Subarachnoid hemorrhage
Subarachnoid hemorrhage
Admission Date:  [**2165-4-9**]              Discharge Date:   [**2165-4-17**]

Date of Birth:  [**2126-6-7**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
Diagnostic Cerebral angiogram [**4-10**]


History of Present Illness:
38 y/o female with no past medical history, was showering
this morning and developed a sudden sharp headache in the
occipital area which radiated down her neck. Her husband was
home
and helped out of the shower and she began to vomit. They then
called EMS. She was transferred to [**Hospital 8**] Hospital and was
found to have a SAH.


Past Medical History:
None

Social History:
Married and lives with husband. Non [**Name2 (NI) 1818**]

Family History:
NC

Physical Exam:
Hunt and [**Doctor Last Name 9381**]:  Grade 3 (drowsy)  [**Doctor Last Name **]: 3  GCS  E: 2     V:5
Motor 6
O: T:  BP:101/53     HR: 78   R   16    O2Sats 95%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**1-23**]        EOMs full
Neck: pain with flexion

Neuro:
Mental status: Drowsy opens eyes to loud voice or physical
stimualtion. Orientated X 3, cooperative with exam

Orientation: Oriented to person, place, and date.
Recall: [**1-24**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.
Recall 2 out of 3 objects in 5 minutes

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2
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 finger rub bilaterally.
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 [**3-28**] throughout. No pronator drift

Sensation: Intact to light touch

Reflexes: B T Br Pa Ac
Right               2+
Left                2+

Toes downgoing bilaterally

Handedness Right

Exam: Nonfocal, no drift, AAOx 3
pleasant and cooperative
RRR, S1 s2 nl
CTAB, no w/c/r
abd: soft, nt/nd
Extr: no c/c/e


Pertinent Results:
CTA Head and neck [**4-9**]
Subarachnoid hemorrhage within the posterior suprasellar,
interpeduncular and prepontine cisterns. No evidence of an
intracranial
aneurysm. Conventional angiography is recommended.
While non-aneurysmal perimesencephalic subarachnoid hemorrhage
is a diagnosis of exclusion, the distribution of the
subarachnoid hemorrhage in this patient would be compatible with
non-aneurysmal perimesencephalic subarachnoid hemorrhage, if
conventional angiography does not reveal a vascular lesion.

[**4-10**] Angio- IMPRESSION: [**Known firstname **] [**Known lastname 76327**] underwent cerebral
angiography which was extensive to delineate a source of her
subarachnoid hemorrhage. No aneurysms, AVM, AV fistula or
vasculitis was identified.

[**4-16**] CTA Head IMPRESSION: 1. No evidence of an aneurysm greater
than 2 mm or arteriovenous malformation within the intracranial
arteries. nonaneurysmal perimesencephalic subarachnoid
hemorrhage is a diagnosis of exclusion, but should be considered
as a diagnostic possibility, in light of a negative conventional
angiogram on [**2165-4-10**].
2. Interval resolution of subarachnoid hemorrhage. No new
intracranial
hemorrhage.

[**4-16**] MRI C & T Spine: . No evidence of a vascular malformation
in the cervical or thoracic spine.

2. Mild degenerative changes at C2-3 and C3-4.

3. Diffusely abnormal bone marrow signal could be due to red
marrow
reconversion in the setting of anemia, chronic systemic illness,
or smoking.
However, an infiltrative disorder cannot be excluded. Recommend
correlation
with clinical history and laboratory data.

4. 2.3 cm left thyroid nodule. Recommend ultrasound, if not
performed
previously.


Brief Hospital Course:
Ms. [**Known lastname 76327**] was admitted under the care of the neurosurgery
service to the SICU for further care and treatment of her SAH.
She was kept NPO on the evening of [**4-9**] with a plan for cerebral
angiogram on [**4-10**]. Her angiogram proved to be negative for
aneurysm and she was transferred back to the ICU and continued
on nimodipine and IVF with vasospasm watch. She continued to do
well and only complained of headache. Twice she had some vague
complaints of lef arm pain with the headaches but his was
imprved with pain medications. She was tried on ultram on [**4-13**]
as the patient felt that the oxycodone and fioricet made her
nauseous. She was started on a 3 day course of prednisone for
headache control on [**4-14**] with good effect. On [**4-15**] she was
cleared for transfer to the step down unit. On [**4-16**] she remained
neurologically stable and underwent a CTA and MRI of her
cervical and thoracic spines to rule out source of hemorrhage
which was essentially negative.

She was evaluated by Pt and was cleared for home.  Now dod, she
is afebriel, VSS, and neuro stable.  She is tolerating oral diet
and voiding spontaneously.  She is set for d/c home and will f/u
accordingly.

Medications on Admission:
None

Discharge Medications:
1. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: One
(1) Tablet PO Q4H (every 4 hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
2. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
4. [**First Name5 (NamePattern1) **]     [**Last Name (NamePattern1) 12106**] Sig: One (1) use as needed when walking
Miscellaneous once a day.
Disp:*1 1* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Non aneursymal Subarachnoid Hemorrhage
headache


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.


Discharge Instructions:
??????	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:
Follow up in 4 weeks with Dr [**First Name (STitle) **] call [**Telephone/Fax (1) 1669**] for an
appointment.

Please follow up with your Primary care [**Provider Number 76328**] weeks upon
discharge from the hospital.



Completed by:[**2165-4-17**]
{'Subarachnoid hemorrhage'}


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 vomiting

PRESENT ILLNESS: 38 y/o female with no past medical history, was showering
this morning and developed a sudden sharp headache in the
occipital area which radiated down her neck. Her husband was
home
and helped out of the shower and she began to vomit. They then
called EMS. She was transferred to [**Hospital 8**] Hospital and was
found to have a SAH.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]:  Grade 3 (drowsy)  [**Doctor Last Name **]: 3  GCS  E: 2     V:5
Motor 6
O: T:  BP:101/53     HR: 78   R   16    O2Sats 95%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**1-23**]        EOMs full
Neck: pain with flexion

FAMILY HISTORY: NC

SOCIAL HISTORY: Married and lives with husband. Non [**Name2 (NI) 1818**] 

### Response:
{'Subarachnoid hemorrhage'}
