CHIEF COMPLAINT: Sudden onset severe headache

PRESENT ILLNESS: 74F spanish speaking, with HTN, experienced sudden onset severe
HA on [**2168-4-26**] in R temporal region, but also with some neck
discomfort. No trauma.  Pt apparently had not taken any BP meds
that day.  EMS called and initial SBP 220-248.  Pt brought to
[**Hospital1 18**] where Pt alert and neurologically intact by report. Placed
on Nitroprusside and labetalol gtt.  CT revealed SAH in basal
cisterns B/L.  CTA performed revealed no obvious aneurysm.

MEDICAL HISTORY: 1. DM
2. HTN

MEDICATION ON ADMISSION: Synthroid 200mcg daily
Lipitor 80mg daily
Zetia 10mg daily
Labetolol 200mg daily
Citalopram 20mg daily
Meclizine 25mg daily
Enalapril 20mg daily
Tizanidine 2mg
Insulin Lente 35-40units twice daily
ASA 81mg daily
Folic Acid 800mg daily
MVI daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afeb bp130/70 (on admission 220-248/90-119) hr60-80  rr20-22
General: WNWD
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no carotid bruits
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: non-contribuitory

SOCIAL HISTORY: resides at home with daughters, denies tobacco use
Subarachnoid hemorrhage,Communicating hydrocephalus,Unspecified transient cerebral ischemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Acute conjunctivitis, unspecified,Retention of urine, unspecified,Hypopotassemia
Subarachnoid hemorrhage,Communicat hydrocephalus,Trans cereb ischemia NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Acute conjunctivitis NOS,Retention urine NOS,Hypopotassemia
Admission Date:  [**2168-4-26**]              Discharge Date:   [**2168-5-6**]

Date of Birth:  [**2094-1-3**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Sudden onset severe headache

Major Surgical or Invasive Procedure:
[**4-26**]: Cerebral Angiogram
[**5-4**]: Placement of VP shunt


History of Present Illness:
74F spanish speaking, with HTN, experienced sudden onset severe
HA on [**2168-4-26**] in R temporal region, but also with some neck
discomfort. No trauma.  Pt apparently had not taken any BP meds
that day.  EMS called and initial SBP 220-248.  Pt brought to
[**Hospital1 18**] where Pt alert and neurologically intact by report. Placed
on Nitroprusside and labetalol gtt.  CT revealed SAH in basal
cisterns B/L.  CTA performed revealed no obvious aneurysm.

Past Medical History:
1. DM
2. HTN


Social History:
resides at home with daughters, denies tobacco use

Family History:
non-contribuitory

Physical Exam:
VS: afeb bp130/70 (on admission 220-248/90-119) hr60-80  rr20-22
General: WNWD
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no carotid bruits
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: A&O x 3, interactive, appropriate, following all commands
CN: I ?????? not tested, II,III ?????? PERRL (3-2mm OU), VFF by threat;
III,IV,VI ?????? EOMI, no ptosis, no nystagmus; V- sensation intact
to LT; VII ?????? R facial weakness/asymmetry; VIII ?????? hears finger
rub
B; IX,X ?????? palate elevates symmetrically; [**Doctor First Name 81**] ?????? SCM/Trapezii [**4-25**]
B;
XII ?????? tongue protrudes midline, no atrophy or fasciculations
Motor: nl bulk and tone, no tremor, rigidity or bradykinesia. No

pronator drift. Full power throughout UE and LE.
DTRs: [**Name2 (NI) **] (C56) BR (C6) Tri (C7) Pa (L34) Ac (S12) Plantar
L 2 2 1 1 1 mute
R 2 2 1 1 1 mute
Sensory: w/d to pinch throughout.
Coord: finger tap rapid & symm, F??????N & FNF intact B.
Gait: deferred

Pertinent Results:
[**2168-5-5**] 06:38AM BLOOD WBC-15.9* RBC-3.22* Hgb-9.8* Hct-29.7*
MCV-92 MCH-30.3 MCHC-32.8 RDW-13.4 Plt Ct-454*
[**2168-5-2**] 02:47AM BLOOD Neuts-69.3 Lymphs-23.4 Monos-6.4 Eos-0.7
Baso-0.2
[**2168-5-5**] 06:38AM BLOOD Glucose-171* UreaN-13 Creat-0.6 Na-133
K-3.5 Cl-99 HCO3-21* AnGap-17
[**2168-5-5**] 06:38AM BLOOD Calcium-8.5 Phos-2.8 Mg-2.1
[**2168-5-1**] 03:14AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.016
[**2168-5-1**] 03:14AM URINE Blood-TR Nitrite-NEG Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG

URINE CULTURE (Final [**2168-5-2**]):    NO GROWTH.

Blood Culture, Routine (Final [**2168-5-6**]):    NO GROWTH.

GRAM STAIN (Final [**2168-5-1**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
   FLUID CULTURE (Preliminary):    NO GROWTH.

[**2168-5-1**] 12:55 pm BLOOD CULTURE      Source: Venipuncture.
   Blood Culture, Routine (Pending):

GRAM STAIN (Final [**2168-5-4**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
   FLUID CULTURE (Preliminary):    NO GROWTH.

CTA HEAD W&W/O C & RECONS  [**2168-4-25**] 9:52 PM
1. 2-mm outpouching, from the posterolateral aspect of
paraclinoid portion of the cavernous segment of the left
internal carotid artery, seen on the thick section MIP
reformations can represent a tiny aneurysm.
2. Focal prominence at the termination of the left supraclinoid
internal carotid artery likely represents tortuosity, as this is
not confirmed on multiple planes.
3. Atherosclerotic disease involving the cavernous internal
carotid arteries on both sides.
4. Extensive subarachnoid hemorrhage with small amount of
intraventricular component, as described above, without shift of
the midline structures or intraparenchymal hemorrhage.

CT HEAD W/O CONTRAST  [**2168-4-26**] 3:21 AM
Similar appearance of subarachnoid hemorrhage, now with a small
amount of intraventricular blood in the occipital [**Doctor Last Name 534**] of the
left lateral ventricle.

CT HEAD W/O CONTRAST  [**2168-4-26**] 9:56 AM
There is interval placement of the intraventricular drain, with
tip in the region of the right foramen of [**Last Name (un) 2044**]. Interval
development of small amount of blood in the body of the right
lateral ventricle without significant change in the extent of
subarachnoid hemorrhage as well as small amount of blood in the
left lateral ventricle.

CTA HEAD W&W/O C & RECONS  [**2168-4-28**] 2:16 PM
1. Improvement in ventricular size following change in position
of the ventricular drain.
2. Subarachnoid hemorrhage.
3. No evidence of vasospasm or aneurysm identified on CT
angiography.

CT HEAD W/O CONTRAST  [**2168-4-30**] 11:27 AM
1. No significant change in the subarachnoid hemorrhage and
dependent layering blood within the lateral ventricles.
2. Slight increase in size of the ventricular system from [**2168-4-28**].

CAROT/CEREB [**Hospital1 **]  [**2168-5-3**] 10:53 AM
1. Severe vasospasm of the right A1 segment of the anterior
cerebral artery.
2. Moderate vasospasm of the left P1 segment of the posterior
cerebral artery.
3. No aneurysms or arteriovenous malformations.
4. Treatment of vasospasm with Verapamil.

CT HEAD W/O CONTRAST  [**2168-5-4**] 12:00 PM
1. Interval decrease in subarachnoid hemorrhage and hemorrhage
within the basal cisterns.
2. No change in the ventricular system compared to [**2168-4-30**].

CT HEAD W/O CONTRAST  [**2168-5-4**] 4:52 PM
1. Unchanged appearance of subarachnoid hemorrhage in the sulci
and basal cisterns since the prior study five hours ago.
2. Unchanged ventricular system compared to the [**2168-4-30**].

Brief Hospital Course:
Patient admitted to [**Hospital1 18**] from OSH for definitive treatment of a
SAH. On transfer her BP was quite elevated and initial
management began in the ED with labetalol and Nipride. She was
admitted to the ICU for close mental status monitoring and blood
pressure management. She was also started on Nimodipine. She was
taken for angiogram on [**4-26**] which was negative for aneurysm or
vascular malformation. On [**4-26**], she also became more lethargic
than her initial presentation. An EVD was placed by Dr. [**First Name (STitle) **]
in the ICU, and mental status significantly improved. On [**4-27**]
erythromycin was started for conjunctivitis. CTA on [**4-28**] revealed
no evidence of vasospasm or aneurysm. The patient failed an EVD
clamping trial on [**4-29**]. On [**4-30**] the patient was found to be more
lethargic and was febrile to 102.8, blood culture at this time
was negative; repeat CT scan demonstrated slightly increased
ventricular size. On [**5-1**] the patient was started on a dilantin
to Keppra transition. CSF analysis revealed 4+ PMNs without
microorganisms, culture revealed no growth. On [**5-2**] the patient
failed a second EVD clamping trial, and again failed a third EVD
clamping trial on [**5-3**]. On [**5-3**] the patient again underwent
angiogram which demonstrated severe vasospasm of the right ACA,
moderate vasospasm of the left PCA, and no aneurysms or AVMs.
Verapamil was administered for treatment of the vasospasm. Due
to multiple failed EVD clamping trials, the patient was taken to
the OR for VP shunt placement on [**5-4**]. CSF analysis from [**5-4**]
revealed 1+ PMNs and was negative for microorganisms, culture at
time of discharge is pending but has had no growth to date. The
patient's Foley catheter was reinserted on [**5-5**] secondary to
inability to void. The patient was evaluated by physical therapy
and determined to be appropriate for rehabilitation. The patient
was discharged to rehabilitation on [**5-6**] in stable condition.

Medications on Admission:
Synthroid 200mcg daily
Lipitor 80mg daily
Zetia 10mg daily
Labetolol 200mg daily
Citalopram 20mg daily
Meclizine 25mg daily
Enalapril 20mg daily
Tizanidine 2mg
Insulin Lente 35-40units twice daily
ASA 81mg daily
Folic Acid 800mg daily
MVI daily

Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever, pain.
3. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours): discontinue on [**5-16**](completion of 21 day course).
4. Levothyroxine 100 mcg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Diphenhydramine HCl 12.5 mg/5 mL Elixir Sig: One (1)  PO Q6H
(every 6 hours) as needed.
10. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**12-23**]
Tablets PO Q6H (every 6 hours) as needed for headache.
11. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4-6H () as
needed.
12. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
13. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
14. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
15. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

16. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
17. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
18. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

19. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Subarachnoid hemorrhage


Discharge Condition:
stable


Discharge Instructions:
General Instructions

??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	You may wash your hair only after sutures and/or staples have
been removed.
??????	You may shower before this time using a shower cap to cover
your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in 10 days for removal of your
staples or sutures.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast.
{'Subarachnoid hemorrhage,Communicating hydrocephalus,Unspecified transient cerebral ischemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Acute conjunctivitis, unspecified,Retention of urine, unspecified,Hypopotassemia'}


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: Sudden onset severe headache

PRESENT ILLNESS: 74F spanish speaking, with HTN, experienced sudden onset severe
HA on [**2168-4-26**] in R temporal region, but also with some neck
discomfort. No trauma.  Pt apparently had not taken any BP meds
that day.  EMS called and initial SBP 220-248.  Pt brought to
[**Hospital1 18**] where Pt alert and neurologically intact by report. Placed
on Nitroprusside and labetalol gtt.  CT revealed SAH in basal
cisterns B/L.  CTA performed revealed no obvious aneurysm.

MEDICAL HISTORY: 1. DM
2. HTN

MEDICATION ON ADMISSION: Synthroid 200mcg daily
Lipitor 80mg daily
Zetia 10mg daily
Labetolol 200mg daily
Citalopram 20mg daily
Meclizine 25mg daily
Enalapril 20mg daily
Tizanidine 2mg
Insulin Lente 35-40units twice daily
ASA 81mg daily
Folic Acid 800mg daily
MVI daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: afeb bp130/70 (on admission 220-248/90-119) hr60-80  rr20-22
General: WNWD
HEENT: Anicteric, MMM without lesions, OP clear
Neck: Supple, no carotid bruits
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: non-contribuitory

SOCIAL HISTORY: resides at home with daughters, denies tobacco use 

### Response:
{'Subarachnoid hemorrhage,Communicating hydrocephalus,Unspecified transient cerebral ischemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Acute conjunctivitis, unspecified,Retention of urine, unspecified,Hypopotassemia'}
