CHIEF COMPLAINT: Syncope and headache.

PRESENT ILLNESS: Mr. [**Known lastname 94081**] is an 81-year-old
gentleman with a complicated past medical history who
presented from an outside hospital with a large subarachnoid
hemorrhage and subdural hematoma.  The patient had a headache
a syncopal event with loss of consciousness for approximately
five minutes.  He had no history of trauma.  The patient may
have hit his head with the syncopal episode.  The patient
does have mild baseline dementia which waxes and wanes.

MEDICAL HISTORY: Shows a right parietal stroke in [**2115-4-13**], prostate cancer, coronary artery disease, carotid
disease, abdominal aortic aneurysm, polycystic kidney
disease, chronic renal insufficiency and renal artery
stenosis, congestive heart failure (with an ejection fraction
of approximately 35 to 40 percent) diagnosed in [**2115-5-14**],
and hypercholesterolemia.

MEDICATION ON ADMISSION: Aspirin 325 mg once daily, folic
acid 1 mg once daily, Lasix 40 mg two in the morning and one
in the evening, hydralazine 50 mg three times daily, Lipitor
40 mg once daily, Lopressor 100 mg twice daily, Plavix 75 mg
once daily, and Isordil 10 mg three times daily.

ALLERGIES: He had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage,Congestive heart failure, unspecified,Atrial fibrillation,Other pulmonary insufficiency, not elsewhere classified,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension,Closed fracture of three ribs,Unspecified fall,Polycystic kidney, unspecified type,Aortocoronary bypass status,Unspecified disorder of kidney and ureter
Subarachnoid hemorrhage,CHF NOS,Atrial fibrillation,Other pulmonary insuff,Hyperosmolality,Hypertension NOS,Fracture three ribs-clos,Fall NOS,Polycystic kidney NOS,Aortocoronary bypass,Renal & ureteral dis NOS
Admission Date:                   Discharge Date: [**2115-10-22**]

Date of Birth:                    Sex:

Service:


CHIEF COMPLAINT:  Syncope and headache.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 94081**] is an 81-year-old
gentleman with a complicated past medical history who
presented from an outside hospital with a large subarachnoid
hemorrhage and subdural hematoma.  The patient had a headache
a syncopal event with loss of consciousness for approximately
five minutes.  He had no history of trauma.  The patient may
have hit his head with the syncopal episode.  The patient
does have mild baseline dementia which waxes and wanes.

PAST MEDICAL HISTORY:  Shows a right parietal stroke in [**2115-4-13**], prostate cancer, coronary artery disease, carotid
disease, abdominal aortic aneurysm, polycystic kidney
disease, chronic renal insufficiency and renal artery
stenosis, congestive heart failure (with an ejection fraction
of approximately 35 to 40 percent) diagnosed in [**2115-5-14**],
and hypercholesterolemia.

PAST SURGICAL HISTORY:  Shows a carotid endarterectomy in
[**2111-9-13**], abdominal aortic aneurysm repair in [**2104-10-13**], and a coronary artery bypass grafting in [**2103-10-14**].

MEDICATIONS ON ADMISSION:  Aspirin 325 mg once daily, folic
acid 1 mg once daily, Lasix 40 mg two in the morning and one
in the evening, hydralazine 50 mg three times daily, Lipitor
40 mg once daily, Lopressor 100 mg twice daily, Plavix 75 mg
once daily, and Isordil 10 mg three times daily.

ALLERGIES:  He had no known drug allergies.

PHYSICAL EXAMINATION ON PRESENTATION:  The temperature was
98.4, the blood pressure was 116/33, the heart rate was 71,
the respirations were 18, and oxygen saturation was 95
percent on 3 liters nasal cannula.  The patient was
lethargic.  Arousable to stimulation.  Followed simple
commands appropriately.  Oriented times two - to person and
place.  The pupils were equal, round, and reactive to light
and accommodation at 4 to 3 brisk.  The extraocular movements
were intact.  The face was symmetrical.  The tongue was
midline.  He had normal palate elevation.  He was moving all
extremities.  No pronator drift.  Difficult to test strength
secondary to lethargy.  Sensation was grossly intact.  The
toes were upgoing bilaterally.

RADIOLOGIC STUDIES:  A CAT scan did show a massive
subarachnoid hemorrhage and left subdural with rightward
subfalcine herniation.

SUMMARY OF HOSPITAL COURSE:  The patient was admitted to
Medicine Service for workup of syncope.  An arterial line was
placed for blood pressure management.  He was placed in a
hard collar.  He was also seen in consultation by the Trauma
Service.  Dr. [**First Name (STitle) **] [**Name (STitle) 739**], then Neurosurgery
attending, did have a long discussion with the family
regarding his situation and surgical versus nonsurgical
treatment, and all his comorbidities were also discussed.
Based on their wishes, he was to be treated aggressively
medically.  His systolic pressure was to be maintained at 130
to 160.

He was admitted to the Intensive Care Unit for close
monitoring.  He was started on Nipride to maintain the above-
mentioned blood pressure parameters.  The next day he was
arousable, and verbal, and was following commands (left more
so than right) with a noticeable right hemiparesis.  The
syncopal workup recommended ruling out myocardial infarction,
obtaining a transthoracic echocardiogram, cardiac monitoring;
which were all performed.  The patient was also started on
Dilantin for seizure prophylaxis, and therapeutic levels were
maintained.

On [**10-15**], the patient was more lethargic and hard to
arouse.  He did open to stimulation but was not following
commands.  A repeat head CT was performed which was stable in
appearance.  He did have a central line placed without
difficulty.  He also had a cervical spine MRI to assess for a
ligamentous injury which showed no ligamentous disruption.

On [**10-17**], the patient's examination off propofol did
show some purposeful left upper extremity movements.  He was
able to withdraw bilaterally in the lower extremities, but
little movement in the right upper extremity.  His eyes were
opened and reactive.  He did have a question of a pneumonia
seen on chest x-ray and was started on Levaquin.  He was
getting tube feedings.

He was transfused with 2 units of packed red blood cells on
[**10-21**] for a hematocrit of 25.9.  There was family
meeting with Dr. [**First Name (STitle) **] [**Name (STitle) 739**], and members of the
team, with the family on [**2115-10-21**].  The family did
request that the patient be made comfort measures only
secondary to his prognosis which at best was expected to
recover with significant impairment of functional mobility.
The patient did expire on [**2115-10-22**].



                        [**Name6 (MD) **] [**Name8 (MD) 739**], MD [**MD Number(2) 2930**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2116-2-14**] 13:55:17
T:  [**2116-2-14**] 18:53:27
Job#:  [**Job Number 94082**]
{'Subarachnoid hemorrhage,Congestive heart failure, unspecified,Atrial fibrillation,Other pulmonary insufficiency, not elsewhere classified,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension,Closed fracture of three ribs,Unspecified fall,Polycystic kidney, unspecified type,Aortocoronary bypass status,Unspecified disorder of kidney and ureter'}


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: Syncope and headache.

PRESENT ILLNESS: Mr. [**Known lastname 94081**] is an 81-year-old
gentleman with a complicated past medical history who
presented from an outside hospital with a large subarachnoid
hemorrhage and subdural hematoma.  The patient had a headache
a syncopal event with loss of consciousness for approximately
five minutes.  He had no history of trauma.  The patient may
have hit his head with the syncopal episode.  The patient
does have mild baseline dementia which waxes and wanes.

MEDICAL HISTORY: Shows a right parietal stroke in [**2115-4-13**], prostate cancer, coronary artery disease, carotid
disease, abdominal aortic aneurysm, polycystic kidney
disease, chronic renal insufficiency and renal artery
stenosis, congestive heart failure (with an ejection fraction
of approximately 35 to 40 percent) diagnosed in [**2115-5-14**],
and hypercholesterolemia.

MEDICATION ON ADMISSION: Aspirin 325 mg once daily, folic
acid 1 mg once daily, Lasix 40 mg two in the morning and one
in the evening, hydralazine 50 mg three times daily, Lipitor
40 mg once daily, Lopressor 100 mg twice daily, Plavix 75 mg
once daily, and Isordil 10 mg three times daily.

ALLERGIES: He had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage,Congestive heart failure, unspecified,Atrial fibrillation,Other pulmonary insufficiency, not elsewhere classified,Hyperosmolality and/or hypernatremia,Unspecified essential hypertension,Closed fracture of three ribs,Unspecified fall,Polycystic kidney, unspecified type,Aortocoronary bypass status,Unspecified disorder of kidney and ureter'}
