CHIEF COMPLAINT: vertigo, nausea, vomiting

PRESENT ILLNESS: This is a 59yo RH man with no significant pmh who presented to
the ED [**2172-7-21**] at [**Hospital1 18**] for evaluation of sudden onset vertigo,
"eyes moving to the right" and then vomiting while having
dinner. There were no complaints of headache. ECG in the ED
revealed ST depressions in V2-V6 wiht elevated troponin, so
heparin gtt was started for 1hr, and pt was given asa. There was
a brief episode of a.fib in the ED as well, controlled with
metoprolol. In the ED the patient began to become somewhat
somnelent, and went for head CT which revealed L cerebellar
hemorrhage, into lateral ventricles. Subsequent MRI also
revealed old L corona radiata stroke. Unclear whether there was
an underlying ischemic stroke before the bleed or not.
He was admitted to the ICU for close monitoring, and
Neurosurgery placed a vent drain which did not drain much fluid,
and has now been discontinued. The patient remained stable in
the ICU, and is now transferred out with only some residual
vertigo, esp. while sitting up. Cardiology has also consulted on
Mr.[**Name14 (STitle) 56065**] and suggested treatment of bp with B-blockers, and if
a.fib returns to start amiodarone for rx. They also recommend
outpatient stress test for
further risk stratification.

MEDICAL HISTORY: spina bifida

MEDICATION ON ADMISSION: NONE

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99 ; BP 140/60 ; HR 66 ; RR 18; O2 sat 98%
gen - nad. appears comfortable.
heent - mmm. o/p clear. no scleral icterus or injection.
neck - supple.
lungs - cta bilaterally
heart - rrr, nl s1/s2
abd - soft, nt/nd, nabs
ext - warm, 2+ peripheral pulses throughout. no edema.

FAMILY HISTORY: no strokes, or intracranial bleeds in the family

SOCIAL HISTORY: from [**Country 32814**]. was up visiting his daughter, and was supposed
to leave [**2172-7-22**]. rest of family is in [**Country 32814**]
Intracerebral hemorrhage,Cerebral embolism with cerebral infarction,Atrial fibrillation,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery
Intracerebral hemorrhage,Crbl emblsm w infrct,Atrial fibrillation,Subendo infarct, initial,Hypertension NOS,Crnry athrscl natve vssl
Admission Date:  [**2172-7-20**]              Discharge Date:   [**2172-8-13**]

Date of Birth:  [**2113-6-13**]             Sex:   M

Service: NMED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
vertigo, nausea, vomiting

Major Surgical or Invasive Procedure:
Interventricular Cerebral Drain placed and removed.

History of Present Illness:
This is a 59yo RH man with no significant pmh who presented to
the ED [**2172-7-21**] at [**Hospital1 18**] for evaluation of sudden onset vertigo,
"eyes moving to the right" and then vomiting while having
dinner. There were no complaints of headache. ECG in the ED
revealed ST depressions in V2-V6 wiht elevated troponin, so
heparin gtt was started for 1hr, and pt was given asa. There was
a brief episode of a.fib in the ED as well, controlled with
metoprolol. In the ED the patient began to become somewhat
somnelent, and went for head CT which revealed L cerebellar
hemorrhage, into lateral ventricles. Subsequent MRI also
revealed old L corona radiata stroke. Unclear whether there was
an underlying ischemic stroke before the bleed or not.
He was admitted to the ICU for close monitoring, and
Neurosurgery placed a vent drain which did not drain much fluid,
and has now been discontinued. The patient remained stable in
the ICU, and is now transferred out with only some residual
vertigo, esp. while sitting up. Cardiology has also consulted on
Mr.[**Name14 (STitle) 56065**] and suggested treatment of bp with B-blockers, and if
a.fib returns to start amiodarone for rx. They also recommend
outpatient stress test for
further risk stratification.


Past Medical History:
spina bifida

Social History:
from [**Country 32814**]. was up visiting his daughter, and was supposed
to leave [**2172-7-22**]. rest of family is in [**Country 32814**]


Family History:
no strokes, or intracranial bleeds in the family

Physical Exam:
T 99 ; BP 140/60 ; HR 66 ; RR 18; O2 sat 98%
gen - nad. appears comfortable.
heent - mmm. o/p clear. no scleral icterus or injection.
neck - supple.
lungs - cta bilaterally
heart - rrr, nl s1/s2
abd - soft, nt/nd, nabs
ext - warm, 2+ peripheral pulses throughout. no edema.

neurologic:
MS: Alert and Oriented x3. Cooperative with exam. Speech fluent
per daughter with no dysarthria. Able to relate coherent details

of HPI.

CN: PERRL. EOMs intact but violent nystagmus to the left. Facial

sensation and movement intact bilaterally. Tongue protrudes
midline without fasiculations. Sternocleidomastoids intact
bilaterally. Shoulder shrug intact bilaterally.

Motor: Normal bulk and tone throughout. No fasiculations. No
pronator drift.
B T D WE WF FF FE IP Hams. Quad AT [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 938**]
R 5 5 5 5 5 5 5 5 5 5 5 5 5

L 5 5 5 5 5 5 5 5 5 5 5 5 5


Reflexes: brisk throughout. left toe upgoing, right toe
downgoing.

Sensation:
Intact bilaterally to light touch and temperature.
Proprioception
intact.

Coordination:
[**Last Name (LF) 43945**], [**First Name3 (LF) **], and FFM intact bilaterally - ataxia mild, L > R.

Gait: deferred


Pertinent Results:
[**2172-7-20**] 08:51PM   GLUCOSE-139* UREA N-20 CREAT-1.2 SODIUM-141
POTASSIUM-3.3 CHLORIDE-103 TOTAL CO2-22 ANION GAP-19
[**2172-7-20**] 08:51PM   ALT(SGPT)-20 AST(SGOT)-28 CK(CPK)-149 ALK
PHOS-91 AMYLASE-75 TOT BILI-0.6
[**2172-7-20**] 08:51PM   LIPASE-19
[**2172-7-20**] 08:51PM   cTropnT-0.27*
[**2172-7-20**] 08:51PM   CK-MB-5
[**2172-7-20**] 08:51PM   TOT PROT-8.2 CALCIUM-9.9 PHOSPHATE-3.6
MAGNESIUM-2.0
[**2172-7-20**] 08:51PM   WBC-15.3* RBC-5.30 HGB-16.8 HCT-47.1 MCV-89
MCH-31.6 MCHC-35.6* RDW-12.8
[**2172-7-20**] 08:51PM   PLT COUNT-275
[**2172-7-20**] 08:51PM   PT-13.1 PTT-22.6 INR(PT)-1.1

Transthoracic Echocardiogram:
The left atrium is mildly dilated. No atrial septal defect or
patent foramen ovale is seen by 2D, color Doppler or saline
contrast with maneuvers. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. There is moderate global left ventricular hypokinesis.
Overall left ventricular systolic function is moderately
depressed (EF 35%). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets are mildly
thickened. There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are mildly
thickened. Trivial mitral regurgitation is seen. There is no
pericardial effusion.

Head CT:
There is a mild to moderate amount of hemorrhage within both
lateral
ventricles tracking down to the third and fourth ventricles. A 2
x 1.4 cm
hemorrhage area is also seen in the left cerebellar hemisphere.
There is no
evidence of hydrocephalus or mass effect. There is no shift of
normally
midline structures. the density values of the remaining brain
parenchyma are
within normal limits. The surruouding soft tissue and osseous
structures are
unremarkable.

Brain MRI/MRA:
The hemorrhage in the left cerebellar hemisphere is identified,
together with the blood, which has dissected into the
ventricular system.
Multiple lacunar infarcts are identified, including some within
the pons.
There is a focus of restricted diffusion in the left posterior
frontal white
matter, which has a slight increased signal on T2W sequence,
consistent with
subacute infarction. There are multiple T2 high signal intensity
foci
consistent with microvascular angiopathy. A shunt catheter has
been placed
since the CT scan with its tip in a position appropriate for
right lateral
ventricle. There is no evidence of a focal extraaxial lesion or
fluid
collection. Multiple punctate hemorrhages are noted in the
cerebellar
hemisphere and in the basal ganglia. This patient is rather
young, and the
distribution of the foci of presumed hemorrhage are atypical,
but it would
raise the question of amyloid angiopathy.
MRA OF THE CIRCLE OF [**Location (un) **] AND ITS MAJOR TRIBUTARIES:
There is no evidence of aneurysm or flow abnormality. There is
no evidence of
high-flow vascular abnormality in the left cerebellar hemishere.


Carotid Ultrasound: Right less than 40% and left 40-59% ICA
stenoses and antegrade
flow in the vertebral arteries.


Brief Hospital Course:
Mr.[**Known lastname 56066**] was admitted initially to the Neurosurgery Service,
and a interventricular drain was placed, however never drained
any fluid. Head CTs remained unchanged. The patient had no
further episodes of a.fib, and no futher chest pain. He was
stabilized in the ICU with his blood pressure under control, and
he underwent a full stroke work-up. It was felt that he likely
had ischemic strokes in the cerebellum and left corona radiata
and that these were due to his new onset a.fib.
Probably the hemorrhage came about after the heparin was started
in the ED for the ECG changes and troponin leak, however the
true course of events cannot be absolutely determined.
His Cholesterol was checked, and Total Cholesterol 193,
Triglycerides 219, HDL 40, LDL 109. He was started on lipitor.
Additionally, Cardiology consulted, and felt that if a.fib
started again, to start amiodarone (which did not have to be
done) - and also felt that due to the cardiac issues on this
admission, wall abnormalities and decreased EF seen on the echo
- that he should have follow up outpatient stress testing.
Mr.[**Known lastname 56066**] did well throughout the rest of the admission and
worked with PT/OT extensively once out on the floor.

Medications on Admission:
NONE

Discharge Medications:
asa 81 qd
atorvastatin 20 qd
captopril 75 tid
lansoprazole 30 qd
metoprolol 50 tid


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
Cerebellar Hemorrhage
Stroke

Discharge Condition:
GOOD

Discharge Instructions:
Please walk with assistance as needed, use walker.

Followup Instructions:
Please follow-up with your primary care doctor and cardiologist
in [**Country 32814**].

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2172-8-11**]
{'Intracerebral hemorrhage,Cerebral embolism with cerebral infarction,Atrial fibrillation,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}


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: vertigo, nausea, vomiting

PRESENT ILLNESS: This is a 59yo RH man with no significant pmh who presented to
the ED [**2172-7-21**] at [**Hospital1 18**] for evaluation of sudden onset vertigo,
"eyes moving to the right" and then vomiting while having
dinner. There were no complaints of headache. ECG in the ED
revealed ST depressions in V2-V6 wiht elevated troponin, so
heparin gtt was started for 1hr, and pt was given asa. There was
a brief episode of a.fib in the ED as well, controlled with
metoprolol. In the ED the patient began to become somewhat
somnelent, and went for head CT which revealed L cerebellar
hemorrhage, into lateral ventricles. Subsequent MRI also
revealed old L corona radiata stroke. Unclear whether there was
an underlying ischemic stroke before the bleed or not.
He was admitted to the ICU for close monitoring, and
Neurosurgery placed a vent drain which did not drain much fluid,
and has now been discontinued. The patient remained stable in
the ICU, and is now transferred out with only some residual
vertigo, esp. while sitting up. Cardiology has also consulted on
Mr.[**Name14 (STitle) 56065**] and suggested treatment of bp with B-blockers, and if
a.fib returns to start amiodarone for rx. They also recommend
outpatient stress test for
further risk stratification.

MEDICAL HISTORY: spina bifida

MEDICATION ON ADMISSION: NONE

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99 ; BP 140/60 ; HR 66 ; RR 18; O2 sat 98%
gen - nad. appears comfortable.
heent - mmm. o/p clear. no scleral icterus or injection.
neck - supple.
lungs - cta bilaterally
heart - rrr, nl s1/s2
abd - soft, nt/nd, nabs
ext - warm, 2+ peripheral pulses throughout. no edema.

FAMILY HISTORY: no strokes, or intracranial bleeds in the family

SOCIAL HISTORY: from [**Country 32814**]. was up visiting his daughter, and was supposed
to leave [**2172-7-22**]. rest of family is in [**Country 32814**] 

### Response:
{'Intracerebral hemorrhage,Cerebral embolism with cerebral infarction,Atrial fibrillation,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery'}
