CHIEF COMPLAINT: L frontal hemorrhage

PRESENT ILLNESS: 75yo with hx of HTN, DM, breast CA, prior TIA was in USOH
last PM unitl approx 19:00 when, while watching TV with her
husband, she was noted to be "sleepy". Approx 30 minutes later,
she lost bladder then bowel continence and was brought to OSH by

MEDICAL HISTORY: DMII
HTN
Breast CA, s/p mastectomy [**2-8**]
TIA [**2105**]
Carotid stenosis

MEDICATION ON ADMISSION: Avandia 8 qd
Glipizide 10 qd
Lasix 20qd
Norvasc 5 qd
Plavix 75qd
Meclizine 12.5qd
Metformin 1000 qd
Protonix 40qd
Tamoxifen 10 qd
Vicodin 1 tab qd

ALLERGIES: Aspirin

PHYSICAL EXAM: Exam on admission
General: intubated, partially sedated
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no LAD, no carotid bruits, no thyromegaly
CV: RRR s1s2 no m/r/g
Resp: CTAB no r/w/r
Abd: +BS Soft/NT/ND no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: lives at home with husband, no kids or family nearby. two
sisters in [**Name2 (NI) **]
Intracerebral hemorrhage,Methicillin susceptible pneumonia due to Staphylococcus aureus,Hyposmolality and/or hyponatremia,Other convulsions,Compression of brain,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hemiplegia, unspecified, affecting unspecified side,Encounter for palliative care,Anemia, unspecified,Edema of larynx,Unspecified circulatory system disorder
Intracerebral hemorrhage,Meth sus pneum d/t Staph,Hyposmolality,Convulsions NEC,Compression of brain,Hypertension NOS,DMII wo cmp nt st uncntr,Unsp hemiplga unspf side,Encountr palliative care,Anemia NOS,Edema of larynx,Circulatory disease NOS
Admission Date:  [**2121-12-20**]              Discharge Date:   [**2122-1-3**]

Date of Birth:  [**2046-8-24**]             Sex:   F

Service: NEUROLOGY

Allergies:
Aspirin

Attending:[**First Name3 (LF) 6075**]
Chief Complaint:
L frontal hemorrhage

Major Surgical or Invasive Procedure:
none

History of Present Illness:
75yo with hx of HTN, DM, breast CA, prior TIA was in USOH
last PM unitl approx 19:00 when, while watching TV with her
husband, she was noted to be "sleepy". Approx 30 minutes later,
she lost bladder then bowel continence and was brought to OSH by

approx 21:15. CT head done at 22:30 showed large left anterior
frontal hemorrhage with extension into the ventricle, plus
midline shift. Arrangements were made for tranport to [**Hospital1 18**]. Pt
went from GCS 14 to 8 by time of arrival to [**Hospital1 18**]. Pt intubated
on arrival for airway protection. Of note, Pt reportedly with R
hemiparesis per EMS and ED staff prior to intubation.


Past Medical History:
DMII
HTN
Breast CA, s/p mastectomy [**2-8**]
TIA [**2105**]
Carotid stenosis


Social History:
lives at home with husband, no kids or family nearby. two
sisters in [**Name2 (NI) **]

Family History:
noncontributory

Physical Exam:
Exam on admission
General: intubated, partially sedated
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no LAD, no carotid bruits, no thyromegaly
CV: RRR s1s2 no m/r/g
Resp: CTAB no r/w/r
Abd: +BS Soft/NT/ND no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

MS: intubated, sedated, though with some purposeful movements-
reaching towards ETT
CN: I - not tested, II,III - PERRL; III,IV,VI - no
oculocephalic;
V- no corneal reflexes; VII - facial strength and symmetry
difficult to assess;IX,X - appearing to gag on ETT
Motor: nl bulk and tone, no tremor, rigidity or bradykinesia.
Appears to be moving all 4 est though L>R; withdraws to ungula
pressure in all 4 ext.
DTRs: [**Name2 (NI) **] (C56) BR (C6) Tri (C7) Pa (L34) Ac (S12) Plantar
L 2 2 2 2 2 down
R 2 2 2 2 2 up
Sensory: w/d to ungual pressure in all 4 ext.


Pertinent Results:
Admission: CT head: large L anterior frontal hemorrhage
extending into the
lateral ventricle; midline shift apparent.


Brief Hospital Course:
Pt was admitted to the neurosurgical service and then
transferred to the neurology service on HD 3 because of the lack
of any possible interventions for the patient.

Her hospital course by system:

Neuro: Pt was started on dilantin. She was weaned off all
sedating meds but continued to have significantly depressed
mental status, only posturing to deep stimulation. An EEG was
performed on [**9-24**] that showed diffuse slowing with no
epileptiform activity. LFT's and ammnonia were also checked and
were normal.  Her exam remained essentially unchanged during her
course.

CV: Pt initially on labetolol drop which was weaned [**12-30**], after
which she was given PRN hydralazine and lopressor for any
Systolic BP's greater than 160.  She remained stable on these
medications for the remainder of her course

RESP: Pt was dependent on mechanical ventilation throughout her
course. She did develop a ventilator associated pneumonia for
which she was treated with vancomycin and zosyn.

ID: Pt began to be febrile on [**12-20**], cultures from [**12-21**] and
[**12-23**] positive. Sputum positive for coag + staph and klebsiella,
urine positive for coag - staph and enterococcus. She was
started on vancomycin and zosyn. [**12-27**] follow up cultures showed
negative urine but sputum positive for staph aureus.
Antibiotics continued throughout her course. Her fever curve
improved over the course of her stay.

FEN/GI: Pt started on NG tube feeds of promote w/ fiber that she
tolerated well. She did have some hypernatremia that was
addressed by increased free water boluses and decreasing
infusions of IV NS.  She was continued on protonix during her
stay.

ENDO: Pt was on an insulin sliding scale with stable d sticks
throughout course.

DISPO: Multiple discussions with pt's husband were held
regarding her neurologic status and poor prognosis. He seemed to
understand her situation but was very reluctant to make her CMO.
Family meeting held again on [**1-2**] and the decision was made to
make her CMO on [**1-2**] afternoon. She was extubated at that time.
 Time of death: 4:13pm on [**2122-1-3**].  Husband was present.
Denied autopsy.

Medications on Admission:
Avandia 8 qd
Glipizide 10 qd
Lasix 20qd
Norvasc 5 qd
Plavix 75qd
Meclizine 12.5qd
Metformin 1000 qd
Protonix 40qd
Tamoxifen 10 qd
Vicodin 1 tab qd


Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
stroke

Discharge Condition:
deceased

Discharge Instructions:
deceased

Followup Instructions:
deceased
{'Intracerebral hemorrhage,Methicillin susceptible pneumonia due to Staphylococcus aureus,Hyposmolality and/or hyponatremia,Other convulsions,Compression of brain,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hemiplegia, unspecified, affecting unspecified side,Encounter for palliative care,Anemia, unspecified,Edema of larynx,Unspecified circulatory system disorder'}


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: L frontal hemorrhage

PRESENT ILLNESS: 75yo with hx of HTN, DM, breast CA, prior TIA was in USOH
last PM unitl approx 19:00 when, while watching TV with her
husband, she was noted to be "sleepy". Approx 30 minutes later,
she lost bladder then bowel continence and was brought to OSH by

MEDICAL HISTORY: DMII
HTN
Breast CA, s/p mastectomy [**2-8**]
TIA [**2105**]
Carotid stenosis

MEDICATION ON ADMISSION: Avandia 8 qd
Glipizide 10 qd
Lasix 20qd
Norvasc 5 qd
Plavix 75qd
Meclizine 12.5qd
Metformin 1000 qd
Protonix 40qd
Tamoxifen 10 qd
Vicodin 1 tab qd

ALLERGIES: Aspirin

PHYSICAL EXAM: Exam on admission
General: intubated, partially sedated
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no LAD, no carotid bruits, no thyromegaly
CV: RRR s1s2 no m/r/g
Resp: CTAB no r/w/r
Abd: +BS Soft/NT/ND no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: lives at home with husband, no kids or family nearby. two
sisters in [**Name2 (NI) **] 

### Response:
{'Intracerebral hemorrhage,Methicillin susceptible pneumonia due to Staphylococcus aureus,Hyposmolality and/or hyponatremia,Other convulsions,Compression of brain,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Hemiplegia, unspecified, affecting unspecified side,Encounter for palliative care,Anemia, unspecified,Edema of larynx,Unspecified circulatory system disorder'}
