CHIEF COMPLAINT: ICH

PRESENT ILLNESS: 86yM with history of bilateral frontal subdural hemorrhages
who p/w with a 2 day h/o increasing confusion, hypertension, and
vomiting for 2 days. In [**Hospital1 18**] ED, CT revealed left posterior
occipital lobe hemorrhage with extention into left lateral,
third, and fourth ventricle.  The patient has been completely
uncooperative and confused since last night.

MEDICAL HISTORY: MI([**2156**])
TIA vs Stroke([**2163**])
BPH-TURP
multiple falls

MEDICATION ON ADMISSION: Zantac
lopressor
simvastatin
lisionpril
finasteride

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1, BP 170/80, HR 85 , R 18, Sat 100% at room air
Gen- Awake and alert, attentive to voice
HEENT: NCAT, OP clear, anicteric sclera
NECK: no carotid bruits bilaterally
CV: regular heart sounds, no MRG
PULM: CTA B
Abd: soft, NT, ND, BS+
Extrem: no CCE

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Originally from [**Country 532**]
Married with grown children
Former Physics Professor
Intracerebral hemorrhage,Subendocardial infarction, initial episode of care,Obstructive hydrocephalus,Pneumonia, organism unspecified,Hyperosmolality and/or hypernatremia,Right bundle branch block,Unspecified essential hypertension
Intracerebral hemorrhage,Subendo infarct, initial,Obstructiv hydrocephalus,Pneumonia, organism NOS,Hyperosmolality,Rt bundle branch block,Hypertension NOS
Admission Date:  [**2168-12-10**]              Discharge Date:   [**2168-12-22**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Extraventricular drain placement.

History of Present Illness:
86yM with history of bilateral frontal subdural hemorrhages
who p/w with a 2 day h/o increasing confusion, hypertension, and
vomiting for 2 days. In [**Hospital1 18**] ED, CT revealed left posterior
occipital lobe hemorrhage with extention into left lateral,
third, and fourth ventricle.  The patient has been completely
uncooperative and confused since last night.


Past Medical History:
MI([**2156**])
TIA vs Stroke([**2163**])
BPH-TURP
multiple falls


Social History:
Originally from [**Country 532**]
Married with grown children
Former Physics Professor


Family History:
Unknown

Physical Exam:
T 99.1, BP 170/80, HR 85 , R 18, Sat 100% at room air
Gen- Awake and alert, attentive to voice
HEENT: NCAT, OP clear, anicteric sclera
NECK: no carotid bruits bilaterally
CV: regular heart sounds, no MRG
PULM: CTA B
Abd: soft, NT, ND, BS+
Extrem: no CCE

NEUROLOGIC EXAM:

Mental Status: Alert, oriented.  Patient can only speak Russian.


Language: unable to check.
Mild dysarthria noted.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VF:Full to confrontation from the
left and not from the right
III, IV, VI: extra ocular movements: moves on his own
V: Facial sensation intact
VII: No facial droop
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally
XII: Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No pronator drift on
right.


  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  4    4    4  4    4  4  4  4   4   4  4    4     4    4
R  4    4    4  4    4  4  4  4   4   4  4    4     4    4

-Sensory: no deficits to pain at all four
-extinction not checked

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2   2   2    2   1
R  2   2   2    2   1
Plantar response was down on left and down on right

-Coordination: not checked
-Gait: not checked.


Pertinent Results:
[**2168-12-14**] 01:07PM BLOOD WBC-12.3* RBC-4.02* Hgb-13.1* Hct-38.6*
MCV-96 MCH-32.7* MCHC-34.1 RDW-13.2 Plt Ct-335
[**2168-12-14**] 01:07PM BLOOD PT-14.0* PTT-26.2 INR(PT)-1.2*
[**2168-12-14**] 01:07PM BLOOD Glucose-131* UreaN-40* Creat-1.3* Na-148*
K-4.2 Cl-114* HCO3-21* AnGap-17
[**2168-12-13**] 10:25AM BLOOD CK(CPK)-115
[**2168-12-11**] 09:00PM BLOOD CK-MB-25* MB Indx-6.5 cTropnT-0.55*
[**2168-12-12**] 01:49AM BLOOD CK-MB-29* MB Indx-6.2* cTropnT-1.20*
[**2168-12-12**] 09:56AM BLOOD CK-MB-15* MB Indx-4.4 cTropnT-0.97*
[**2168-12-12**] 06:03PM BLOOD CK-MB-9 cTropnT-1.0*
[**2168-12-13**] 10:25AM BLOOD CK-MB-5
[**2168-12-10**] 03:15PM BLOOD Calcium-9.0 Phos-2.4* Mg-1.9
[**2168-12-14**] 01:07PM BLOOD Calcium-9.2 Phos-2.0* Mg-2.5
[**2168-12-10**] 03:15PM BLOOD Phenyto-13.5
[**2168-12-14**] 02:25AM BLOOD Phenyto-13.8
[**2168-12-13**] 04:45PM URINE Blood-LG Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2168-12-13**] 04:45PM URINE RBC-[**11-29**]* WBC-0-2 Bacteri-FEW Yeast-NONE
Epi-0-2
[**2168-12-14**] 04:56AM CEREBROSPINAL FLUID (CSF) WBC-250 RBC-[**Numeric Identifier 20194**]*
Polys-88 Lymphs-2 Monos-10
[**2168-12-14**] 04:56AM CEREBROSPINAL FLUID (CSF) TotProt-228*
Glucose-98

CT-head [**2168-12-10**]
IMPRESSION: Large intraventricular hemorrhage involving the left
lateral ventricle, fourth ventricle, third ventricle, and the
left temporal [**Doctor Last Name 534**]. Subdural component layering along the left
tentorium. Given the prominence of the ventricles compared to
the previous examination, there may be a component of
obstructive hydrocephalus. Possible acute hemorrhage within the
posterior aspect of the left occipital lobe.

CT-head [**2168-12-14**]
IMPRESSION:
1. Right ventriculostomy catheter unchanged in position, with
decrease in extent of intraventricular hemorrhage.
2. Unchanged left occipital hemorrhage.

ECHO TTE [**2168-12-12**]
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is mild regional left ventricular systolic
dysfunction with inferior hypokinesis. There is no ventricular
septal defect. Right ventricular chamber size and free wall
motion are normal. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Mild (1+) aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. Trivial mitral
regurgitation is seen. The tricuspid valve leaflets are mildly
thickened. The estimated pulmonary artery systolic pressure is
normal. There is no pericardial effusion.
IMPRESSION: Regional LV systolic dysfunction c/w CAD.
EF 45%


Brief Hospital Course:
Mr. [**Known lastname 20782**] was initially admitted to the Neurosurgery service in
the ICU. His hospital course by problem is as follows:

NEURO - His calculated ICH score was [**4-15**] for age, GCS between 4
and 13, greater than 30cc and IVH.  This score portends a very
poor prognosis.  The family was made aware of this prognosis on
several occasions.  The patient's code status was made DNR/DNI
by the family.  The systolic blood pressure was maintained in
the 120-180 range.  He was treated with dilantin 100 q8h for
seizure prophylaxis, and later in his course required Ativan
additionally for L arm and leg rhythmic twitching.  Neurosurgery
placed an extraventricular drain.  Intraventricular TPA was used
to keep the ventricular system patent.  Repeat CT scan on the
5th day of admission was suggestive of improved ventricular
patency.  The patient's neurological function waxed and waned
but with no significant ability to respond to his environment.
Repeat imaging showed no improvement in his bleed. His CSF
studies were concerning for possible meningitis as there was a
dissociation between the RBC and WBC ratio. The culture was
negative. He had been initially treated with Keflex and then was
switched to Zosyn and vancomycin, however lastly was treated
briefly with meropenem and vancomycin without improvement. Given
his grim prognosis, the family decided to make him CMO. The
drain was removed and he was started on morphine, Ativan and
scopolamine.

CARDS - The patient's course was complicated by an NSTEMI - no
intervention was pursued after cardiology was asked to comment.
The patient was briefly thought to be in AFIB, but this proved
to be just RBBB with intermittent second degree AVB and frequent
APC. After he was made CMO, his family wanted to continue the
metoprolol to prevent tachycardia.

ID - During his admission, he spiked fevers. He was pan
cultured, as above, and was found to have CSF concerning for
infection as well as a PNA. He was treated with the antibiotics
as above until made CMO.

FEN - NGT placed by IR on the fourth day of admission.  TF were
initiated thereafter. The family requested to keep the TF
runting despite his CMO status.

RENAL- He developed hypernatremia while in the ICU. This was
treated with free water via TF and IVF. It was felt that he was
probably pre-renal and might have had a component of Diabetes
Insipidus. This was not explored further as he was CMO.

He was awaiting transfer to hospice but died prior to discharge.


Medications on Admission:
Zantac
lopressor
simvastatin
lisionpril
finasteride


Discharge Medications:
NA

Discharge Disposition:
Extended Care

Discharge Diagnosis:
1. Stroke, with intraventricular hemorrhage
2. Hypernatremia


Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Intracerebral hemorrhage,Subendocardial infarction, initial episode of care,Obstructive hydrocephalus,Pneumonia, organism unspecified,Hyperosmolality and/or hypernatremia,Right bundle branch block,Unspecified essential hypertension'}


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: ICH

PRESENT ILLNESS: 86yM with history of bilateral frontal subdural hemorrhages
who p/w with a 2 day h/o increasing confusion, hypertension, and
vomiting for 2 days. In [**Hospital1 18**] ED, CT revealed left posterior
occipital lobe hemorrhage with extention into left lateral,
third, and fourth ventricle.  The patient has been completely
uncooperative and confused since last night.

MEDICAL HISTORY: MI([**2156**])
TIA vs Stroke([**2163**])
BPH-TURP
multiple falls

MEDICATION ON ADMISSION: Zantac
lopressor
simvastatin
lisionpril
finasteride

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.1, BP 170/80, HR 85 , R 18, Sat 100% at room air
Gen- Awake and alert, attentive to voice
HEENT: NCAT, OP clear, anicteric sclera
NECK: no carotid bruits bilaterally
CV: regular heart sounds, no MRG
PULM: CTA B
Abd: soft, NT, ND, BS+
Extrem: no CCE

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Originally from [**Country 532**]
Married with grown children
Former Physics Professor 

### Response:
{'Intracerebral hemorrhage,Subendocardial infarction, initial episode of care,Obstructive hydrocephalus,Pneumonia, organism unspecified,Hyperosmolality and/or hypernatremia,Right bundle branch block,Unspecified essential hypertension'}
