CHIEF COMPLAINT: patient found unresponsive at home

PRESENT ILLNESS: The pt is a 76 year old , RHM , with a history of stroke in
the past, presents after being found unresponsive.
On the night of admission at approximately 5 pm the patiemt was
in his usual stat of health.  He went upstairs as he normally
does.  The patients wife became concerned when the patient did
not come down for dinner.
At approxilately 830 to 9 pm the wife went upstairs and found
the
patiemt unconscious and snoring.  He was unarrousable and had
vomited as per the wife.
Th [**Name2 (NI) 105968**] has been in his usual satte of health.
He was not complaining of headache.  There was no nausea or
vomiting noted.

MEDICAL HISTORY: polio
stroke in the past (thought to be cerebellar)

MEDICATION ON ADMISSION: Aspirin
Simvastatin

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Physical Exam:
Vitals: Intubated T:afebrile    BP:183/125  SaO2:
General: Patient intubated.
HEENT: NC/AT, no scleral icterus noted, Dry mucous membranes.
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: N/C

SOCIAL HISTORY: Lives at home with his wife and has three daughters
Intracerebral hemorrhage,Compression of brain,Obstructive hydrocephalus,Other amyloidosis,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Personal history of poliomyelitis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified cerebrovascular disease
Intracerebral hemorrhage,Compression of brain,Obstructiv hydrocephalus,Amyloidosis NEC,Hypertension NOS,Cardiac dysrhythmias NEC,Prsnl hst poliomyelitis,Hx TIA/stroke w/o resid,Cerebrovasc disease NOS
Admission Date:  [**2107-9-1**]              Discharge Date:   [**2107-9-1**]

Date of Birth:  [**2031-3-28**]             Sex:   M

Service: NEUROLOGY

Allergies:
No Allergies/ADRs on File

Attending:[**Last Name (NamePattern1) 11784**]
Chief Complaint:
patient found unresponsive at home

Major Surgical or Invasive Procedure:
Intubation


History of Present Illness:
The pt is a 76 year old , RHM , with a history of stroke in
the past, presents after being found unresponsive.
On the night of admission at approximately 5 pm the patiemt was
in his usual stat of health.  He went upstairs as he normally
does.  The patients wife became concerned when the patient did
not come down for dinner.
At approxilately 830 to 9 pm the wife went upstairs and found
the
patiemt unconscious and snoring.  He was unarrousable and had
vomited as per the wife.
Th [**Name2 (NI) 105968**] has been in his usual satte of health.
He was not complaining of headache.  There was no nausea or
vomiting noted.


Past Medical History:
polio
stroke in the past (thought to be cerebellar)

Social History:
Lives at home with his wife and has three daughters

Family History:
N/C

Physical Exam:
ADMISSION PHYSICAL EXAM:
Physical Exam:
Vitals: Intubated T:afebrile    BP:183/125  SaO2:
General: Patient intubated.
HEENT: NC/AT, no scleral icterus noted, Dry mucous membranes.
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: Intubated. Not responsive to sternal rub.  Does
not grimace to painful stimuli.
Does not open eyes to command.
Does not follow commands.
-Cranial Nerves:
I: Olfaction not tested.
III, IV, VI: Pupils are midlne on primary gaze.
The left pupil in 2 mm and minimally reactive. The left pupil is
2.5 mm and minimally reactive.
No corneal reflex.

-Motor:
No spontaneous movement.
Th epatient does withdraw from pain , more so on teh left than
the right.
-Sensory: Withdraws to pain.
-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  1  1   1     1   1
R  1  1   1     1   1
Left upgoing toe.

-Coordination: Unable to assess.

-Gait: Unable to assess.

EXAM ON PRONOUNCIATION OF DEATH
GEN: patient lying in bed, unresponsive
HEENT: no breath felt at mouth, pupils fixed and dilated
bilaterally
CV: no heart beat auscultated
PULM: no breath sounds auscultated
EXT: cool

Pertinent Results:
ADMISSION LABS:

[**2107-8-31**] 09:25PM BLOOD WBC-11.6* RBC-4.69 Hgb-14.5 Hct-43.1
MCV-92 MCH-31.0 MCHC-33.8 RDW-14.3 Plt Ct-256
[**2107-8-31**] 09:25PM BLOOD PT-12.2 PTT-21.7* INR(PT)-1.0
[**2107-8-31**] 09:25PM BLOOD Fibrino-592*
[**2107-9-1**] 02:18AM BLOOD Glucose-124* UreaN-14 Creat-0.5 Na-140
K-4.7 Cl-103 HCO3-26 AnGap-16
[**2107-9-1**] 02:18AM BLOOD ALT-18 AST-34 CK(CPK)-262
[**2107-9-1**] 02:18AM BLOOD CK-MB-10 MB Indx-3.8
[**2107-8-31**] 09:25PM BLOOD Calcium-8.4 Phos-2.9 Mg-1.8
[**2107-9-1**] 03:22AM BLOOD Osmolal-294
[**2107-9-1**] 02:18AM BLOOD TSH-0.62
[**2107-8-31**] 09:25PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2107-8-31**] 09:32PM BLOOD Glucose-146* Lactate-2.1* Na-140 K-3.6
Cl-100 calHCO3-26

Patient made CMO on the day he expired so he did not have labs
drawn at that time.

Imaging:
CT HEAD [**2107-8-31**]: IMPRESSION: Large left-sided intraparenchymal
hemorrhage with resultant subfalcine and uncal herniation. There
is intraventricular hemorrhage, with associated hydrocephalus.

CXR [**2107-8-31**]: IMPRESSION: Endotracheal tube tip terminates at the
level of thoracic inlet, and could be slightly advanced, as it
terminates 9 cm from the carina. Mild bibasilar atelectasis.
Evaluation of the costophrenic angles is limited on this study.


Brief Hospital Course:
The pt is a 76 year old RHM with a history of stroke in the past
who presented after being found unresponsive, with CT scan
showing a large left sided intraparenchymal hemmorhage. Etiology
was likely hypertensive in nature given the lobar distribution,
but should also consider amyloid angiopathy given the patient's
age.  Per family discussion, patient was made CMO on [**9-1**].
.
# NEURO: patient's bleed was considered devastating, and it was
unlikely he would recover any meaningful neurological function.
Prior to family decision, he was loaded with mannitol in order
to allow family members enough time to gather at the bedside.
He was pthen laced on a morphine gtt and ativan gtt once
discussion was had with family to make him CMO.  He was
terminally extubated. Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] was called to the
bedside to pronounce the patient's death at 3:03pm on [**9-1**].
Patient had no pupillary response, no heart beat and no breath
sounds, and was determined to have expired.  His family and
friends were at the bedside.  They declined autopsy as did the
ME.


Medications on Admission:
Aspirin
Simvastatin


Discharge Medications:
N/A pt expired

Discharge Disposition:
Expired

Discharge Diagnosis:
large intraparenchymal hemorrhage


Discharge Condition:
Pt expired.


Discharge Instructions:
Patient expired on [**9-1**] at 3:03pm surrounded by family and
friends.

Followup Instructions:
N/A, pt expired
{'Intracerebral hemorrhage,Compression of brain,Obstructive hydrocephalus,Other amyloidosis,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Personal history of poliomyelitis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified cerebrovascular disease'}


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: patient found unresponsive at home

PRESENT ILLNESS: The pt is a 76 year old , RHM , with a history of stroke in
the past, presents after being found unresponsive.
On the night of admission at approximately 5 pm the patiemt was
in his usual stat of health.  He went upstairs as he normally
does.  The patients wife became concerned when the patient did
not come down for dinner.
At approxilately 830 to 9 pm the wife went upstairs and found
the
patiemt unconscious and snoring.  He was unarrousable and had
vomited as per the wife.
Th [**Name2 (NI) 105968**] has been in his usual satte of health.
He was not complaining of headache.  There was no nausea or
vomiting noted.

MEDICAL HISTORY: polio
stroke in the past (thought to be cerebellar)

MEDICATION ON ADMISSION: Aspirin
Simvastatin

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Physical Exam:
Vitals: Intubated T:afebrile    BP:183/125  SaO2:
General: Patient intubated.
HEENT: NC/AT, no scleral icterus noted, Dry mucous membranes.
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: N/C

SOCIAL HISTORY: Lives at home with his wife and has three daughters 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Obstructive hydrocephalus,Other amyloidosis,Unspecified essential hypertension,Other specified cardiac dysrhythmias,Personal history of poliomyelitis,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Unspecified cerebrovascular disease'}
