CHIEF COMPLAINT: R gaze palsy and new
garbled speech

PRESENT ILLNESS: [**Age over 90 **]-year-old right-handed
man with history of stroke, hypertension, and colon cancer who
presents as a transfer from an OSH with new IPH.  Found at his
[**Hospital1 1501**] around 1030AM w/garbled speech, R-sided gaze and was
transferred to an OSH with a reported BP of 210/100s and
reportedly "neurologically intact."  He reportedly vomited at
1140 prior to a head CT, and was therefore intubated w/etomidate
and succinylcholine prior to scan.  His OSH presentation vitals
were T 97.4, P 45, R 16, BP 163/78, pOx 98%.  Where a head CT
demonstrated a R frontal SDH w/2.4cm midline shift.   At OSH was
given labetalol 20 mg, etenu, ativan 2 mg, succ, decadron 10 mg,
keppra 500 mg, ativan 2 mg, and was transferred to [**Hospital1 18**] for
further evaluation.

MEDICAL HISTORY: -ICH in [**2125**] consistent with amyloid angiopathy, status post a
left frontal craniotomy
-stage IIIB (T3, N1) colon cancer; diagnosed at age 88;
underwent
a laparoscopic right colectomy; pt elected not to undergo
adjuvant chemo
-Hypertension
-Spinal stenosis, status post L3 through L5 laminectomy
=status post right hip replacement.

MEDICATION ON ADMISSION: 1. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. sodium chloride 1 gram Tablet Sig: One (1) Tablet PO three
times a day.

ALLERGIES: lisinopril / hydrochlorothiazide

PHYSICAL EXAM: PHYSICAL EXAM:
Vitals: 195/93, R 18, HR 78, pOx 100%, ventalated
General: intubated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple,
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: brady
Abdomen: soft, NT/ND,
Extremities: bipedal edema
Skin: no rashes or lesions noted.

FAMILY HISTORY: His father had a stroke.  No family history of seizures.  The
patient's brother and both died of nonspecified
cancers in their late 70s and early 80s.

SOCIAL HISTORY: The patient is a widower.  He has three
children, a daughter who lives in [**Name (NI) 5256**], a son who
lives
in [**Name (NI) 8780**], and another son [**Name (NI) **] who lives here in [**Name (NI) 86**].  He
is
a former cigar smoker, but quit  years ago. He currently is not
drinking alcohol.  He is retired, having previously worked in
retail.  He currently lives in an [**Hospital3 **] facility.
Subdural hemorrhage,Compression of brain,Other amyloidosis,Subarachnoid hemorrhage,Do not resuscitate status,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of malignant neoplasm of large intestine,Hip joint replacement,Unspecified cerebrovascular disease,Encounter for palliative care
Subdural hemorrhage,Compression of brain,Amyloidosis NEC,Subarachnoid hemorrhage,Do not resusctate status,Hypertension NOS,Hx TIA/stroke w/o resid,Hx of colonic malignancy,Joint replaced hip,Cerebrovasc disease NOS,Encountr palliative care
Admission Date:  [**2131-10-10**]              Discharge Date:   [**2131-10-12**]


Service: NEUROLOGY

Allergies:
lisinopril / hydrochlorothiazide

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
R gaze palsy and new
garbled speech

Major Surgical or Invasive Procedure:
Intubation at OSH

History of Present Illness:
[**Age over 90 **]-year-old right-handed
man with history of stroke, hypertension, and colon cancer who
presents as a transfer from an OSH with new IPH.  Found at his
[**Hospital1 1501**] around 1030AM w/garbled speech, R-sided gaze and was
transferred to an OSH with a reported BP of 210/100s and
reportedly "neurologically intact."  He reportedly vomited at
1140 prior to a head CT, and was therefore intubated w/etomidate
and succinylcholine prior to scan.  His OSH presentation vitals
were T 97.4, P 45, R 16, BP 163/78, pOx 98%.  Where a head CT
demonstrated a R frontal SDH w/2.4cm midline shift.   At OSH was
given labetalol 20 mg, etenu, ativan 2 mg, succ, decadron 10 mg,
keppra 500 mg, ativan 2 mg, and was transferred to [**Hospital1 18**] for
further evaluation.

ROS could not be preformed secondary to poor mental status and
intubation

Past Medical History:
-ICH in [**2125**] consistent with amyloid angiopathy, status post a
left frontal craniotomy
-stage IIIB (T3, N1) colon cancer; diagnosed at age 88;
underwent
a laparoscopic right colectomy; pt elected not to undergo
adjuvant chemo
-Hypertension
-Spinal stenosis, status post L3 through L5 laminectomy
=status post right hip replacement.

Social History:
The patient is a widower.  He has three
children, a daughter who lives in [**Name (NI) 5256**], a son who
lives
in [**Name (NI) 8780**], and another son [**Name (NI) **] who lives here in [**Name (NI) 86**].  He
is
a former cigar smoker, but quit  years ago. He currently is not
drinking alcohol.  He is retired, having previously worked in
retail.  He currently lives in an [**Hospital3 **] facility.

Family History:
His father had a stroke.  No family history of seizures.  The
patient's brother and both died of nonspecified
cancers in their late 70s and early 80s.

Physical Exam:
PHYSICAL EXAM:
Vitals: 195/93, R 18, HR 78, pOx 100%, ventalated
General: intubated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple,
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: brady
Abdomen: soft, NT/ND,
Extremities: bipedal edema
Skin: no rashes or lesions noted.

Neurologic:

Mental Status exam:
did no open eyes to noxious. intubated
GCS:6
level of arousal -1
best verbal -1
best motor -4

-Cranial Nerves:
pupils equal are 2mm -> 1 mm. No gaze deviation, no dolls.  +
Left corneal, abscent right corneal.  no bobbing or robbing.  No
nystagmus.  +gag, +cough.

-Motor/sensory: increased tone in bilateral lower extremities.
with flicker of withdrawal in all 4 to noxious.  no localizing.


-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Toes upgoing bilaterally

Dischareg exam:
Deceased

Pertinent Results:
Admission labs:
[**2131-10-10**] 06:15PM BLOOD WBC-13.8* RBC-4.15* Hgb-12.9* Hct-37.3*
MCV-90 MCH-31.1 MCHC-34.6 RDW-12.6 Plt Ct-198
[**2131-10-10**] 06:15PM BLOOD Neuts-92.0* Lymphs-6.7* Monos-1.1*
Eos-0.1 Baso-0.1
[**2131-10-10**] 06:15PM BLOOD PT-12.4 PTT-18.0* INR(PT)-1.0
[**2131-10-10**] 06:15PM BLOOD Glucose-172* UreaN-15 Creat-1.1 Na-140
K-4.5 Cl-103 HCO3-26 AnGap-16
[**2131-10-10**] 06:21PM BLOOD Lactate-2.2*
.
.
Microbiology:
[**2131-10-10**]	MRSA SCREEN	MRSA SCREEN-PENDING
.
.
Radiology:
CT HEAD W/O CONTRAST	Study Date of [**2131-10-10**] 7:21 PM
FINDINGS: There is a large right frontal lobe intraparenchymal
hemorrhage
with minimal interval change from prior exam. There is marked
subfalcine
herniation with leftward shift of midline structures,
approximating 2.6 cm,
previously 2.4 cm. There is significant mass effect on the right
lateral
ventricle with complete effacement of the frontal [**Doctor Last Name 534**]. Again
noted is
transcortical hemorrhagic extension from the right frontal
hematoma with a
combination of right frontal subdural and subarachnoid hematoma.
A small
amount of intraventricular blood is seen layering in the
occipital horns, a
new finding from prior exam. New left parafalcine subarachnoid
hemorrhage is
seen along the cerebral vertex. There is blood in the
interpeduncular
cistern. While there is patency of the suprasellar cistern and
the
perimesencephalic cistern, the degree of subfalcine herniation
is significant.
There is left frontal lobe encephalomalacia as seen on prior CT
from [**2131-9-27**].
Mucosal thickening is noted in the paranasal sinuses. Mastoid
air cells and
middle ear cavities are well aerated. The bony calvarium appears
intact aside
from surgical change in the left frontal lobe.

IMPRESSION: Large right frontal parenchymal hematoma with
transcortical
extension and associated right frontal extra-axial hematoma.
Significant
subfalcine herniation with leftward shift. New areas of
subarachnoid
hemorrhage along the left cerebral vertex, new intraventricular
hemorrhage.
Patent basilar cisterns.

Brief Hospital Course:
[**Age over 90 **]-year-old right-handed man with history of previous ICH felt
secondary to amyloid, hypertension, and colon cancer s.p
colectomy and elected not to have chemotheraoy who presented as
a transfer from an OSH with new IPH and ASDH.  Patient was found
with garbled speech and right-sided gaze at his [**Hospital3 **]
- it was unclear whether he fell. EMS were called and patient
was transferred to an OSH where he was noted to have severe
hypertension with BP 210/100s. Patient was intubated prior to
scan. Head CT demonstrated a R frontal SDH  with 2.4cm midline
shift and right frontal IPH. Patient was administered IV
labetalol,  keppra and dexamethasone and was transferred for
neurosurgical evaluation. Neurosurgery was consulted and
discussion was had with the HCP regarding likely severely
debilitated outcome post surgery. In line with the patient's
wishes, he was made DNR/DNI. His HCP indicated that he should
not undergo any aggressive medical interventions. The plan was
to keep him intubated until the rest of his family could arrive,
and additional decisions regarding his plan of care could be
made at that time. Repeat CT at [**Hospital1 18**] revealed a large right
frontal parenchymal hematoma with transcortical extension and
associated right frontal extra-axial hematoma with significant
subfalcine herniation with increased 2.6cm midline shift and new
areas of subarachnoid hemorrhage along the left cerebral vertex
with intraventricular extension. Patient was transferred to the
ICU. When his family arrived the next morning, they decided to
change his goals of care to comfort care measures only. Pastoral
and palliative care were sought. Prior to elective extubation,
exam revealed extension of LUE to noxious and triple flexion
LLE, localising RUE and flexion RLE with pupils pinpoint 1mm and
reactive, present corneals and gag/cough with plantars extensor
bilaterlly. He was extubated on [**10-11**] and patient died in the
early hours of [**2131-10-12**].


Medications on Admission:
1. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. sodium chloride 1 gram Tablet Sig: One (1) Tablet PO three
times a day.

Discharge Medications:
Deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
Deceased

Discharge Condition:
Deceased

Discharge Instructions:
Deceased

Followup Instructions:
Deceased
{'Subdural hemorrhage,Compression of brain,Other amyloidosis,Subarachnoid hemorrhage,Do not resuscitate status,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of malignant neoplasm of large intestine,Hip joint replacement,Unspecified cerebrovascular disease,Encounter for palliative care'}


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: R gaze palsy and new
garbled speech

PRESENT ILLNESS: [**Age over 90 **]-year-old right-handed
man with history of stroke, hypertension, and colon cancer who
presents as a transfer from an OSH with new IPH.  Found at his
[**Hospital1 1501**] around 1030AM w/garbled speech, R-sided gaze and was
transferred to an OSH with a reported BP of 210/100s and
reportedly "neurologically intact."  He reportedly vomited at
1140 prior to a head CT, and was therefore intubated w/etomidate
and succinylcholine prior to scan.  His OSH presentation vitals
were T 97.4, P 45, R 16, BP 163/78, pOx 98%.  Where a head CT
demonstrated a R frontal SDH w/2.4cm midline shift.   At OSH was
given labetalol 20 mg, etenu, ativan 2 mg, succ, decadron 10 mg,
keppra 500 mg, ativan 2 mg, and was transferred to [**Hospital1 18**] for
further evaluation.

MEDICAL HISTORY: -ICH in [**2125**] consistent with amyloid angiopathy, status post a
left frontal craniotomy
-stage IIIB (T3, N1) colon cancer; diagnosed at age 88;
underwent
a laparoscopic right colectomy; pt elected not to undergo
adjuvant chemo
-Hypertension
-Spinal stenosis, status post L3 through L5 laminectomy
=status post right hip replacement.

MEDICATION ON ADMISSION: 1. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. sodium chloride 1 gram Tablet Sig: One (1) Tablet PO three
times a day.

ALLERGIES: lisinopril / hydrochlorothiazide

PHYSICAL EXAM: PHYSICAL EXAM:
Vitals: 195/93, R 18, HR 78, pOx 100%, ventalated
General: intubated
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple,
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: brady
Abdomen: soft, NT/ND,
Extremities: bipedal edema
Skin: no rashes or lesions noted.

FAMILY HISTORY: His father had a stroke.  No family history of seizures.  The
patient's brother and both died of nonspecified
cancers in their late 70s and early 80s.

SOCIAL HISTORY: The patient is a widower.  He has three
children, a daughter who lives in [**Name (NI) 5256**], a son who
lives
in [**Name (NI) 8780**], and another son [**Name (NI) **] who lives here in [**Name (NI) 86**].  He
is
a former cigar smoker, but quit  years ago. He currently is not
drinking alcohol.  He is retired, having previously worked in
retail.  He currently lives in an [**Hospital3 **] facility. 

### Response:
{'Subdural hemorrhage,Compression of brain,Other amyloidosis,Subarachnoid hemorrhage,Do not resuscitate status,Unspecified essential hypertension,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of malignant neoplasm of large intestine,Hip joint replacement,Unspecified cerebrovascular disease,Encounter for palliative care'}
