CHIEF COMPLAINT: Large Left IPH/IVH

PRESENT ILLNESS: This is a 51 year old man known to Dr. [**First Name (STitle) **] and our
service for subarachnoid hemorrhage last year and was found
to have a fairly large arteriovenous malformation in the left
thalamus.  He had a basilar tip aneurysm that was coiled.  He
also was seen to have a very dystrophic anterior cerebral artery
aneurysm.  He had radiosurgery for this in 06/[**2195**].  He was seen
in follow up in [**Month (only) 956**] and he reported occasional feelings of
right-sided hand numbness and a sensation of being very hot.
Cerebral Angiogram was done on [**2197-1-30**] and this showed
arteriovenous malformation with slightly  diminished flow
compared to an angiogram from a year ago. The basilar aneurysm
that was coiled continued to stay obliterated. The anterior
communicating segment continued to be dysmorphic secondary to
the
increased flow and is aneurysmally dilated;  however, there was
no distinct saccular areas.

MEDICAL HISTORY: HTN, SAH, basilar tip aneurysm s/p coiling [**4-7**], AVM: single
fraction tx to brain on Wed [**2196-5-4**]

MEDICATION ON ADMISSION: Expired

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pupils fixed/ nonreactive, no cough/no gag, not overbreathing
vent.

FAMILY HISTORY: Father history of aneurysm

SOCIAL HISTORY: RH, married with 1 child, unemployed, worked as a chemist, lives
in
[**Location (un) 3307**], no ETOH/Smoke
Subarachnoid hemorrhage,Cerebral edema,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Diabetes insipidus,Unspecified essential hypertension,Encounter for palliative care
Subarachnoid hemorrhage,Cerebral edema,Acute respiratry failure,Hyperosmolality,Diabetes insipidus,Hypertension NOS,Encountr palliative care
Admission Date:  [**2197-2-20**]              Discharge Date:   [**2197-2-21**]

Date of Birth:  [**2145-6-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Large Left IPH/IVH

Major Surgical or Invasive Procedure:
None


History of Present Illness:
This is a 51 year old man known to Dr. [**First Name (STitle) **] and our
service for subarachnoid hemorrhage last year and was found
to have a fairly large arteriovenous malformation in the left
thalamus.  He had a basilar tip aneurysm that was coiled.  He
also was seen to have a very dystrophic anterior cerebral artery
aneurysm.  He had radiosurgery for this in 06/[**2195**].  He was seen
in follow up in [**Month (only) 956**] and he reported occasional feelings of
right-sided hand numbness and a sensation of being very hot.
Cerebral Angiogram was done on [**2197-1-30**] and this showed
arteriovenous malformation with slightly  diminished flow
compared to an angiogram from a year ago. The basilar aneurysm
that was coiled continued to stay obliterated. The anterior
communicating segment continued to be dysmorphic secondary to
the
increased flow and is aneurysmally dilated;  however, there was
no distinct saccular areas.

His well reports that he was doing well until this evening he
complained of a posterior headache and feeling of heaviness in
his feet. He became unresponsive and EMS was called. He was
noted
to have fixed pupils and GCS of 3 on arrival and he was
intubated
in the ED.


Past Medical History:
HTN, SAH, basilar tip aneurysm s/p coiling [**4-7**], AVM: single
fraction tx to brain on Wed [**2196-5-4**]


Social History:
RH, married with 1 child, unemployed, worked as a chemist, lives
in
[**Location (un) 3307**], no ETOH/Smoke


Family History:
Father history of aneurysm


Physical Exam:
Pupils fixed/ nonreactive, no cough/no gag, not overbreathing
vent.

Expired on [**2197-2-21**]

Pertinent Results:
[**2197-2-20**] Head CT:
FINDINGS:
There is a large left intra-axial hematoma of mixed attenuation
8.0 x 3.9 x 4.2 cm in AP x transverse x CC dimensions. There is
associated interhemispheric bifrontal and left parietal
subarachnoid hemorrhage with a possible small subdural
component. There is also extension of blood products into the
left occipital [**Doctor Last Name 534**] as well as into the fourth ventricle. There
is diffuse sulcal effacement of the left as well as right
hemispheres. Left lateral ventricle is displaced and effaced
inferiorly with entrapment of the right lateral ventricle
specifically the temporal and occipital horns. There is an
effacement of the suprasellar cistern consistent with downward
transtentorial herniation. Note is made of a preexisting
underlying intraventricular large arteriovenous malformation
with associated calcifications. Patient is also status post
aneurysm clipping at the basilar tip.

There is mild mucosal thickening involving the anterior
ethmoidal air cells. Remainder of paranasal sinuses and mastoid
air cells are well aerated. Globes and soft tissues are
unremarkable.

IMPRESSION:
1. Large left frontoparietal intra-axial hematoma with
associated
interhemispheric and left parietal subarachnoid hemorrhage and
possible
concurrent subdural component with significant mass effect
causing rightward shift of 9 mm and downward transtentorial
herniation as well as global sulcal effacement and left lateral
ventricular effacement with trapping of the right temporal and
occipital horns.

2. Underlying intraventricular large AVM, likely underlying
cause of acute
hemorrhage.

3. Status post basilar tip aneurysm clipping.

4. Blood extending to the left lateral ventricle and fourth
ventricle.

[**2197-2-21**] CTP:
IMPRESSION: No intracranial blood flow.

Brief Hospital Course:
51M admitted to the ICU. Admission exam was poor and Dr [**First Name (STitle) **]
spoke to the family and recommended withdrawing care given his
poor exam and devastating bleed.
Family came in and further discussions were had. CTP was done
and confirmed brain death. Family continues to wait for other
family memebers to arrive prior to withdrawing vent support.

NEOB was contact[**Name (NI) **] and spoke with the family but declined
donation.

Patiented was determined to be brain dead on [**2197-2-21**]. He
expired on [**2197-2-22**] at 13:30 with family by his side.

Medications on Admission:
Expired

Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Large left IPH
IVH
Cerebral edema
Respiratory failure


Discharge Condition:
Brain death confirmed on [**2197-2-21**]
Expired on [**2197-2-22**]


Discharge Instructions:
Expired

Followup Instructions:
N/A



Completed by:[**2197-2-22**]
{'Subarachnoid hemorrhage,Cerebral edema,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Diabetes insipidus,Unspecified essential hypertension,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: Large Left IPH/IVH

PRESENT ILLNESS: This is a 51 year old man known to Dr. [**First Name (STitle) **] and our
service for subarachnoid hemorrhage last year and was found
to have a fairly large arteriovenous malformation in the left
thalamus.  He had a basilar tip aneurysm that was coiled.  He
also was seen to have a very dystrophic anterior cerebral artery
aneurysm.  He had radiosurgery for this in 06/[**2195**].  He was seen
in follow up in [**Month (only) 956**] and he reported occasional feelings of
right-sided hand numbness and a sensation of being very hot.
Cerebral Angiogram was done on [**2197-1-30**] and this showed
arteriovenous malformation with slightly  diminished flow
compared to an angiogram from a year ago. The basilar aneurysm
that was coiled continued to stay obliterated. The anterior
communicating segment continued to be dysmorphic secondary to
the
increased flow and is aneurysmally dilated;  however, there was
no distinct saccular areas.

MEDICAL HISTORY: HTN, SAH, basilar tip aneurysm s/p coiling [**4-7**], AVM: single
fraction tx to brain on Wed [**2196-5-4**]

MEDICATION ON ADMISSION: Expired

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Pupils fixed/ nonreactive, no cough/no gag, not overbreathing
vent.

FAMILY HISTORY: Father history of aneurysm

SOCIAL HISTORY: RH, married with 1 child, unemployed, worked as a chemist, lives
in
[**Location (un) 3307**], no ETOH/Smoke 

### Response:
{'Subarachnoid hemorrhage,Cerebral edema,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Diabetes insipidus,Unspecified essential hypertension,Encounter for palliative care'}
