CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64-year-old
female with a history of diabetes and hypertension.  She was
recently worked up for headache, neck pain, and vision loss.
The patient then had a fall down the stairs with no loss of
consciousness of head injury.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage,Hematoma complicating a procedure,Congestive heart failure, unspecified,Communicating hydrocephalus,Compression of brain,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Subarachnoid hemorrhage,Hematoma complic proc,CHF NOS,Communicat hydrocephalus,Compression of brain,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2195-11-22**]       Discharge Date:  [**2196-1-13**]

Date of Birth:   [**2131-6-28**]       Sex:  F

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  The patient is a 64-year-old
female with a history of diabetes and hypertension.  She was
recently worked up for headache, neck pain, and vision loss.
The patient then had a fall down the stairs with no loss of
consciousness of head injury.

The patient was brought into to the Emergency Department by
ambulance.  She denied chest pain, shortness of breath, or a
family history of stroke or aneurysm.

CONCISE SUMMARY OF HOSPITAL COURSE:  On physical examination,
the patient's temperature was 97.8 degrees Fahrenheit, her
heart rate was 67, her blood pressure was 159/66, and her
oxygen saturation was 100% on a nonrebreather mask.  The
patient was alert and confused.  Not following commands.  She
was moving all four extremities spontaneously to pain.  She
opened her eyes.  Her face was symmetric.

The patient did deteriorate shortly after admission.  A head
computed tomography showed a large subarachnoid hemorrhage
(left greater than right).  She had a vent drain placed on
admission to the Intensive Care Unit.  She was emergently
intubated.  Her blood pressure was kept below 130.  She had a
computed tomography angiogram which showed a left middle
cerebral artery aneurysm which was unable to be coiled.

The patient was taken to the operating room for aneurysm
clipping on [**2195-11-23**].  Preoperatively her exam was
significant for right dense hemiparesis and she was able to
follow commands. She tolerated the procedure well.
Postoperatively, the patient was moving her left side
spontaneously, leg more than the arm.  The right side was
hemiplegic.  The pupils were equal, round, and reactive to
light.  She moved the left side to command on the 11th and
withdrew her lower extremities briskly (right upper).  She
had slight internal rotation to painful stimulation.  She was
continued on a vent drain and to be intubated.

On the 12th, the patient went to angiogram to assess
placement of the clip which was in good placement, and there
was no evidence of vasospasm.  The patient continued to be
maintained with every 1-hour neurologic checks in the
Intensive Care Unit with a vent drain in place.

On the 13th, she was squeezing the left hand to command and
wiggling her toes to command.  No movement on the right side.
Slight internal rotation of the right upper extremity to
pain.

A computed tomography scan on [**2195-11-27**] showed no
change.  The patient continued to be monitored with every
1-hour neurologic checks in the Intensive Care Unit.

On the [**2195-11-30**] HHH therapy was initiated to prevent
vasospasm.  The patient opened her eyes and squeezed her hand
on the left.  The right upper extremity was plegic.  She
withdrew her lower extremity.  Vent drain remained at 10 cm
above the tragus.  She spiked a temperature to 102.4 on the
18th and was treated with Levaquin prophylactically and
continued to be on Kefzol for vent drain prophylaxis.

She was extubated on [**2195-12-2**].  The patient failed
extubation and was re-intubated on the 20th.  She was opening
her eyes and squeezing the left hand to voice.  She was
following commands and was wiggling toes on the left side
with a right facial grimace and minimal withdrawal on the
right upper extremity.

A head computed tomography showed stable left frontotemporal
and parietal hematoma, decreased midline shift, decreased
[**Doctor Last Name 352**]/white differentiation, and question of a left
frontotemporal infarction.

On the 25th, the patient turned her head to stimulation and
attempted to localize in the left upper.  Minimal internal
rotation of the right arm.  Slight withdrawal in the right
lower extremity.  Pupils were 3 mm and trace reactive.  The
patient continued to be maintained with HHH therapy with
boluses intermittently intravenous fluids to keep her
pressure at 160 to 180.

On [**12-8**], the patient's neurologic status deteriorated.
She became more lethargic and was not moving her left upper
extremity or lower extremity.  She was taken for a STAT head
computed tomography and emergent angiogram.

A head computed tomography on [**12-9**] showed severe mass
effect with left hemispheric, left-to-right shift and subfalcine
herniation. Computed tomography and angiogram showed a large
amount of swelling.  The patient was receiving mannitol and
Decadron.

On [**2195-12-9**] the patient was taken to the operating
room for a craniectomy on the left side due to edema.  The
patient tolerated the procedure well.  Postoperatively, the
patient was intubated and sedated.  She was opening her eyes
to noxious stimulation, localizing in the left upper,
withdrawing bilateral lower extremity.  Pupils were 4 mm down
to 3 mm.  The vent drain continued to be in place at a level
of 10 cm above the tragus.

The patient had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 1661**]-[**Location (un) 1662**] drain in place which was
discontinued on [**2195-12-12**].  She was localizing in the
left upper extremity and opening her eyes to stimulation.
Pupils were equal and brisk.  She was moving her toes (left
greater than right).

On [**12-15**], the patient was opening her eyes
spontaneously.  She was turning her head toward the examiner.
The right upper extremity continued to have slight internal
rotation, briskly localizing on the left.  She was
withdrawing her toes.  She moved the left spontaneously with
minimal withdrawal to pain.  Her bran flap was flat and soft.
She continued with her vent drain in place.  She was set up
for trach and percutaneous endoscopic gastrostomy tube which
was done.

The patient received trach and percutaneous endoscopic
gastrostomy tube on [**2195-12-16**].  The patient tolerated
the procedure well.  She continued to be neurologically
unchanged.

A head computed tomography on [**12-18**] showed no
hydrocephalus.  Continued mass effect from swelling.  The
patient continued to have vent drain in place.  The
craniectomy site was flat.  The patient did not follow
commands but was awake and attentive.  Briskly localizing in
the left upper extremity.  Minimal internal rotation of the
right upper extremity on the 7th.

A computed tomography on [**12-21**] showed an increase in
ventricle size with hydrocephalus.  The drain was put back
down to 8; had been at 12.  The patient was opening her eyes
and attentive.  She was purposeful on the left upper
extremity.  She was not following commands.  The patient
remained monoplegic in the right upper extremity.

The patient went into congestive heart failure on the 14th;
diagnosed by x-ray.

On [**2195-12-29**] the patient went to the operating room
for bone flap replacement.  The patient tolerated the
procedure well.  She was turning her head toward the
examiner.  She continued to have a right facial grimace and
internal rotation of the right upper extremity to pain.  The
patient's blood pressure was controlled to 130 to 150.  She
had a stable blood gas.  The vent drain remained at 10 cm
above the tragus.

Her neurologic status remained stable, and she was taken back
to the operating room on [**1-5**] for a right occipital
ventriculoperitoneal shunt placement.  The patient tolerated
that procedure well as well.  The patient was monitored in
the Intensive Care Unit for 24 hours and was then transferred
to the regular floor on [**1-6**].  She remained
neurologically the same.  She was awake and attentive.  She
was moving the left side to command.  She was wiggling her
toes to command with a right upper extremity plegia.  The
patient was made do not resuscitate/do not intubate by the
family in case of any untold events but continued to receive
full care.  She was awake and attentive.  She was squeezing
the left hand and wiggling her toes.

DISCHARGE DISPOSITION:  She was transferred to the regular
floor.  She was seen by Physical Therapy and Occupational
Therapy.  She was found to require acute rehabilitation.  Her
incisions were clean, dry, and intact.  Her staples were
removed from her shunt on [**2196-1-15**].  Her craniectomy
incision was clean, dry, and intact.  Her staples had been
removed.  She was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 1132**] in one
month for a repeat head computed tomography.

MEDICATIONS ON DISCHARGE:  (Her medications at the time of
discharge included)
 1.  Heparin 5000 units subcutaneously q.12h.
 2.  Hydralazine 50 mg by mouth four times per day.
 3.  Captopril 50 mg by mouth three times per day (hold for a
systolic blood pressure of less than 110).
 4.  Dilantin 250 mg three times per day.
 5.  Cefepime 1 g intravenously q.12h. (for 10 days).
 6.  Metoprolol 150 mg by mouth three times per day.
 7.  Miconazole powder 2% four times per day as needed.
 8.  Ipratropium one inhaler q.6h.
 9.  Albuterol 1 nebulizer q.6h.
10.  Nystatin suspension four times per day as needed.
11.  Colace 100 mg by mouth twice per day.
12.  Dulcolax 10 mg per rectum at hour of sleep as needed.
13.  Senna one tablet by mouth twice per day as needed.
14.  Lansoprazole 30 mg per percutaneous endoscopic
gastrostomy tube once per day.
15.  Tylenol 650 mg per percutaneous endoscopic gastrostomy
tube q.4h. as needed.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was stable.






                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2196-1-12**]  10:15
T:  [**2196-1-12**]  10:34
JOB#:  [**Job Number 100703**]


Name:  [**Known lastname 11160**], [**Known firstname 16051**] A                   Unit No:  [**Numeric Identifier 16052**]

Admission Date:  [**2168-3-14**]     Discharge Date:  [**2196-1-15**]

Date of Birth:   [**2131-6-28**]     Sex:  F

Service:

ADDENDUM:  Mrs.[**Doctor Last Name 16053**] discharge was delayed until [**2196-1-15**]
due to lack of rehab beds.  Her condition remains unchanged.
She is neurologically stable with follow up with Dr. [**Last Name (STitle) 365**] in
three to four weeks time.





                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 5862**]

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2196-1-15**]  09:35
T:  [**2196-1-15**]  09:11
JOB#:  [**Job Number 16054**]


Name:  [**Known lastname 11160**], [**Known firstname 16051**] A                   Unit No:  [**Numeric Identifier 16052**]

Admission Date:  [**2168-3-14**]     Discharge Date:  [**2196-1-15**]

Date of Birth:   [**2131-6-28**]     Sex:  F

Service:

ADDENDUM:  Mrs.[**Doctor Last Name 16053**] discharge was delayed until [**2196-1-15**]
due to lack of rehab beds.  Her condition remains unchanged.
She is neurologically stable with follow up with Dr. [**Last Name (STitle) 365**] in
three to four weeks time.





                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 5862**]

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2196-1-15**]  09:35
T:  [**2196-1-15**]  09:11
JOB#:  [**Job Number 16177**]
{'Subarachnoid hemorrhage,Hematoma complicating a procedure,Congestive heart failure, unspecified,Communicating hydrocephalus,Compression of brain,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: 

PRESENT ILLNESS: The patient is a 64-year-old
female with a history of diabetes and hypertension.  She was
recently worked up for headache, neck pain, and vision loss.
The patient then had a fall down the stairs with no loss of
consciousness of head injury.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage,Hematoma complicating a procedure,Congestive heart failure, unspecified,Communicating hydrocephalus,Compression of brain,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
