CHIEF COMPLAINT: Intraparenchymal hemorrhage

PRESENT ILLNESS: Pt is a 64f who was in her usual state until this evening
when she was in her bathroom and her family heard her fall. When
they arrived she was reportedly minimally responsive and 911 was
called. Upon EMS arrival she was awake and verbal though she had
left sided hemi-paresis. She was hypertensive during transport
and EMS had difficulty controlling it. She was reported to be as
high as systolic in the 220's. Head CT at OSH showed large right
basal ganglia hemorrhage measuring 7cm x 3.3cm with extension
into the ventricles and approximately 10mm midline shift. She
was
intubated at OSH when she became less responsive and transferred
to [**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: Reported as none from OSH

MEDICATION ON ADMISSION: None per report

ALLERGIES: Lactose

PHYSICAL EXAM: BP: 189/ 92  HR:  87  R       O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 1.5mm sluggishly reactive  EOMs Unable to
evaluate
Neck: Supple. C Collar in place
Extrem: Warm and well-perfused.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with family at home
Intracerebral hemorrhage,Cerebral edema,Pneumonitis due to inhalation of food or vomitus,Aphasia,Hemiplegia, unspecified, affecting unspecified side,Other pulmonary insufficiency, not elsewhere classified,Dysphagia, unspecified,External ophthalmoplegia,Unspecified essential hypertension,Other alteration of consciousness,Do not resuscitate status,Surgical or other procedure not carried out because of patient's decision,Unspecified fall,Other specified cardiac dysrhythmias
Intracerebral hemorrhage,Cerebral edema,Food/vomit pneumonitis,Aphasia,Unsp hemiplga unspf side,Other pulmonary insuff,Dysphagia NOS,External ophthalmoplegia,Hypertension NOS,Other alter consciousnes,Do not resusctate status,No proc/patient decision,Fall NOS,Cardiac dysrhythmias NEC
Admission Date:  [**2176-12-14**]              Discharge Date:   [**2176-12-30**]

Date of Birth:  [**2112-2-4**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Lactose

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Intraparenchymal hemorrhage


Major Surgical or Invasive Procedure:
None


History of Present Illness:
Pt is a 64f who was in her usual state until this evening
when she was in her bathroom and her family heard her fall. When
they arrived she was reportedly minimally responsive and 911 was
called. Upon EMS arrival she was awake and verbal though she had
left sided hemi-paresis. She was hypertensive during transport
and EMS had difficulty controlling it. She was reported to be as
high as systolic in the 220's. Head CT at OSH showed large right
basal ganglia hemorrhage measuring 7cm x 3.3cm with extension
into the ventricles and approximately 10mm midline shift. She
was
intubated at OSH when she became less responsive and transferred
to [**Hospital1 18**] for further evaluation.


Past Medical History:
Reported as none from OSH


Social History:
Lives with family at home


Family History:
NC

Physical Exam:
BP: 189/ 92  HR:  87  R       O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 1.5mm sluggishly reactive  EOMs Unable to
evaluate
Neck: Supple. C Collar in place
Extrem: Warm and well-perfused.

Neuro:
Mental status: Intubated. Not following commands. No eye
opening.

Motor: Localizes with RUE, brisk withdrawl to noxious of RLE.
Extensor posturing LUE. Weak withdrawl LLE

On discharge: Neurologically she has minimal eye opening,
follows commands intermitently on the right and moves the right
side spont/antigravity.


Pertinent Results:
CT HEAD W/O CONTRAST [**2176-12-14**]
Redemonstration of a 6.7 x 2.9 cm right intra-axial hemorrhage
centered within the basal ganglia with intraventricular
extension, likely
hypertensive hemorrhage. Stable 7-mm leftward shift with slight
interval
increase in contralateral occipital [**Doctor Last Name 534**] entrapment and diffuse
sulcal
effacement, right greater than left. No new focus of hemorrhage.
No evidence of subfalcine or transtentorial or tonsillar
herniation.

[**2176-12-30**] 06:00AM BLOOD WBC-9.0 RBC-2.89* Hgb-9.0* Hct-25.3*
MCV-87 MCH-31.0 MCHC-35.5* RDW-15.0 Plt Ct-416
[**2176-12-28**] 06:27AM BLOOD Neuts-73.4* Lymphs-17.3* Monos-5.1
Eos-3.8 Baso-0.4
[**2176-12-30**] 06:00AM BLOOD Plt Ct-416
[**2176-12-30**] 06:00AM BLOOD Glucose-106* UreaN-20 Creat-0.6 Na-142
K-3.7 Cl-106 HCO3-30 AnGap-10
[**2176-12-14**] 04:40PM BLOOD CK(CPK)-114
[**2176-12-13**] 11:11PM BLOOD Lipase-49
[**2176-12-30**] 06:00AM BLOOD Calcium-8.8 Phos-4.7* Mg-2.4
[**2176-12-26**] 06:33AM BLOOD CRP-51.0*
[**2176-12-29**] 05:18AM BLOOD Vanco-12.6

Brief Hospital Course:
64 y/o F who was found in her bathroom after family heard a
fall. Patient was seen to be minimally responsive and family
called 911. Was L side hemiparetic when seen by EMS, but awake
and verbal. Patient was seen to be hypertensive on route to
hospital with SBP into the 220s. Head CT revealed a R sided
basal ganglia hemorrhage with IVH extension. She was intubated
and transferred to [**Hospital1 18**] for further neurosurgical work up. On
examination, patient is following commands with R side and L
hemiparesis, pupils PERRL. Patient was extubated. On [**12-15**] pt
exam remained stable and continued to follow commands on her
right side but with no eye opening. Her mannitol was weaned to
25G q6 which was weaned over two days. Stroke neurology was
consulted to aid in family discussions regarding prognosis. They
felt that compression of the lateral hypothalamus and mass
effect on structures of the anterior cranial fossa have resulted
in a depressed level of consciousness. They would recommend a
drain if needed. The family stated that Mrs. [**Known lastname 88193**] clearly
did not want to be severely disabled if anything untoward were
to happen,
per her family. She was made a DNR/DNI. The family are refused
surgical intervention the family including EVD placement at this
time. Dr [**First Name (STitle) **] had further discussions with the family on [**12-17**]
with the outcome of continued medical management. Her cervical
spine was cleared and her collar was removed on [**12-18**].  On [**12-20**]
she had a PEG placed.

As off [**12-19**] patient was cleared to transfer to the SDU,
however, there was no bed availability thus patient remained in
ICU.

Ms [**Known lastname 88193**] remained neurologically with left arm plegia. On
[**12-25**] she was noted to develop fevers, her Dilantin was dc'd,
Lenis were negative for DCT. An echo was done which showed no
vegitation and a EF of 70%. ID was reconsulted, they recommended
changing her VAP antibiotics (which she was already on) to
Vanco, Cipro and Zosyn.
She has removed afebrile since [**12-28**] though she developed
diahrea which has been negative for C-Diff.

Neurologically she has minimal eye opening, follows commands
intermitently on the right and moves the right side
spont/antigravity.

Medications on Admission:
None per report

Discharge Medications:
1. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
2. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
3. acetaminophen 650 mg/20.3 mL Solution Sig: One (1)  PO Q6H
(every 6 hours) as needed for fever.
4. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

5. hydralazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours).
6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
7. docusate sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
8. insulin regular human 100 unit/mL Solution Sig: One (1)
Injection four times a day.
9. Keppra 750 mg Tablet Sig: One (1) Tablet PO twice a day.
10. Heparin Flush (10 units/ml) 1 mL IV PRN line flush
Temporary Central Access-Floor:    Flush with 10 mL Normal
Saline followed by Heparin as above daily and PRN.
11. ranitidine HCl 150 mg Tablet Sig: 0.5 Tablet PO BID (2 times
a day).
12. piperacillin-tazobactam-dextrs 4.5 gram/100 mL Piggyback
Sig: One (1)  Intravenous Q8H (every 8 hours) for 10 days: stop
date [**1-10**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 1293**] - [**Location (un) 1294**]

Discharge Diagnosis:
R basal Ganglia hemorrhage with IVH extension


Discharge Condition:
Mental Status: Nonverbal
Level of Consciousness: Lethargic but arousable.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, or
Ibuprofen etc.
CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **] to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.

PLEASE OBTAIN A CXR PRIOR TO LEAVING REHAB TO FOLLOW UP ON YOUR
PNEUMONIA



Completed by:[**2176-12-30**]
{"Intracerebral hemorrhage,Cerebral edema,Pneumonitis due to inhalation of food or vomitus,Aphasia,Hemiplegia, unspecified, affecting unspecified side,Other pulmonary insufficiency, not elsewhere classified,Dysphagia, unspecified,External ophthalmoplegia,Unspecified essential hypertension,Other alteration of consciousness,Do not resuscitate status,Surgical or other procedure not carried out because of patient's decision,Unspecified fall,Other specified cardiac dysrhythmias"}


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: Intraparenchymal hemorrhage

PRESENT ILLNESS: Pt is a 64f who was in her usual state until this evening
when she was in her bathroom and her family heard her fall. When
they arrived she was reportedly minimally responsive and 911 was
called. Upon EMS arrival she was awake and verbal though she had
left sided hemi-paresis. She was hypertensive during transport
and EMS had difficulty controlling it. She was reported to be as
high as systolic in the 220's. Head CT at OSH showed large right
basal ganglia hemorrhage measuring 7cm x 3.3cm with extension
into the ventricles and approximately 10mm midline shift. She
was
intubated at OSH when she became less responsive and transferred
to [**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: Reported as none from OSH

MEDICATION ON ADMISSION: None per report

ALLERGIES: Lactose

PHYSICAL EXAM: BP: 189/ 92  HR:  87  R       O2Sats
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 1.5mm sluggishly reactive  EOMs Unable to
evaluate
Neck: Supple. C Collar in place
Extrem: Warm and well-perfused.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with family at home 

### Response:
{"Intracerebral hemorrhage,Cerebral edema,Pneumonitis due to inhalation of food or vomitus,Aphasia,Hemiplegia, unspecified, affecting unspecified side,Other pulmonary insufficiency, not elsewhere classified,Dysphagia, unspecified,External ophthalmoplegia,Unspecified essential hypertension,Other alteration of consciousness,Do not resuscitate status,Surgical or other procedure not carried out because of patient's decision,Unspecified fall,Other specified cardiac dysrhythmias"}
