CHIEF COMPLAINT: headache x 1wk

PRESENT ILLNESS: 72-year-old right-handed woman with PMH atrial fibrillation on
coumadin, HTN who presents with 1 wk of right frontal headache
after hitting her head. She was seen by PCP today and noted to
be unsteady with walking and not looking to her left.  History
obtained from friends [**Name (NI) 3551**] and [**Name (NI) 553**].
<br>
Pt was pushed while in line resulting in her banging her head
against the wall about 1 week ago.  Since then, she's had a
headache.  Yesterday, around 1:30pm, pt had worsening of her
right frontal headache upon returning from brunch.  She then
went to BINGO last night and a friend had to help her walk back.

MEDICAL HISTORY: - ? afib on coumadin - when asked why she is on coumadin, pt
responds "i think i have a beating [**Last Name **] problem".
- h/o TIAs(?) - described by friends as episodes of
unresponsiveness, inability to speak and staring straight ahead
with return back to baseline.
- urinary incontinence at nighttime (has been seeing a
urologist)
PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @[**Location (un) **] [**Location (un) 1459**]

MEDICATION ON ADMISSION: fosamax 70mg qSun
diovan 320mg QD
triamterene/HCTZ 37.5mg-25mg QD
warfarin 5mg qSuTWFSa and 7.5mg qMTh
synthroid 100mcg QD
simvastatin 20mg QD
sanctura 20mg [**Hospital1 **]
aggrenox 25/200mg [**Hospital1 **]
protonix 40mg QD
citalopram 30mg QD
MVI
os-cal 500mg [**Hospital1 **]
chantix 2mg [**Hospital1 **]

ALLERGIES: Penicillins / Percocet / Motrin / Tagamet

PHYSICAL EXAM: T- 97.9  BP- 144/75  HR- 86  RR- 16  100 O2Sat RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: supple, no carotid or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: quit smoking in [**1-24**] but has had cig/day for the past 5 days.
ETOH 1-2 drinks/wk.  Retired office clerk.  Lives in [**Name (NI) 3786**]
friend [**Name (NI) 3551**].
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Striking against or struck accidentally by other stationary object with subsequent fall,Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Anticoagulants causing adverse effects in therapeutic use,Abnormal coagulation profile,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Atrial fibrillation
Brain hem NEC w/o coma,Stat obj w sub fall NEC,Subarachnoid hem-no coma,Adv eff anticoagulants,Abnrml coagultion prfile,Hypertension NOS,Long-term use anticoagul,Atrial fibrillation
Admission Date:  [**2177-4-28**]              Discharge Date:   [**2177-5-2**]

Date of Birth:  [**2104-8-19**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins / Percocet / Motrin / Tagamet

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
headache x 1wk


Major Surgical or Invasive Procedure:
None


History of Present Illness:
72-year-old right-handed woman with PMH atrial fibrillation on
coumadin, HTN who presents with 1 wk of right frontal headache
after hitting her head. She was seen by PCP today and noted to
be unsteady with walking and not looking to her left.  History
obtained from friends [**Name (NI) 3551**] and [**Name (NI) 553**].
<br>
Pt was pushed while in line resulting in her banging her head
against the wall about 1 week ago.  Since then, she's had a
headache.  Yesterday, around 1:30pm, pt had worsening of her
right frontal headache upon returning from brunch.  She then
went to BINGO last night and a friend had to help her walk back.

<br>
By this morning, patient was vomiting x2 and needed help getting
down the stairs.  She was evaluated by her PCP who was concerned
b/c the pt was not looking to the left and sent her to OSH for a
head CT where they found a right parieto-occipital ICH with
intraventricular spread on the right.
<br>
She was subsequently transferred to [**Hospital1 18**] ED, where she was
discovered to have a supratherapeutic INR 3.9 and was given 4
vials of profiline, 2U FFP and 10mg vitamin K for reversal.
Repeat NCHCT (~5hrs after initial OSH HCT) showed that
hemorrhage was relatively stable (reviewed with radiologist in
ED).  She
also rec'd Dilantin 1g IV and 2mg IV morphine just prior to this
evaluation.


Past Medical History:
- ? afib on coumadin - when asked why she is on coumadin, pt
responds "i think i have a beating [**Last Name **] problem".
- h/o TIAs(?) - described by friends as episodes of
unresponsiveness, inability to speak and staring straight ahead
with return back to baseline.
- urinary incontinence at nighttime (has been seeing a
urologist)
PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @[**Location (un) **] [**Location (un) 1459**]


Social History:
quit smoking in [**1-24**] but has had cig/day for the past 5 days.
ETOH 1-2 drinks/wk.  Retired office clerk.  Lives in [**Name (NI) 3786**]
friend [**Name (NI) 3551**].


Family History:
NC

Physical Exam:
T- 97.9  BP- 144/75  HR- 86  RR- 16  100 O2Sat RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: supple, no carotid or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:  Limited by IV morphine administered.
MS: not alert but arousable.  oriented to person, place, date,
situation.  inattentive but able to followed simple commands.
no
alien hand.  fluent w/comprehension intact.  alexic. registers
[**12-19**] despite clues at 30 seconds.

CN:
I: not tested
II,III:  right gaze preference, decr'd blink to threat from the
left, when asked how many people in the room did not see people
standing to left of bed until instructed to look further to the
left.  PERRL 4mm to 2mm
III,IV,V: EOMI intact to OCM, no ptosis.  No nystagmus
V:  sensation intact V1-V3 to LT
VII:  Facial strength intact/symmetrical
VIII:  hears finger rub bilaterally
IX,X:  palate elevates symmetrically, uvula midline
[**Doctor First Name 81**]:  SCM/trapezeii [**4-21**] bilaterally
XII:  tongue protrudes midline, no dysarthria

Motor: Normal bulk and tone; +Asterixis. No pronator drift.
Some
motor impersistence on the left.

   Delt [**Hospital1 **] Tri WE     FE     Grip  IO
   C5   C6 C7  C6     C7     C8/T1 T1
L  5-   5  5   5      4+     5     5
R  5    5  5   5      5      5     5

   IP  Quad Hamst DF  [**Last Name (un) 938**]    PF
   L2  L3   L4-S1 L4  L5     S1/S2
L  5   5    5     5   5      5
R  5   5    5     5   5      5

Reflex: No clonus
   [**Hospital1 **] Tri Bra Pat An Plantar
   C5 C7  C6  L4  S1 CST
L  2  2   2   2   2  Extensor
R  2  2   2   2   2  Flexor

Sensation: Intact to light touch and w/d's to noxious stim b/l.
Coordination: finger-nose-finger normal on the right, too
distracted to perform using left hand.
Gait/Romberg: deferred due to severe oversedation from IV pain
meds.


Pertinent Results:
EKG:
Sinus rhythm. Normal tracing. No previous tracing available for
comparison.
   Intervals Axes
Rate PR QRS QT/QTc P QRS T
88 192 100 400/449 75 -8 41

Labs:
143  106  15
----+----+---<111
3.4   30  0.9

estGFR: 62/74 (click for details)
Ca: 9.3 Mg: 1.9 P: 3.4
ALT: 17 AP: 74 Tbili: 0.3 Alb:
AST: 23 LDH:  Dbili:  TProt:
[**Doctor First Name **]:  Lip: 15
MCV 95

8.9 > 11.5 < 345
      34.8

N:81.4 L:13.3 M:4.7 E:0.3 Bas:0.2
PT: 36.3  PTT: 31.1  INR: 3.9

CXR [**2177-4-28**] The hemidiaphragms are in normal position. There is
no evidence of pleural effusion. The size of the cardiac
silhouette is at the upper range of normal. There is slight
tortuosity of the thoracic aorta. There is no evidence of
hyperhydration, no evidence is seen of parenchymal opacity
suggestive of pneumonia. No pathologic mediastinal widening, the
hilar contours are normal.

NCHCT [**2177-4-28**] 3.5 cm intraparenchymal hemorrhage with
surrounding vasogenic edema. A small amount of subarachnoid
hemorrhage is noted along the right superior convexity.
Appearance of organized hematoma within the right lateral
ventricular body, suggesting subacute nature. Mass effect on the
occipital [**Doctor Last Name 534**] of the right lateral ventricle, and mild leftward
shift of the normally midline structures. Intraventricular
extension. Overall, the findings are not changed from the study
performed at outside hospital roughly three hours prior.

Repeat NCHCT [**2177-4-29**] Unchanged right parietooccipital hemorrhage
with intraventricular extension. No change in mass effect.

MRI/MRA on [**2177-5-2**] showed severe intracranial atherosclerotic
disease diffusely (both posterior and anterior circulation),
with surprisingly intact extracranial anatomy. The MRI showed
extensive white matter disease with multiple infarctions,
periventricular and the tip of the L temporal lobe. The GRE did
not reveal any microhemorrhages.

Brief Hospital Course:
BRIEF ICU COURSE:
Admitted initially to the Neuro ICU for close monitoring of her
clinical status and blood pressure. Her clinical exam and a
repeat non-contrast head CT were unchanged on the second day of
hospitalization. Her BP was well controlled (100-110 systolic)
on her home medications. Therefore, she was transferred to the
floor with telemetry.

She did not require additional Vitamin K or FFP to maintain her
INR at goal of 1.5 or lower. Her coags were checked q4h
initially and then spaced to q8h once stable.

Her TSH was found to be low at 0.24. T3 low at 64 (nl > 80), and
T4 1.5 (normal 0.9 - 1.7) - her levothyroxine was slightly
increased.

She was treated with phenytoin to prevent seizures, with a goal
level of > 10, especially because of her subarachnoid blood.
This should be discontinued in time, especially when it
potentially interferes with other medications. She is to take it
until follow-up.

BRIEF FLOOR COURSE:
She continued to show a stable neurological examination with a
field cut, neglect and mild disorientation. She was treated with
standard analgesics for continued headache, but eventually
needed stronger medication (IV Dilaudid low dose), leading to
excessive sedation. It was discontinued in the AM of [**2177-5-1**].

MRI/MRA showed severe intracranial atherosclerotic disease
diffusely (both posterior and anterior circulation), with
surprisingly intact extracranial anatomy. The MRI showed
extensive white matter disease with multiple infarctions,
periventricular and the tip of the L temporal lobe. The GRE did
not reveal any microhemorrhages - so even though technically she
could restart Coumadin (no microbleeds), there is no data to
support that with extensive intracranial atherosclerosis
Coumadin is superior to Aspirin.

She was discharged in stable condition and will follow up with
Dr [**Last Name (STitle) **] (Stroke Service) as outlined her discharge orders.

NOTE PLEASE BE AWARE OF POTENTIAL MEDICATION INTERACTIONS -
Calcium Carbonate and phenytoin, levothyroxine and others.

Medications on Admission:
fosamax 70mg qSun
diovan 320mg QD
triamterene/HCTZ 37.5mg-25mg QD
warfarin 5mg qSuTWFSa and 7.5mg qMTh
synthroid 100mcg QD
simvastatin 20mg QD
sanctura 20mg [**Hospital1 **]
aggrenox 25/200mg [**Hospital1 **]
protonix 40mg QD
citalopram 30mg QD
MVI
os-cal 500mg [**Hospital1 **]
chantix 2mg [**Hospital1 **]

ALL: PCN, percocet, percodan, motrin, tagamet, raw mushrooms


Discharge Medications:
1. Citalopram 20 mg Tablet [**Hospital1 **]: 1.5 Tablets PO DAILY (Daily).
2. Hexavitamin     Tablet [**Hospital1 **]: One (1) Cap PO DAILY (Daily).
3. Calcium Carbonate 500 mg Tablet, Chewable [**Hospital1 **]: One (1)
Tablet, Chewable PO TID W/MEALS (3 TIMES A DAY WITH MEALS).
4. Valsartan 160 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY (Daily).

5. Triamterene-Hydrochlorothiazid 37.5-25 mg Capsule [**Hospital1 **]: One
(1) Cap PO DAILY (Daily).
6. Simvastatin 10 mg Tablet [**Hospital1 **]: Two (2) Tablet PO DAILY
(Daily).
7. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
8. Phenytoin Sodium Extended 100 mg Capsule [**Last Name (STitle) **]: One (1) Capsule
PO TID (3 times a day).
9. Levothyroxine 112 mcg Tablet [**Last Name (STitle) **]: One (1) Tablet PO DAILY
(Daily).
10. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Powder in
Packet [**Telephone/Fax (3) **]: One (1) Powder in Packet PO BID (2 times a day) for
1 days.
11. Senna 8.6 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO BID (2 times a
day) as needed.
12. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) [**Telephone/Fax (3) **]: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
13. Docusate Sodium 100 mg Tablet [**Telephone/Fax (3) **]: One (1) Tablet PO BID (2
times a day).
14. Sodium Phosphates     Solution [**Telephone/Fax (3) **]: Forty Five (45) ML PO
ONCE (Once) as needed for PRN severe constipation for 1 doses.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

Discharge Diagnosis:
Right parieto-occpital intraparenchymal hemorrhage and small
frontal traumatic subarachnoid hemorrhage.


Discharge Condition:
Stable


Discharge Instructions:
You have been admitted with a brain hemorrhage in the R parietal
and occipital area (right side of back of head) - you also had a
small R frontal (right side of forehead) bleed, as a consequence
of the trauma about a week earlier. We think both bleeds are
directly or indirectly related to your fall and Coumadin use.
We've spoken to your PCP about the recurrent strokes leading to
the use of Coumadin. For now, we do NOT want you to take
Coumadin.

Please take all your medications excactly as directed and please
attend all your follow-up appointments.

Please report to the nearest ER or call 911 or your PCP
immediately when you experience recurrence of weakness,
numbness, tingling, problems with speech, vision, language,
walking, thinking, headache, or difficulties arousing, or any
other signs or symptoms of concern.

Followup Instructions:
Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 2574**]
Date/Time:[**2177-7-8**] 1:30


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

Completed by:[**2177-5-2**]
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Striking against or struck accidentally by other stationary object with subsequent fall,Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Anticoagulants causing adverse effects in therapeutic use,Abnormal coagulation profile,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Atrial fibrillation'}


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: headache x 1wk

PRESENT ILLNESS: 72-year-old right-handed woman with PMH atrial fibrillation on
coumadin, HTN who presents with 1 wk of right frontal headache
after hitting her head. She was seen by PCP today and noted to
be unsteady with walking and not looking to her left.  History
obtained from friends [**Name (NI) 3551**] and [**Name (NI) 553**].
<br>
Pt was pushed while in line resulting in her banging her head
against the wall about 1 week ago.  Since then, she's had a
headache.  Yesterday, around 1:30pm, pt had worsening of her
right frontal headache upon returning from brunch.  She then
went to BINGO last night and a friend had to help her walk back.

MEDICAL HISTORY: - ? afib on coumadin - when asked why she is on coumadin, pt
responds "i think i have a beating [**Last Name **] problem".
- h/o TIAs(?) - described by friends as episodes of
unresponsiveness, inability to speak and staring straight ahead
with return back to baseline.
- urinary incontinence at nighttime (has been seeing a
urologist)
PCP [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] @[**Location (un) **] [**Location (un) 1459**]

MEDICATION ON ADMISSION: fosamax 70mg qSun
diovan 320mg QD
triamterene/HCTZ 37.5mg-25mg QD
warfarin 5mg qSuTWFSa and 7.5mg qMTh
synthroid 100mcg QD
simvastatin 20mg QD
sanctura 20mg [**Hospital1 **]
aggrenox 25/200mg [**Hospital1 **]
protonix 40mg QD
citalopram 30mg QD
MVI
os-cal 500mg [**Hospital1 **]
chantix 2mg [**Hospital1 **]

ALLERGIES: Penicillins / Percocet / Motrin / Tagamet

PHYSICAL EXAM: T- 97.9  BP- 144/75  HR- 86  RR- 16  100 O2Sat RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: supple, no carotid or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: NC

SOCIAL HISTORY: quit smoking in [**1-24**] but has had cig/day for the past 5 days.
ETOH 1-2 drinks/wk.  Retired office clerk.  Lives in [**Name (NI) 3786**]
friend [**Name (NI) 3551**]. 

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Striking against or struck accidentally by other stationary object with subsequent fall,Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Anticoagulants causing adverse effects in therapeutic use,Abnormal coagulation profile,Unspecified essential hypertension,Long-term (current) use of anticoagulants,Atrial fibrillation'}
