CHIEF COMPLAINT: Seizure

PRESENT ILLNESS: HPI: The pt is a 64 year-old male, w/ hx of recently discharged
([**2157-4-30**]) following a mechanical fall, resulting in SAH/subdural
hematoma (right parietal with frontotemporal extension) and
right humeral/distal radius fracture, who presented at [**Hospital1 18**] ED
on status epilepticus after he was found at [**Hospital3 **]
(1050am) with generalized tonic-tonic movements, described as
eyes rolling
back, head tilted to the left, arms jerking. Episode lasted 3
minutes. He was post-ictal with confusion. Able to say he was
fine but unable to follow commands. He was oriented to location
& time. While awaiting transfer to [**Hospital1 18**] his seizure reoccurred,
marked by arm and leg stiffening with eyes deviated to the left,
head tilted to the left. He was in status in for approx about 1
hr. Received ativan 2mg x 3, then loaded with Pht 1gm and
rapidly intubated for respiratory support. Since then he has
remained postictal. Noted to have elevated temp (tm 101.8) and
started on ceftriaxone & vancomycin.

MEDICAL HISTORY: - He has been admitted to [**Hospital1 18**] approximatley four times within
the last year, due to injuries sustained during mechanical
falls.

MEDICATION ON ADMISSION: - Levetiracetam 500 mg [**Hospital1 **]
- Calcium Carbonate 500 mg [**Hospital1 **]
- Citalopram 40 mg DAILY
- Atorvastatin 40 mg DAILY
- Multivitamin po DAILY
- Nadolol 40 mg DAILY
- Ritonavir 100 mg DAILY
- Omeprazole 20 mg DAILY
- Tramadol 50 mg as needed for pain.
- Emtricitabine-Tenofovir 200-300 mg DAILY
- Docusate Sodium 100 mg [**Hospital1 **]
- Senna 8.6 mg [**Hospital1 **]
- Darunavir 800 mg DAILY
- Bisacodyl 10mg Tablet, Delayed Release (E.C.) prn DAILY
- Lactulose 10 gram/15 mL Syrup TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:101.8 P:78 R:18 BP:131/81 SaO2:
General: sedated, intubated, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: (+) right arm cast.
Skin: no rashes or lesions noted.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current or
prior tobacco use. There is no history of alcohol abuse. Pt
currently lives at [**Location 583**] House Rehab but was most recently at
[**Hospital1 **] for acute rehab from his recent fall.
Grand mal status,Cerebral edema,Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Asymptomatic human immunodeficiency virus [HIV] infection status,Cirrhosis of liver without mention of alcohol,Unspecified deficiency anemia,Hypotension, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cerebral artery occlusion, unspecified without mention of cerebral infarction,Fall from other slipping, tripping, or stumbling
Grand mal status,Cerebral edema,Subdural hem w/o coma,Asymp hiv infectn status,Cirrhosis of liver NOS,Deficiency anemia NOS,Hypotension NOS,BPH w/o urinary obs/LUTS,Crbl art oc NOS wo infrc,Fall from slipping NEC
Admission Date:  [**2157-5-1**]              Discharge Date:   [**2157-5-4**]

Date of Birth:  [**2093-2-14**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Seizure

Major Surgical or Invasive Procedure:
Intubation
Central line (IJ) placement


History of Present Illness:
HPI: The pt is a 64 year-old male, w/ hx of recently discharged
([**2157-4-30**]) following a mechanical fall, resulting in SAH/subdural
hematoma (right parietal with frontotemporal extension) and
right humeral/distal radius fracture, who presented at [**Hospital1 18**] ED
on status epilepticus after he was found at [**Hospital3 **]
(1050am) with generalized tonic-tonic movements, described as
eyes rolling
back, head tilted to the left, arms jerking. Episode lasted 3
minutes. He was post-ictal with confusion. Able to say he was
fine but unable to follow commands. He was oriented to location
& time. While awaiting transfer to [**Hospital1 18**] his seizure reoccurred,
marked by arm and leg stiffening with eyes deviated to the left,
head tilted to the left. He was in status in for approx about 1
hr. Received ativan 2mg x 3, then loaded with Pht 1gm and
rapidly intubated for respiratory support. Since then he has
remained postictal. Noted to have elevated temp (tm 101.8) and
started on ceftriaxone & vancomycin.


Past Medical History:
- He has been admitted to [**Hospital1 18**] approximatley four times within
the last year, due to injuries sustained during mechanical
falls.

- Hx of multiple falls - s/p bifrontal hemorrhagic contusions
[**9-29**]
- HIV, [**2156-6-28**]: CD4 count: 131 VL: < 48.
- Cryptogenic cirrhosis w/ h/o variceal bleed w/ esophageal
banding, last GI bleed in [**2154**], followed at [**Hospital1 3278**]
- Macrocytic anemia
- BPH
- R hip pain s/p R hip surgery
- Gait disorder due to:  s/p right hip fracture, fixated with
plate and screws; s/p right shoulder separation fixated with
wire


Social History:
Social history is significant for the absence of current or
prior tobacco use. There is no history of alcohol abuse. Pt
currently lives at [**Location 583**] House Rehab but was most recently at
[**Hospital1 **] for acute rehab from his recent fall.

Family History:
There is no family history of premature coronary artery disease
or sudden death.


Physical Exam:
Vitals: T:101.8 P:78 R:18 BP:131/81 SaO2:
General: sedated, intubated, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: (+) right arm cast.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: sedated, drowsy, responds to noxious stimuli.
-Cranial Nerves: Olfaction not tested.  PERRL 4 to 3mm slow
reactive. There is no ptosis bilaterally. corneal reflex. No
nystagmus, conjugated eyes. No facial droop, facial musculature
symmetric.
-Motor:normal bulk, increase appendicular tone.
-Sensory: withdraws to deep mpressure stimuli throughout.
- Reflex: No clonus
 [**Hospital1 **]  	Tri 	Bra 	Pat  	An   	Toes
 C5  	C7  	C6  	L4   	S1 	CST
L2   	2   	2    	2    	2   	up
R2   	2   	2    	2    	2       up

-Coordination& Gait: deferred


Pertinent Results:
Labs:
     Admission
133 | 100 | 11
----------------< 123
4.6 |  27 | 0.7

      13.0
6.1 >------< 205
      37.8

CD4: 206

Subsequent hospital stay:
C. dif screening: Negative

[**2157-5-4**]  WBC-6.5 RBC-3.64* Hgb-12.3* Hct-36.0* MCV-99*
MCH-33.8* MCHC-34.1 RDW-14.6 Plt Ct-277
[**2157-5-4**] Glucose-89 UreaN-7 Creat-0.6 Na-136 K-3.5 Cl-103
HCO3-25 AnGap-12
Calcium-8.1* Phos-2.7 Mg-1.6

[**2157-5-3**] 07:30AM BLOOD Phenyto-9.5*

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- - - - - -
Imaging:

CT Head ([**4-30**]):
FINDINGS: Overall, there is little change in comparison one day
prior.
Bilateral temporal [**Month/Year (2) 3630**] and left frontal [**Month/Year (2) 3630**] parenchymal
hematomas are
similar to one day prior. Right parietal subdural hematoma
measures 7 mm in
thickness, similar to minimally decreased. Small bifrontal
extra-axial
hematomas, likely subdural are unchanged. Subarachnoid blood
adjacent to the
frontal lobes bilaterally, most prominently adjacent to the falx
from the
parasagittal sulci are unchanged. Right temporal and small
subdural hematoma
is also unchanged.

Right inferior frontal [**Month/Year (2) 3630**] encephalomalacia is similar to the
prior study.
Edema surrounding the parenchymal hemorrhages, greatest
involving the left
frontal and temporal [**Month/Year (2) 3630**] is unchanged.

There is no shift of midline structures. The basal cisterns are
patent. The
ventricles are unchanged in size and configuration. Small
hyperdensity
associated with the left occipital [**Doctor Last Name 534**] (2A:16) is unchanged,
may reflect a
tiny amount of intraventricular blood.

The visualized paranasal sinuses and mastoid air cells are
normally
pneumatized and aerated. The right frontal and zygomatic arch
fractures are
again noted, as described on previous studies.

IMPRESSION: Little change in appearance of multifocal,
multicompartmental
hemorrhage in comparison to 17 hours prior.

CT Head ([**5-1**]):
FINDINGS: There is a right-sided subdural hematoma measuring
approximately 7
mm, not significantly changed (2A, 24). Subarachnoid hemorrhage
on the
frontal lobes adjacent to the falx and parasagittal sulci is
unchanged.
Bilateral frontal [**Month/Year (2) 3630**] and left temporal [**Month/Year (2) 3630**] intraparenchymal
hematomas are
similar in appearance. Small amount of intraventricular
hemorrhage layering
in the left posterior [**Doctor Last Name 534**] of the lateral ventricle is similar
in appearance.
There is no shift of normally midline structures. The basilar
cisterns are
preserved. The ventricles are unchanged in configuration. Small
amount of
edema surrounding the tiny foci of intraparenchymal hemorrhage
is similar in
appearance.

The visualized paranasal sinuses are clear. Right frontal bone
and right
zygomatic arch fracture, unchanged.

IMPRESSION: No significant change when compared to prior exam.
Multifocal
and multicompartmental intracranial hemorrhage including
subdural,
subarachnoid, intraparenchymal and intraventricular hemorrhage
as described
above. No shift of normally midline structures.


Brief Hospital Course:
64 year-old male, w/ hx of recently discharged ([**2157-4-30**])
following a mechanical fall, resulting in SAH/subdural hematoma
(right parietal with frontotemporal extension) and right
humeral/distal radius fracture, who presented at [**Hospital1 18**] ED on
status epilepticus in the setting of subdural hematoma.

Hospital Course:

#Neuro: The patient was loaded with a total of 4mg of Ativan, 1g
of Dilantin and 1g of Keppra.  His Keppra was continued on
1000mg [**Hospital1 **] and he was also started on standing Dilantin 100mg
tid.  It was thought that his seizures were secondary to a
combination of of his cortical blood and subtherapeutic keppra.
He remained seizure-free overnight, and was transferred to the
floor on [**5-2**]. The patient remained seizure-free on the floor as
well. His mental status gradually improved (initially oriented
only to person, but later improved to name, date, and "hospital,
though the wrong hospital).  He continued to be moderately
inattentive. Other features of his neurological exam also
improved during the course of his stay. He initially showed
nystagmus with decreased pupillary reflex, which resolved after
one day and is likely secondary to the anti-convulsants. He
still shows proximal bilateral lower extremity weakness ([**4-25**] IP
strength), with difficulty with hip flexion. There is some
concern for an attention deficit to the R side, but neglect is
unlikely b/c patient is able to sense stimuli from both sides
simultaneously without extinction. He is being weaned off
Dilantin, with the goal of long-term maintenance therapy on
1500mg Keppra.  He will continue on two more days of Dilantin
after transfer to bridge him to his final dose of Keppra.  He
will need to continue on AEDs for at least 2 years due to
extensive cortical scarring from the multiple subdural and
subarachnoid hematomas.

#CV: On admission the patient was noted to be hypotensive as
well as bradycardic.  He was initially placed on dopamine, and
was also bolused with fluids.  The hypotension quickly resolved,
and was thought to be due to a combination of dehydration, plus
the medication effects of dilantin, nadolol and propofol.  His
nadolol was initially held, but was restarted on [**2157-5-4**]. His
blood pressures have been stable on the floor. He was monitored
by EKG, which showed no abnormalities except for occasional
sinus bradycardias and PVC's.

#Resp: He was initially intubated for airway protection, but was
extubated on [**5-2**]. He has not had any aspirations or other
respiratory complications during his course.

#ID: Given his HIV status, the patient was seen by infectious
disease on admission.  He was initially started on vancomycin,
ceftriaxone, ampicillin and acyclovir for meningeal prophylaxis,
however after his seizures were treated he was afebrile, with
improved mental status.  It was thought that his seizures were
secondary to his cortical blood and low dose of keppra, and the
prior brain trauma placed him a greater risk for herniation if
an LP were attempted.  Given his improving exam, the decision
was made not to undergo a lumbar puncture, and antibiotics were
discontinued on [**5-2**]. His HIV meds (Ritonavir, Truvada, and
Darunavir) were restarted on [**2157-5-3**]. CD4 count on [**2157-5-1**] was
206.

#GI: His nadolol for variceal prophylaxis was initially held,
given hypotension, but was restarted on [**2157-5-4**]. He was
evaluated by speech & swallow on [**2157-5-3**] and cleared for thin
liquids and ground solids. He has tolerated the diet well and
transitioned to regular POs and PO meds on [**2157-5-4**].

Medications on Admission:
- Levetiracetam 500 mg [**Hospital1 **]
- Calcium Carbonate 500 mg [**Hospital1 **]
- Citalopram 40 mg DAILY
- Atorvastatin 40 mg DAILY
- Multivitamin po DAILY
- Nadolol 40 mg DAILY
- Ritonavir 100 mg DAILY
- Omeprazole 20 mg DAILY
- Tramadol 50 mg as needed for pain.
- Emtricitabine-Tenofovir 200-300 mg DAILY
- Docusate Sodium 100 mg [**Hospital1 **]
- Senna 8.6 mg [**Hospital1 **]
- Darunavir 800 mg DAILY
- Bisacodyl 10mg Tablet, Delayed Release (E.C.) prn DAILY
- Lactulose 10 gram/15 mL Syrup TID


Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
2. Lactulose 10 gram/15 mL Syrup Sig: Fifteen (15) ML PO TID (3
times a day).
3. Ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
4. Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
5. Darunavir 400 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

6. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed for constipation.
7. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as
needed for constipation.
8. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

10. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
11. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
12. Phenytoin 50 mg Tablet, Chewable Sig: Two (2) Tablet,
Chewable PO twice a day for 5 doses: Stop after the evening dose
on [**5-6**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Seizure disorder
Subdural hematomas secondary to several recent falls


Discharge Condition:
Oriented to person, situation, and hospital (not to [**Hospital1 18**]).  Is
able to report date by looking at calendar, with improving time
orientation day by day.  Bilateral ileopsoas weakness, 4+/5.
Unable to walk independently, but steadily improving per PT.


Discharge Instructions:
You were admitted for evaluation and treatment following a
prolonged seizure.  We believe that this event is secondary to
the blood overlying your brain, which occurred with your most
recent fall.  This blood is very irritating and will likely
cause further seizures without anti-seizure drugs.  You need
further rehab for your weakness and deconditioning, as well as
to evaluate the reasons for your recent falls.

Followup Instructions:
See Dr. [**First Name (STitle) **] [**Name (STitle) **], [**Hospital1 18**] Neurologist, on Tuesday, [**7-19**] at 1pm.  His office is in the [**Location (un) **] of the [**Hospital Ward Name 23**]
Building on the [**Hospital1 18**] [**Hospital Ward Name 516**].  Call [**Telephone/Fax (1) 2574**] with any
questions, including directions.


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

Completed by:[**2157-5-4**]
{'Grand mal status,Cerebral edema,Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Asymptomatic human immunodeficiency virus [HIV] infection status,Cirrhosis of liver without mention of alcohol,Unspecified deficiency anemia,Hypotension, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cerebral artery occlusion, unspecified without mention of cerebral infarction,Fall from other slipping, tripping, or stumbling'}


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: Seizure

PRESENT ILLNESS: HPI: The pt is a 64 year-old male, w/ hx of recently discharged
([**2157-4-30**]) following a mechanical fall, resulting in SAH/subdural
hematoma (right parietal with frontotemporal extension) and
right humeral/distal radius fracture, who presented at [**Hospital1 18**] ED
on status epilepticus after he was found at [**Hospital3 **]
(1050am) with generalized tonic-tonic movements, described as
eyes rolling
back, head tilted to the left, arms jerking. Episode lasted 3
minutes. He was post-ictal with confusion. Able to say he was
fine but unable to follow commands. He was oriented to location
& time. While awaiting transfer to [**Hospital1 18**] his seizure reoccurred,
marked by arm and leg stiffening with eyes deviated to the left,
head tilted to the left. He was in status in for approx about 1
hr. Received ativan 2mg x 3, then loaded with Pht 1gm and
rapidly intubated for respiratory support. Since then he has
remained postictal. Noted to have elevated temp (tm 101.8) and
started on ceftriaxone & vancomycin.

MEDICAL HISTORY: - He has been admitted to [**Hospital1 18**] approximatley four times within
the last year, due to injuries sustained during mechanical
falls.

MEDICATION ON ADMISSION: - Levetiracetam 500 mg [**Hospital1 **]
- Calcium Carbonate 500 mg [**Hospital1 **]
- Citalopram 40 mg DAILY
- Atorvastatin 40 mg DAILY
- Multivitamin po DAILY
- Nadolol 40 mg DAILY
- Ritonavir 100 mg DAILY
- Omeprazole 20 mg DAILY
- Tramadol 50 mg as needed for pain.
- Emtricitabine-Tenofovir 200-300 mg DAILY
- Docusate Sodium 100 mg [**Hospital1 **]
- Senna 8.6 mg [**Hospital1 **]
- Darunavir 800 mg DAILY
- Bisacodyl 10mg Tablet, Delayed Release (E.C.) prn DAILY
- Lactulose 10 gram/15 mL Syrup TID

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:101.8 P:78 R:18 BP:131/81 SaO2:
General: sedated, intubated, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: (+) right arm cast.
Skin: no rashes or lesions noted.

FAMILY HISTORY: There is no family history of premature coronary artery disease
or sudden death.

SOCIAL HISTORY: Social history is significant for the absence of current or
prior tobacco use. There is no history of alcohol abuse. Pt
currently lives at [**Location 583**] House Rehab but was most recently at
[**Hospital1 **] for acute rehab from his recent fall. 

### Response:
{'Grand mal status,Cerebral edema,Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Asymptomatic human immunodeficiency virus [HIV] infection status,Cirrhosis of liver without mention of alcohol,Unspecified deficiency anemia,Hypotension, unspecified,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Cerebral artery occlusion, unspecified without mention of cerebral infarction,Fall from other slipping, tripping, or stumbling'}
