CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 54 year old
Ethiopian gentleman who fell at work on [**6-1**] and sustained a
back and neck injury. He was at [**Hospital6 2910**]
having physical therapy on [**6-19**] when he had a sudden onset
of severe nausea, vomiting and vertigo. He was transferred to
[**Hospital1 69**] Emergency Room for
further evaluation after a non contrast head CT showed a
cerebellar hemorrhage. The patient was intubated on arrival
for airway protection.

MEDICAL HISTORY: He has a past medical history of back
pain.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Intracerebral hemorrhage,Pneumonia, organism unspecified
Intracerebral hemorrhage,Pneumonia, organism NOS
Admission Date: [**2103-6-19**]        Discharge Date: [**2103-7-11**]

Date of Birth:  [**2048-8-9**]        Sex:  M

Service:  NSU

HISTORY OF PRESENT ILLNESS:  The patient is a 54 year old
Ethiopian gentleman who fell at work on [**6-1**] and sustained a
back and neck injury. He was at [**Hospital6 2910**]
having physical therapy on [**6-19**] when he had a sudden onset
of severe nausea, vomiting and vertigo. He was transferred to
[**Hospital1 69**] Emergency Room for
further evaluation after a non contrast head CT showed a
cerebellar hemorrhage. The patient was intubated on arrival
for airway protection.

PAST MEDICAL HISTORY:  He has a past medical history of back
pain.

ALLERGIES:  None.

PHYSICAL EXAMINATION:  On physical examination, he was sleepy
but easily arousable to voice. The pupils were 4 to 3 mm on
the left and 3.5 to 2.5 on the right. The right eye was down
and he had a skewed deviation, right fourth nerve palsy. He
had a right facial droop. His tongue was midline. His palate
rose symmetrically. His tone was up in his lower extremities,
left greater than right. He had full power [**6-13**] throughout.
Sensation localizes to pain in all four extremities. Reflexes
- he was hyperreflexic, left greater than right. Toes were
upgoing bilaterally. Coordination - he had dysmetria
bilaterally, left greater than right.

His head CT showed a cerebellar hemorrhage, right greater
than left with blood in the third and fourth ventricles and
no hydrocephalus. The bleed was 1.9 x 3.4 x 3 cm with left
temporal [**Doctor Last Name 534**] ventricular dilation.

HOSPITAL COURSE:  He was admitted to the ICU for close
neurologic observation. The patient's mental status
deteriorated upon admission to the ICU and a ventricular
drain was placed without complication. It was leveled at 12
cm above the tragus. On [**6-20**], his eyes remained closed. He
had disconjugate gaze. He localizes the pain on the right
briskly and on the left. Toes were mute bilaterally. He did
withdraw his lower extremities. Pupils were 3 to 2 mm and
reactive. His blood pressure was kept less than 140. He had
an MRI scan that showed no enhancing lesions. The patient had
a repeat head CT on [**2103-6-21**] that was unchanged and
continued to show a large cerebellar hemorrhage with
extension into the third and fourth ventricles with slight
interval enlargement of the lateral ventricles. On
[**2103-6-22**], the patient underwent a diagnostic angiogram to
rule out presence of an AVM. The procedure was negative for
aneurysm or AVM. On the 15th, the patient continued to have
his eyes closed the majority of the time, opens with voice.
The pupils were 3 mm, localizing to pain in both upper
extremities, left greater than right. The patient remained
intubated this whole time. The patient had a chest x-ray on
[**6-25**] that showed right lung opacity. The patient was started
on Levo for suspected pneumonia and remained intubated. The
patient was extubated on [**2103-6-26**], continuing to have his
vent drain in place. He was evaluated by Speech and Swallow.
The patient had C-spine plain films that showed no fracture
or dislocation but multilevel degenerative changes. His
initial swallow evaluation was unsuccessful in swallowing on
his own. Therefore, an NG tube was placed. On [**2103-6-28**], the
patient's strength on the right side was less than previous
exams. He had a 4-/5 grasp on the right and incomplete
elevation of the right eye. He had an MRI scan of the brain
that showed signal change in the right greater than left
colliculi and central pons but no obvious cortical infarct.
His MRI of the cervical spine showed no injury but just
narrowing. On [**2103-6-29**], Stroke/Neurology was consulted
regarding the patient's right-sided weakness.
Stroke/Neurology recommended starting aspirin 10 days after
stroke for stroke prophylaxis and getting an echo, a lipid
panel with homocysteine and keeping his blood pressure less
than 140. On [**7-2**], the patient continued to have lateral
gaze nystagmus mainly on the right with slight right ptosis.
His grasp was [**4-13**] on the right, 4-/5 on the left. IPs were 4.
He continues to have diffuse weakness. The drain was elevated
to 20 cm above the tragus. Neurology recommended an EMG. The
patient continued to be followed by Physical Therapy and
Occupational Therapy. The patient had a head CT on [**2103-7-5**]
that showed no evidence of increased hydrocephalus with drain
being clamped. Therefore, on [**2103-6-6**], the vent drain was
discontinued. The patient had EMG study which just showed
evidence of ICU myopathy. He remained neurologically
unchanged with brisk antigravity strength on the left and
antigravity delay distally on the right. Grasp was [**4-13**] on the
right, [**6-13**] on the left. IPs - the right [**3-13**] and the left 4.
He neurologically remained stable. He had a repeat video
swallow study that showed the patient could tolerate nectar-
thick liquids and soft solids, hold giving meds and hold on
puree. His feeding tube was discontinued and the patient was
transferred to the regular floor on [**2103-7-7**] where he has
continued to be evaluated by Physical Therapy and
Occupational Therapy and felt to require Acute Rehab prior to
discharge to home.

DISCHARGE MEDICATIONS:  Metoprolol 75 mg po bid, hold for SBP
less than 100 and heart rate less than 55, Captopril 75 mg po
tid, hold for SBP less than 100, Percocet one to two tablets
po q4h, prn, Colace 100 mg po bid, citalopram hydrobromide 10
mg po qd, nicardipine 20 mg po q8h, hold for SBP less than
120, heparin 5000 units subcu q12h, Tylenol 650 po q4h prn.

CONDITION ON DISCHARGE:  The patient's condition was stable
at the time of discharge.

FOLLOW UP:  He will follow up with Dr. [**Last Name (STitle) 1132**] in one month
with repeat head CT.




                        [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2103-7-10**] 11:53:22
T:  [**2103-7-10**] 13:15:55
Job#:  [**Job Number 111104**]
{'Intracerebral hemorrhage,Pneumonia, organism unspecified'}


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: The patient is a 54 year old
Ethiopian gentleman who fell at work on [**6-1**] and sustained a
back and neck injury. He was at [**Hospital6 2910**]
having physical therapy on [**6-19**] when he had a sudden onset
of severe nausea, vomiting and vertigo. He was transferred to
[**Hospital1 69**] Emergency Room for
further evaluation after a non contrast head CT showed a
cerebellar hemorrhage. The patient was intubated on arrival
for airway protection.

MEDICAL HISTORY: He has a past medical history of back
pain.

MEDICATION ON ADMISSION: 

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Intracerebral hemorrhage,Pneumonia, organism unspecified'}
