CHIEF COMPLAINT: Decline in mental status

PRESENT ILLNESS: 63F who began to have mental staus decline/dysarthria at
home.  Brought to Needhan [**Hospital1 18**] where had Head CT showing large
L
parietal hemorrhage, was transferred to [**Hospital1 18**] for further
treatment. Upon arrival there was concern for airway safety and
she was intubated (was reportedly moving all extremities prior
to
intubation).

MEDICAL HISTORY: ccy [**2150**], multiple ERCP for biliary strictures, benign
breast tumor, L aneurysm clip [**2130**] (no deficit), chronic
autoimmune hepatitis on steroids, osteoporosis

MEDICATION ON ADMISSION: All:flagyl, levaquin, statins, wellbutrin

ALLERGIES: Wellbutrin / Lipitor / Flagyl / Levaquin

PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]:4    [**Doctor Last Name **]:4     GCS 6T  E:1  V:1T Motor:4
O: T:afeb  BP: 136/76      HR:72    R16       O2Sats 100%
intubated, sedated, examined in ED just after intubated
HEENT: Pupils:4mm reactive
Neck: Supple.
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Thyroid disease is positive in the family, as is
rheumatoid arthritis. Her sister died at 25 years of age of
liver
disease of unknown cause. It is not known whether that also was
autoimmune hepatitis. There is also cirrhosis in the family.

SOCIAL HISTORY: Married, She smokes 4 to 6 cigarettes a day, does
not drink any alcohol. She is a retired [**Hospital3 **] manager.
She watches her grandson a couple times a week. Participates in
book clubs, Mahjong, walks and traveling.
Subarachnoid hemorrhage,Compression of brain,Alkalosis,Autoimmune hepatitis,Long-term (current) use of steroids,Osteoporosis, unspecified,Do not resuscitate status
Subarachnoid hemorrhage,Compression of brain,Alkalosis,Autoimmune hepatitis,Long-term use steroids,Osteoporosis NOS,Do not resusctate status
Admission Date:  [**2156-1-26**]              Discharge Date:   [**2156-1-27**]

Date of Birth:  [**2092-9-17**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Wellbutrin / Lipitor / Flagyl / Levaquin

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Decline in mental status

Major Surgical or Invasive Procedure:
Angiogram with embolization of aneurysm

History of Present Illness:
63F who began to have mental staus decline/dysarthria at
home.  Brought to Needhan [**Hospital1 18**] where had Head CT showing large
L
parietal hemorrhage, was transferred to [**Hospital1 18**] for further
treatment. Upon arrival there was concern for airway safety and
she was intubated (was reportedly moving all extremities prior
to
intubation).


Past Medical History:
ccy [**2150**], multiple ERCP for biliary strictures, benign
breast tumor, L aneurysm clip [**2130**] (no deficit), chronic
autoimmune hepatitis on steroids, osteoporosis


Social History:
Married, She smokes 4 to 6 cigarettes a day, does
not drink any alcohol. She is a retired [**Hospital3 **] manager.
She watches her grandson a couple times a week. Participates in
book clubs, Mahjong, walks and traveling.


Family History:
Thyroid disease is positive in the family, as is
rheumatoid arthritis. Her sister died at 25 years of age of
liver
disease of unknown cause. It is not known whether that also was
autoimmune hepatitis. There is also cirrhosis in the family.


Physical Exam:
Hunt and [**Doctor Last Name 9381**]:4    [**Doctor Last Name **]:4     GCS 6T  E:1  V:1T Motor:4
O: T:afeb  BP: 136/76      HR:72    R16       O2Sats 100%
intubated, sedated, examined in ED just after intubated
HEENT: Pupils:4mm reactive
Neck: Supple.
Extrem: Warm and well-perfused. No C/C/E.

Neuro: no eye opening,WDs all 4 to nox


Pertinent Results:
CTA:
Redemonstrated IP, IC, SAH. Worsened mass effect with 10mm
rightward MLS and effacement of the basal cisterns. There is
downward herniation.
2 aneurysms: Ruptured left MCA 8x4mm, partially calcified right
M1 origin
aneurysm, the latter is amenable to coiling. Possible third
small left MCA
trifurcation aneurysm (3;76) - await reformations.


Brief Hospital Course:
Pt was admitted to the ICU for close neurological observation.
In the afternoon of admission the patient's mental status
declined, including loss of cough and gag. Brain test testing
was initiated by the ICU and concluded that she was brain dead.
Preparations were made for organ donation per the families
request.

Medications on Admission:
All:flagyl, levaquin, statins, wellbutrin


Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
N/A

Discharge Condition:
Deceased

Discharge Instructions:
N/A

Followup Instructions:
N/A

                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2156-1-27**]
{'Subarachnoid hemorrhage,Compression of brain,Alkalosis,Autoimmune hepatitis,Long-term (current) use of steroids,Osteoporosis, unspecified,Do not resuscitate status'}


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: Decline in mental status

PRESENT ILLNESS: 63F who began to have mental staus decline/dysarthria at
home.  Brought to Needhan [**Hospital1 18**] where had Head CT showing large
L
parietal hemorrhage, was transferred to [**Hospital1 18**] for further
treatment. Upon arrival there was concern for airway safety and
she was intubated (was reportedly moving all extremities prior
to
intubation).

MEDICAL HISTORY: ccy [**2150**], multiple ERCP for biliary strictures, benign
breast tumor, L aneurysm clip [**2130**] (no deficit), chronic
autoimmune hepatitis on steroids, osteoporosis

MEDICATION ON ADMISSION: All:flagyl, levaquin, statins, wellbutrin

ALLERGIES: Wellbutrin / Lipitor / Flagyl / Levaquin

PHYSICAL EXAM: Hunt and [**Doctor Last Name 9381**]:4    [**Doctor Last Name **]:4     GCS 6T  E:1  V:1T Motor:4
O: T:afeb  BP: 136/76      HR:72    R16       O2Sats 100%
intubated, sedated, examined in ED just after intubated
HEENT: Pupils:4mm reactive
Neck: Supple.
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Thyroid disease is positive in the family, as is
rheumatoid arthritis. Her sister died at 25 years of age of
liver
disease of unknown cause. It is not known whether that also was
autoimmune hepatitis. There is also cirrhosis in the family.

SOCIAL HISTORY: Married, She smokes 4 to 6 cigarettes a day, does
not drink any alcohol. She is a retired [**Hospital3 **] manager.
She watches her grandson a couple times a week. Participates in
book clubs, Mahjong, walks and traveling. 

### Response:
{'Subarachnoid hemorrhage,Compression of brain,Alkalosis,Autoimmune hepatitis,Long-term (current) use of steroids,Osteoporosis, unspecified,Do not resuscitate status'}
