CHIEF COMPLAINT: Unresponsiveness

PRESENT ILLNESS: HPI: The pt is a 65 year-old right-handed male, w/ hx of
hypertension, dyslipidemia, DM, who presents with an acute
episode of altered mental status earlier this morning. According
to his wife, pt woke up at 6:30am and began to complain of eye
pain and became very pale, then began vomiting multiple times.
He
appeared to have fallen asleep and later became unresponsive &
unarousable. EMS found the patient unresponsive. He was brought
to OSH where he was rapidly intubated and sedated. He was
transferred to [**Hospital1 18**] after he had a HCT that was notable for
intraventricular hemorrhage in all 4 ventricles and a cerebellar
bleed. Following his arrival at [**Hospital1 18**] he was given verced and
fentanyl. No active seizures noted. Neurosurger was consulted
and
determined no further management. Neurology was being consulted
for further evaluation.

MEDICAL HISTORY: - Colonic CA (dx [**2146**]) underwent chemotheraphy. Later dx with
liver CA ([**2150**]). Considered treated.
- HTN, dyslipidemia, DM

MEDICATION ON ADMISSION: - metformin 850mg tid
- ASA 81mg qd
- lovastatin 20mg qd
- metoprolol ER 75mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:112/65 P:50 R: BP: SaO2:
General: Intubated, sedated.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: - non contributory

SOCIAL HISTORY: - lives with wife and 2 sons
Intracerebral hemorrhage,Compression of brain,Obstructive hydrocephalus,Malignant neoplasm of other specified sites of large intestine,Malignant neoplasm of liver, secondary,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Intracerebral hemorrhage,Compression of brain,Obstructiv hydrocephalus,Malignant neo colon NEC,Second malig neo liver,Hyperlipidemia NEC/NOS,Hypertension NOS,DMII wo cmp nt st uncntr
Admission Date:  [**2155-3-16**]              Discharge Date:   [**2155-3-16**]

Date of Birth:  [**2089-11-25**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Unresponsiveness

Major Surgical or Invasive Procedure:
None

History of Present Illness:
HPI: The pt is a 65 year-old right-handed male, w/ hx of
hypertension, dyslipidemia, DM, who presents with an acute
episode of altered mental status earlier this morning. According
to his wife, pt woke up at 6:30am and began to complain of eye
pain and became very pale, then began vomiting multiple times.
He
appeared to have fallen asleep and later became unresponsive &
unarousable. EMS found the patient unresponsive. He was brought
to OSH where he was rapidly intubated and sedated. He was
transferred to [**Hospital1 18**] after he had a HCT that was notable for
intraventricular hemorrhage in all 4 ventricles and a cerebellar
bleed. Following his arrival at [**Hospital1 18**] he was given verced and
fentanyl. No active seizures noted. Neurosurger was consulted
and
determined no further management. Neurology was being consulted
for further evaluation.

His wife denies any recent illness, trauma, fall or c/o
headache,
N/V, bowel or bladder changes. He went to bed last night with no
complaints or difficulty.


Past Medical History:
- Colonic CA (dx [**2146**]) underwent chemotheraphy. Later dx with
liver CA ([**2150**]). Considered treated.
- HTN, dyslipidemia, DM


Social History:
- lives with wife and 2 sons


Family History:
- non contributory


Physical Exam:
Vitals: T:112/65 P:50 R: BP: SaO2:
General: Intubated, sedated.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
- Mental Status: Sedated, intubated, no response to verbal,
tactile or noxious stimuli.
- Cranial Nerves: Olfaction not tested. Pupils 2mm
fixed,non-reactive. Conjugated gaze, (-) VOR, (-) corneal
reflex,
(-) gag reflex. No facial droop.
- Motor: Normal bulk, increase tone throughout. No spontaneous
movements.
- Sensory: No response to deep pressure or noxious stimuli
throughout.
- Reflex: 2 UE bilateral; 1+ LE bilateral
Plantar response was extensor bilaterally.
- Coordination & Gait:unable to assess


Pertinent Results:
Admission Labs:

137 | 106 | 14
---------------< 176
4.2 |  20 | 0.8

      13.4
7.6 >------< 181
      39.0

Ca: 7.5 Mg: 1.3 PO4: 2.5

Imaging:

Head CT
FINDINGS: There is marked intraventricular hemorrhage involving
the entire
ventricular system. There is moderate-to-severe hydrocephalus.
There is no
shift of normally midline structures, although there is
transtentorial
herniation into the foramen magnum, stable. There is no definite

intraparenchymal hemorrhage or extra-axial fluid collection.
There appears to
be mild diffuse cerebral edema. The sulci are effaced at the
level of the
lateral ventricles. There is no evidence of acute fracture.
Patchy opacity
in the bilateral ethmoid air cells are noted.

IMPRESSION: Severe intraventricular hemorrhage with
hydrocephalus and
transtentorial herniation as described above. This is not
significantly
changed when compared to prior exam.

CXR

FINDINGS: A single AP portable upright view of the chest was
obtained.
Endotracheal tube terminates approximately 3.5 cm above the
carina. The
cardiomediastinal silhouette is normal in appearance. There is
evidence of
volume loss in the right hemithorax with an elevated right
hemidiaphragm and a
sharply defined opacity in the right upper lobe consistent with
right upper
lobe collapse. The left lung is clear. A PICC line terminates at
the
cavoatrial junction. No acute osseous abnormalities are
identified. Multiple
foreign bodies, possibly surgical clips, project over the right
upper
quadrant, and are apparently new compared to the prior study.

IMPRESSION:
1. Endotracheal tube terminating 3.5 cm above the carina.
2. Right upper lobe collapse, new compared to prior study dated
[**2155-3-16**]
at 8:20 a.m. from an outside hospital.


Brief Hospital Course:
65 year-old right-handed male, w/ hx of hypertension,
dyslipidemia, DM, who presents with an acute episode of altered
mental status in the setting of intraventricular hemorrhage and
hydrocephalus.  Neurologic exam on admission was notable for
absent brainstem functions.  He was evaluated by Neurosurgery,
who did not recommend further intervention.  Given his
significantly depressed level of consciousness, he was initially
intubated for airway protection.  The team had extensive
conversation with the family regarding the patient's poor
prognosis.  He was initially admitted to the ICU on the
ventilator, however the decision was made to electively extubate
him and make him CMO.  He expired shortly following extubation.

Medications on Admission:
- metformin 850mg tid
- ASA 81mg qd
- lovastatin 20mg qd
- metoprolol ER 75mg qd


Discharge Medications:
None - expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Hemorrhagic stroke with intraventricular extension

Discharge Condition:
Expired

Discharge Instructions:
None

Followup Instructions:
None

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Intracerebral hemorrhage,Compression of brain,Obstructive hydrocephalus,Malignant neoplasm of other specified sites of large intestine,Malignant neoplasm of liver, secondary,Other and unspecified hyperlipidemia,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: Unresponsiveness

PRESENT ILLNESS: HPI: The pt is a 65 year-old right-handed male, w/ hx of
hypertension, dyslipidemia, DM, who presents with an acute
episode of altered mental status earlier this morning. According
to his wife, pt woke up at 6:30am and began to complain of eye
pain and became very pale, then began vomiting multiple times.
He
appeared to have fallen asleep and later became unresponsive &
unarousable. EMS found the patient unresponsive. He was brought
to OSH where he was rapidly intubated and sedated. He was
transferred to [**Hospital1 18**] after he had a HCT that was notable for
intraventricular hemorrhage in all 4 ventricles and a cerebellar
bleed. Following his arrival at [**Hospital1 18**] he was given verced and
fentanyl. No active seizures noted. Neurosurger was consulted
and
determined no further management. Neurology was being consulted
for further evaluation.

MEDICAL HISTORY: - Colonic CA (dx [**2146**]) underwent chemotheraphy. Later dx with
liver CA ([**2150**]). Considered treated.
- HTN, dyslipidemia, DM

MEDICATION ON ADMISSION: - metformin 850mg tid
- ASA 81mg qd
- lovastatin 20mg qd
- metoprolol ER 75mg qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:112/65 P:50 R: BP: SaO2:
General: Intubated, sedated.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: - non contributory

SOCIAL HISTORY: - lives with wife and 2 sons 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Obstructive hydrocephalus,Malignant neoplasm of other specified sites of large intestine,Malignant neoplasm of liver, secondary,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
