CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a right-handed
77-year-old Chinese-speaking man with dementia who presents
with left lower extremity weakness two days after unwitnessed
fall at home.  The patient fell on Saturday afternoon.  As he
is normally home alone all day, no one saw him and the wife
found him on the floor with his head on the recliner when she
arrived home in the afternoon.  The patient aroused easily
and was in his usual state of health until Sunday when he had
sudden profound weakness of the left lower extremity while
walking.  The wife stated that she "carried" him home.  On
the day of admission the patient was lethargic with increased
confusion, though oriented to place and recognized faces.
The patient slept all day according to the family and at
dinner time he dropped his bowel of rice, which he was
holding in his left hand.  The family also noted no visual
nor speech changes.  The family stated that the patient
seemed to comprehend them.  The patient was without
complaints, no headache, numbness or tingling.  The patient
had no recent acute illnesses, no fevers, chills, chest pain,
shortness of breath per family.

MEDICAL HISTORY: 1. Stroke in [**2130**] with residual
left-sided weakness.  2. Left hip fracture.  3. dementia.  4.
Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Hyposmolality and/or hyponatremia,Unspecified fall,Home accidents,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Other late effects of cerebrovascular disease,Other malaise and fatigue
Traumatic subdural hem,Hyposmolality,Fall NOS,Accident in home,Hypertension NOS,Mental disor NEC oth dis,Late effect CV dis NEC,Malaise and fatigue NEC
Admission Date:  [**2148-5-28**]       Discharge Date:  [**2148-6-3**]

Date of Birth:   [**2071-7-22**]       Sex:  M

Service:  Neurosurgery

HISTORY OF PRESENT ILLNESS:  This is a right-handed
77-year-old Chinese-speaking man with dementia who presents
with left lower extremity weakness two days after unwitnessed
fall at home.  The patient fell on Saturday afternoon.  As he
is normally home alone all day, no one saw him and the wife
found him on the floor with his head on the recliner when she
arrived home in the afternoon.  The patient aroused easily
and was in his usual state of health until Sunday when he had
sudden profound weakness of the left lower extremity while
walking.  The wife stated that she "carried" him home.  On
the day of admission the patient was lethargic with increased
confusion, though oriented to place and recognized faces.
The patient slept all day according to the family and at
dinner time he dropped his bowel of rice, which he was
holding in his left hand.  The family also noted no visual
nor speech changes.  The family stated that the patient
seemed to comprehend them.  The patient was without
complaints, no headache, numbness or tingling.  The patient
had no recent acute illnesses, no fevers, chills, chest pain,
shortness of breath per family.

PAST MEDICAL HISTORY:  1. Stroke in [**2130**] with residual
left-sided weakness.  2. Left hip fracture.  3. dementia.  4.
Hypertension.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS:  1. Aricept.  2. Lisinopril.  3. Aspirin.  4.
Vitamin E.

PHYSICAL EXAMINATION:  Temperature 99.8, blood pressure
153/78, heart rate 94, oxygen saturation 96% on room air.
General medical examination was unremarkable.  Neurological
examination showed that the patient was awake, alert,
attentive, oriented x 2.  The family said that this was his
baseline.  His speech was fluent.  He followed simple
commands.  Pupils were equal, round and reactive to light,
2.5 mm to 1.5 mm bilaterally.  Extraocular movements were
full.  The patient seemed to have difficulty understanding a
the task.  Facial movement was symmetric.  There was some
slight decrease in the left nasolabial fold.  The tongue
protruded midline.  Motor examination showed normal bulk and
tone on the right, somewhat flaccid on the left.  On the
right, biceps, triceps, grip, IP, AT, and gastrocnemius were
all [**3-25**].  On the left biceps [**3-25**], triceps 4+/5, grip [**2-24**], IP
4-/5, AT 4-/5, gastrocnemius [**2-24**].  There was left pronator
drift.  Reflexes were all symmetric with some decreased
reflexes at the ankles.  Coordination was intact
finger-to-nose bilaterally.  Fine finger movements were
intact on the right, decreased on the left.  Sensation showed
extinction on the left.  Sensation was intact to vibration
bilaterally.

LABORATORY DATA:  INR 1.1, CK 124, troponin less than 0.03.
Head CT showed a subdural hematoma 1.4 cm at maximum width
with areas of low attenuation suggesting subacute and
organizing.  There was mass effect with left shift by 5 mm.
There was no evidence of herniation, no fractures.  There was
opacification of frontal and ethmoid sinuses, ? sinusitis
versus facial bone fracture.

HOSPITAL COURSE:  The patient was admitted to the
neurosurgery service to the intensive care unit for frequent
neurological checks.  The following morning the patient was
taken to the operating room for a craniotomy and evacuation
of the hematoma.  The surgery went well and the patient
recovered well after surgery.  A drain was placed in the
subdural space and was open after the procedure.

A repeat head CT on [**2148-5-30**] showed good decompression of the
brain and some subdural residual left.  The patient was at
that time still in the intensive care unit.  The patient
continued to have some lower extremity weakness at that time.

On [**2148-5-30**] the patient's subdural drain was removed.  On
[**2148-5-31**] the patient began to develop some hyponatremia with
a sodium of 133, and was fluid restricted at that time.  The
patient was also given labetalol for blood pressure control.
The patient's sodium was monitored as well.  On [**2148-6-1**] the
patient was called out to the floor.  The patient was
evaluated by physical therapy and occupational therapy and
was recommended for rehabilitation due to his somewhat
compromised functional mobility as well as his unsupervised
status for long periods of time at home.

The patient is discharged to rehabilitation today in good
condition.  The patient will have follow up in the future
with Dr. [**Last Name (STitle) 1327**].

DISCHARGE MEDICATIONS:
1. Hydralazine 10 mg p.o. q. 6 hours.
2. Metoprolol 50 mg p.o. b.i.d.
3. Dilantin 100 mg p.o. t.i.d.
4. Pepcid 20 mg p.o. b.i.d.
5. Lisinopril 5 mg p.o. q.d.
6. Tylenol p.r.n.
7. He will continue his Aricept at his usual home dose, as
well as his usual vitamin E.

DISCHARGE DIAGNOSES:  Subdural hematoma status post
evacuation.





                            [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 4525**]
MEDQUIST36

D:  [**2148-6-3**]  11:48
T:  [**2148-6-3**]  12:04
JOB#:  [**Job Number 6824**]


Admission Date:  [**2148-5-28**]       Discharge Date:  [**2148-6-3**]

Date of Birth:   [**2071-7-22**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 77 year old
Chinese speaking male who presented to the [**Hospital1 346**] Emergency Department with left lower
extremity weakness.  The weakness occurred following a fall
two days prior.  The patient is a right handed Chinese
speaking male with baseline dementia.  On presentation, he
had left lower extremity weakness following the unwitnessed
fall at home.  By patient's family report, he fell on
Saturday afternoon having been home alone all day and was
found later that afternoon by his wife.  She managed to
arouse him and move him to a recliner but no further action
was taken.  Following the fall, the patient was in his usual
state of health until the following evening on Sunday when,
by family's report, had had a sudden and profound weakness of
the left lower extremity while walking.  The wife is said to
have carried the patient back to his bed and the EMS was
activated.

On presentation to the Emergency Department, the patient was
lethargic with confusion beyond his normal baseline dementia.
Through a translator, he is oriented to place and recognizes
face although he can be difficult to arouse at times.

By family report there was no noticeable change in visual or
speech patterns and the patient appears to comprehend them.
They do, however, report that he has had difficulty moving
food to his face.

MEDICATIONS:  The patient presented to the Emergency
Department on no chronic medications.

PHYSICAL EXAMINATION: On presentation to the Emergency
Department, vital signs are a blood pressure of 153/78; pulse
94; temperature 99.8 F.; respirations 16; saturation of 96%
on room air.  In general, Mr. [**Known lastname **] is a healthy appearing
gentleman in no acute distress.  He appears comfortable, does
not speak in English but communicates effectively through his
daughter, who is employed in the [**Name (NI) **] Medical System.
HEENT:  Eyes are equal and reactive to light.  There is no
evidence of scleral icterus.  Neck is supple without masses
or lymphadenopathy.  Lungs are clear to auscultation
bilaterally.  Heart shows a regular rate and rhythm, no S1 or
S2.  Abdomen is soft, nontender, nondistended.  Extremities
show no evidence of edema bilaterally.  Neurological
examination shows the patient to be awake, alert and
attentive and oriented times two.  Family endorses that this
is indeed his baseline, again through the interpreter his
speech is fluent and follows commands.  Cranial nerves
examination reveals pupils to be equal and reactive to light,
showing 2.5 mm to 1.5 mm bilaterally; extraocular muscles are
full.  Facial movement is symmetric except for a slight
decrease in the left nasal labial fold.  Tongue protrudes to
the midline.   Motor examination shows the patient to have
full strength in his biceps, triceps, grips, IP, AT and G on
the right.  On the left, he is five out of five biceps, four
plus out of five triceps, four out of five grips, four minus
out of five IP, four minus out of five AT and four to five G.
There is evidence of a left pronator drift.  Reflexes are two
plus throughout.  Coordination is intact.  Sensation likewise
is intact with appropriate proprioception.

LABORATORY STUDIES:  On presentation, the patient's chem-7
was a sodium of 138, potassium 3.5, chloride 99, CO2 30, BUN
22, creatinine 1.1, glucose 130.  Hematocrit was 37.9, white
blood cell count was 11.8 and platelets were 16.7.  PT was
13.0, PTT 24.2, INR 2.1.

A CT scan without contrast of the head performed upon
presentation to the Emergency Department showed evidence of a
subdural hematoma at 1.4 cm at its maximum with areas of
lower attenuations suggesting subacute and organizing
hemorrhage.  There is a small amount of mass effect also
noted with a left shift by 5 mm.  There was no evidence of
herniation and no evidence of fractures.  The presence of
opacification at the frontal and ethmoidal sinuses also is
consistent with sinusitis.

HOSPITAL COURSE:  On [**2148-5-28**], the patient was admitted to
the Intensive Care Unit after a two to three hour stay in the
Emergency Department.  On the morning of [**2148-5-28**], the
patient was taken to the Operating Room and underwent a right
craniotomy for evacuation of subdural hematoma.  The case was
unremarkable and there were no complications noted.

Following surgery, the patient was transferred to the
Intensive Care Unit.  On presentation to the Intensive Care
Unit, the patient's vital signs were all stable and he was
started on prophylactic Dilantin.  In the days following the
surgery, the patient remained neurologically stable with
strength continuing to return to his affected side.

A follow-up CT scan examination performed on [**2148-5-30**],
showed adequate evacuation of subdural hematoma.

Starting on [**5-31**], the patient's intravenous
anti-hypertensive medications, most importantly, Labetalol
were converted to p.o. and the patient was prepared for
movement outside of the Intensive Care Unit.

On [**2148-6-1**], the patient was transferred to a regular
nursing floor and continued to progress well.  On [**2148-6-1**],
the first of several Physical Therapy and Occupational
Therapy assessments were performed.  Based on the patient's
prior baseline dementia and additional deficit following his
surgery, it was felt that he would best be served for
discharge to a rehabilitation facility.  Based on this,
appropriate arrangements were made for the patient to be
transported to [**Hospital6 85**] for
intensive rehabilitation.

On [**2148-6-3**], this transfer took place.  At the time of
discharge, the patient was doing well and able to ambulate
with assistance.

DISCHARGE MEDICATIONS: At the time of discharge, the patient
was on:
1.  Lisinopril 5 mg q. day.
2.  Famotidine 20 mg twice a day.
3.  Phenytoin 100 mg three times a day.
4.  Lopressor 50 mg twice a day.
5.  Hydralazine 10 mg every six hours.
6.  Vitamin E 400 Units p.o. a day.

DISCHARGE INSTRUCTIONS:
1.  Follow-up included an appointment with Dr. [**Last Name (STitle) 1327**] three
to four weeks following discharge.
2.  The patient was scheduled to return for a Dilantin level
to be checked on or about [**2148-6-4**].



                            [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 6825**]
MEDQUIST36

D:  [**2148-6-4**]  14:26
T:  [**2148-6-4**]  15:53
JOB#:  [**Job Number 6826**]


Name:  [**Known lastname 861**], [**Known firstname **] MAN                       Unit No:  [**Numeric Identifier 862**]

Admission Date:  [**2148-5-28**]     Discharge Date:  [**2148-6-3**]

Date of Birth:   [**2071-7-22**]     Sex:  M

Service:  NEUROSURGERY

ADDENDUM:  The patient also was discharged with phenytoin 100
mg t.i.d.  The patient will need Dilantin levels checked as
an outpatient.




                          [**Name6 (MD) 863**] [**Last Name (NamePattern4) 864**], M.D.  [**MD Number(1) 865**]

Dictated By:[**Last Name (NamePattern1) 866**]

MEDQUIST36

D:  [**2148-6-3**]  11:54
T:  [**2148-6-3**]  08:02
JOB#:  [**Job Number 867**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Hyposmolality and/or hyponatremia,Unspecified fall,Home accidents,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Other late effects of cerebrovascular disease,Other malaise and fatigue'}


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: 

PRESENT ILLNESS: This is a right-handed
77-year-old Chinese-speaking man with dementia who presents
with left lower extremity weakness two days after unwitnessed
fall at home.  The patient fell on Saturday afternoon.  As he
is normally home alone all day, no one saw him and the wife
found him on the floor with his head on the recliner when she
arrived home in the afternoon.  The patient aroused easily
and was in his usual state of health until Sunday when he had
sudden profound weakness of the left lower extremity while
walking.  The wife stated that she "carried" him home.  On
the day of admission the patient was lethargic with increased
confusion, though oriented to place and recognized faces.
The patient slept all day according to the family and at
dinner time he dropped his bowel of rice, which he was
holding in his left hand.  The family also noted no visual
nor speech changes.  The family stated that the patient
seemed to comprehend them.  The patient was without
complaints, no headache, numbness or tingling.  The patient
had no recent acute illnesses, no fevers, chills, chest pain,
shortness of breath per family.

MEDICAL HISTORY: 1. Stroke in [**2130**] with residual
left-sided weakness.  2. Left hip fracture.  3. dementia.  4.
Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Hyposmolality and/or hyponatremia,Unspecified fall,Home accidents,Unspecified essential hypertension,Other persistent mental disorders due to conditions classified elsewhere,Other late effects of cerebrovascular disease,Other malaise and fatigue'}
