CHIEF COMPLAINT: aphasia, increasing somnolence

PRESENT ILLNESS: Pt is a 86yo female with history of mild HTN and anemia
presenting with acute altered mental status found to have large
left intracranial hemorrhage.  She was in usual state of health
today and was doing well when she awoke this morning.  Around
845am after her two sons had a verbal argument she was heard
falling to kitchen floor.  When her sons came to the room they
found her awake, eyes open and able to move all extremities.
She
was non-verbal and did not seem to understand what they were
saying.  EMS was called and she bacame more somnolent when they
arrived.  She was taken to an OSH where upon arrival she had
emesis, questionable sz activity and She was intubated.  GCS 3.
CT showed large left BG bleed.  She received manitol and
dilantin
and was transferred to [**Hospital1 18**] for neurosurgical evaluation.  Upon
arrival she was again noted to be GCS 3 off sedation.  She had a
repeat CT showing large left BG hemorrhge with 10mm of midline
shift and mild left uncal herniation.  Neurosurg was consulted
and felt surgical intervention was not indicated.  Neurology was
consulted to aid in continuing of care.

MEDICAL HISTORY: according to sons she is very active and has not chronic medical
issues.  She told them her BP was a little high but she was
never
on meds.
She has mild anemia

MEDICATION ON ADMISSION: iron tabs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
HEENT 	AT/NC, MMM no lesions; NG with brownish drainage
Neck 	Supple, no bruits
Chest 	CTA B
CVS 	RRR,
ABD 	soft, NTND, + BS
SKIN

FAMILY HISTORY: Cancer, HTN

SOCIAL HISTORY: Lives with 2 sons, one of which was recently diagnosed with
rectal cancer.  It has been stressful to her.  No tobacco.
Occaisonal EtOH
Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Unspecified essential hypertension
Intracerebral hemorrhage,Compression of brain,Acute respiratry failure,Hypertension NOS
Admission Date:  [**2163-1-23**]              Discharge Date:   [**2163-1-25**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6075**]
Chief Complaint:
aphasia, increasing somnolence

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Pt is a 86yo female with history of mild HTN and anemia
presenting with acute altered mental status found to have large
left intracranial hemorrhage.  She was in usual state of health
today and was doing well when she awoke this morning.  Around
845am after her two sons had a verbal argument she was heard
falling to kitchen floor.  When her sons came to the room they
found her awake, eyes open and able to move all extremities.
She
was non-verbal and did not seem to understand what they were
saying.  EMS was called and she bacame more somnolent when they
arrived.  She was taken to an OSH where upon arrival she had
emesis, questionable sz activity and She was intubated.  GCS 3.
CT showed large left BG bleed.  She received manitol and
dilantin
and was transferred to [**Hospital1 18**] for neurosurgical evaluation.  Upon
arrival she was again noted to be GCS 3 off sedation.  She had a
repeat CT showing large left BG hemorrhge with 10mm of midline
shift and mild left uncal herniation.  Neurosurg was consulted
and felt surgical intervention was not indicated.  Neurology was
consulted to aid in continuing of care.

ROS:
unable to obtain


Past Medical History:
according to sons she is very active and has not chronic medical
issues.  She told them her BP was a little high but she was
never
on meds.
She has mild anemia

Social History:
Lives with 2 sons, one of which was recently diagnosed with
rectal cancer.  It has been stressful to her.  No tobacco.
Occaisonal EtOH


Family History:
Cancer, HTN


Physical Exam:
PE:
HEENT 	AT/NC, MMM no lesions; NG with brownish drainage
Neck 	Supple, no bruits
Chest 	CTA B
CVS 	RRR,
ABD 	soft, NTND, + BS
SKIN

NEUROLOGICAL
MS: exam on sedation
No eye opening or grimace with sternal rub
Left pupil 3 and nonreative, right 1 and minimal reactive, trace
corneal relfex bilateral, trance gag, no occulocephalics
RUE flaccid, no withdrawl
RLE Triple flex v. withdrawl to pain
LUE withdrawl to pain
LLE withdrawl to pain
Toes up bilateral


Pertinent Results:
[**2163-1-24**] 02:58AM BLOOD WBC-12.1* RBC-3.17* Hgb-10.0* Hct-28.6*
MCV-90 MCH-31.4 MCHC-34.8 RDW-14.2 Plt Ct-180
[**2163-1-23**] 12:30PM BLOOD WBC-11.2* RBC-3.54* Hgb-10.5* Hct-32.2*
MCV-91 MCH-29.7 MCHC-32.6 RDW-14.1 Plt Ct-231
[**2163-1-24**] 02:58AM BLOOD Plt Ct-180
[**2163-1-24**] 02:58AM BLOOD PT-12.7 PTT-25.9 INR(PT)-1.1
[**2163-1-24**] 02:58AM BLOOD Glucose-149* UreaN-13 Creat-0.9 Na-139
K-4.8 Cl-106 HCO3-22 AnGap-16
[**2163-1-24**] 02:58AM BLOOD Triglyc-58 HDL-79 CHOL/HD-2.3 LDLcalc-88
[**2163-1-24**] 02:58AM BLOOD Phenyto-23.6*

Imaging:

CT head:
IMPRESSION:
1. Large left basal ganglia hemorrhage with areas of hypodensity
concerning for hyperacute bleeding. Subfalcine herniation of
approximately 12 mm and mild left-sided uncal herniation is
noted.
2. Effacement of the left lateral ventricle and dilation of the
right lateral  ventricle. Bilateral intraventricular hemorrhage
identified. Diffuse left- sided sulcal effacement.


Brief Hospital Course:
Pt is a 86 yo LHF with mild HTN, anemia presenting with large
left basal ganglia hemmorhage, with intraventricular extension,
likely secondary to HTN.  The patient has very poor prognosis of
meaningful recovery.

She was intubated at an OSH and sent to [**Hospital1 18**].  She was admitted
to the neuro-ICU for further care.  She was started on mannitol.
 Given the over poor prognosis and hope of recovery, a pallative
consult was initiated.  The team met with the family about
withdrawal of care.  It was decided to extubate the patient on
[**2163-1-24**] and make the patient comfort measures only.  She was
discharge to home hospice.  We informed the family that she may
not make the journey home but they wanted to try.  She will be
transported home today


Medications on Admission:
iron tabs

Discharge Medications:
Morphine Concentrate 20 mg/mL Solution Sig: One (1)  PO q4:prn:
2-4mg as needed for comfort, if iv fails.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 83590**] Hospice

Discharge Diagnosis:
Left basal ganglia hemorrhage


Discharge Condition:
Non responsive, negative dolls eyes, no corneal or gag reflexes,
agonal breathing


Discharge Instructions:
You were admitted after a fall and an inability to speak. You
continued to worsen.  You were taken to an outside hospital were
you were intubated and were found to have a very large bleed.
You were sent to [**Hospital1 18**] for further care.  The prognosis of
recovery was very poor you were made comfort care and sent home
with hospice.


Followup Instructions:
none





Name:  [**Known lastname 13295**],[**Known firstname 665**]                 Unit No:   [**Numeric Identifier 13296**]

Admission Date:  [**2163-1-23**]              Discharge Date:   [**2163-1-25**]

Date of Birth:  [**2076-11-27**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1725**]
Addendum:
changd morphine dose on discharge

Discharge Medications:
1. Morphine Concentrate 20 mg/mL Solution Sig: as directed  PO
q1hour:prn: 5-30mg every hour as needed for comfort.
Disp:*1 30cc bottle* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 13297**] Hospice

                             [**First Name11 (Name Pattern1) 657**] [**Last Name (NamePattern4) 1735**] MD [**MD Number(1) 1736**]

Completed by:[**2163-1-25**]
{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,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: aphasia, increasing somnolence

PRESENT ILLNESS: Pt is a 86yo female with history of mild HTN and anemia
presenting with acute altered mental status found to have large
left intracranial hemorrhage.  She was in usual state of health
today and was doing well when she awoke this morning.  Around
845am after her two sons had a verbal argument she was heard
falling to kitchen floor.  When her sons came to the room they
found her awake, eyes open and able to move all extremities.
She
was non-verbal and did not seem to understand what they were
saying.  EMS was called and she bacame more somnolent when they
arrived.  She was taken to an OSH where upon arrival she had
emesis, questionable sz activity and She was intubated.  GCS 3.
CT showed large left BG bleed.  She received manitol and
dilantin
and was transferred to [**Hospital1 18**] for neurosurgical evaluation.  Upon
arrival she was again noted to be GCS 3 off sedation.  She had a
repeat CT showing large left BG hemorrhge with 10mm of midline
shift and mild left uncal herniation.  Neurosurg was consulted
and felt surgical intervention was not indicated.  Neurology was
consulted to aid in continuing of care.

MEDICAL HISTORY: according to sons she is very active and has not chronic medical
issues.  She told them her BP was a little high but she was
never
on meds.
She has mild anemia

MEDICATION ON ADMISSION: iron tabs

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE:
HEENT 	AT/NC, MMM no lesions; NG with brownish drainage
Neck 	Supple, no bruits
Chest 	CTA B
CVS 	RRR,
ABD 	soft, NTND, + BS
SKIN

FAMILY HISTORY: Cancer, HTN

SOCIAL HISTORY: Lives with 2 sons, one of which was recently diagnosed with
rectal cancer.  It has been stressful to her.  No tobacco.
Occaisonal EtOH 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Unspecified essential hypertension'}
