CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 60 year old man with a
past medical history significant for generalized tonic/clonic
seizures since age 7 (has never been seizure free).  He now
presents from an outside hospital after seizure on [**2111-1-9**]
and subsequently hitting his head on concrete and developing
a subarachnoid hemorrhage.  He states that his typical
seizures come on without warning and he is not sure how long
they last but is told that both his arms and legs shake and
he recalls having bitten his tongue on occasion and loss of
control of his bladder/bowel.  He states that his seizures
are all typically the same and he has about one per month but
some are at night and he is not sure how often these occur
(His wife has told him about them before.).  He said that
several days before admission, he was walking ([**2111-1-9**]) down
the street to his daughter's house and suddenly had one of
these seizures, without warning, and hit his head on the
concrete.  He doesn't recall what happened after that but
apparently someone called 911 and brought him to the
hospital.  The next thing he remembers is awakening in the
hospital and he says that was his longest post ictal period.
He does mention that on the day of the seizure, he had been
having a sore throat and a dry cough.  He had gone to his
primary care physician who diagnosed him with a upper
respiratory infection.  Since then, he has had some low grade
temperatures but no congestion.  He said that he has a
throbbing headache in the bitemporal region currently, not
relieved by Tylenol and not accompanied by photophobia,
nausea or vomiting.  He has had this headache only since
being hospitalized and it has moved from the bifrontal region
to the bitemporal region over the last couple of days.  He
states that he has had no visual changes, no numbness or
weakness and no other pain.  He says that at home, he is on
Dilantin 100 mg three times a day, Phenobarbital 120 mg q
h.s. and Zonegran 300 mg q h.s.  Per a note by Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
in [**Month (only) 404**], Mr. [**Name14 (STitle) 32504**] has imbalance and osteoporosis from
long term Dilantin therapy and the plan at that time was to
decrease the Dilantin and gradually increase the Zonegran.
At the outside hospital, Mr. [**Name14 (STitle) 32504**] was on Dilantin 100 mg
four times a day, Phenobarbital 60 mg q h.s. and Zonegran 200
mg q h.s. It is unclear how or why his medications were
changed in this way.

MEDICAL HISTORY: Seizure disorder.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No seizures.

SOCIAL HISTORY: He is retired.  Audiovisual technician. He
is married.  He quit smoking ten years ago.  No alcohol.
Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Superficial injury of cornea,Osteoporosis, unspecified,Fall from other slipping, tripping, or stumbling,Other disorders of neurohypophysis,Epilepsy, unspecified, without mention of intractable epilepsy
Cl skl w oth fx-coma NOS,Food/vomit pneumonitis,Fx dorsal vertebra-close,Superficial inj cornea,Osteoporosis NOS,Fall from slipping NEC,Neurohypophysis dis NEC,Epilep NOS w/o intr epil
Admission Date:  [**2111-1-13**]       Discharge Date:  [**2111-2-2**]

Date of Birth:   [**2050-7-19**]       Sex:  M

Service:  [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.

HISTORY OF PRESENT ILLNESS:  This is a 60 year old man with a
past medical history significant for generalized tonic/clonic
seizures since age 7 (has never been seizure free).  He now
presents from an outside hospital after seizure on [**2111-1-9**]
and subsequently hitting his head on concrete and developing
a subarachnoid hemorrhage.  He states that his typical
seizures come on without warning and he is not sure how long
they last but is told that both his arms and legs shake and
he recalls having bitten his tongue on occasion and loss of
control of his bladder/bowel.  He states that his seizures
are all typically the same and he has about one per month but
some are at night and he is not sure how often these occur
(His wife has told him about them before.).  He said that
several days before admission, he was walking ([**2111-1-9**]) down
the street to his daughter's house and suddenly had one of
these seizures, without warning, and hit his head on the
concrete.  He doesn't recall what happened after that but
apparently someone called 911 and brought him to the
hospital.  The next thing he remembers is awakening in the
hospital and he says that was his longest post ictal period.
He does mention that on the day of the seizure, he had been
having a sore throat and a dry cough.  He had gone to his
primary care physician who diagnosed him with a upper
respiratory infection.  Since then, he has had some low grade
temperatures but no congestion.  He said that he has a
throbbing headache in the bitemporal region currently, not
relieved by Tylenol and not accompanied by photophobia,
nausea or vomiting.  He has had this headache only since
being hospitalized and it has moved from the bifrontal region
to the bitemporal region over the last couple of days.  He
states that he has had no visual changes, no numbness or
weakness and no other pain.  He says that at home, he is on
Dilantin 100 mg three times a day, Phenobarbital 120 mg q
h.s. and Zonegran 300 mg q h.s.  Per a note by Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
in [**Month (only) 404**], Mr. [**Name14 (STitle) 32504**] has imbalance and osteoporosis from
long term Dilantin therapy and the plan at that time was to
decrease the Dilantin and gradually increase the Zonegran.
At the outside hospital, Mr. [**Name14 (STitle) 32504**] was on Dilantin 100 mg
four times a day, Phenobarbital 60 mg q h.s. and Zonegran 200
mg q h.s. It is unclear how or why his medications were
changed in this way.

PAST MEDICAL HISTORY:  Seizure disorder.

ALLERGIES:  No known drug allergies.

MEDICATIONS AT HOME:
1.  Dilantin 100 mg three times a day.
2.  Phenobarbital 120 mg q h.s.
3.  Zonegran 300 mg q h.s.
4.  Multi-vitamins.
5.  Calcium.
6.  Vitamin D.

SOCIAL HISTORY:  He is retired.  Audiovisual technician. He
is married.  He quit smoking ten years ago.  No alcohol.

FAMILY HISTORY:  No seizures.

PHYSICAL EXAMINATION:  Temperature 100.8; blood pressure
144/86; heart rate 70; oxygen saturation 96% on room air;
weight 86.2 kg.  General:  Medical examination unremarkable.
Neurologic:  Alert and oriented times three.  Speech fluent
with no paraphasic errors.  Able to related detailed history
of present illness with good memory of past and recent
events.  Cranial nerves:  Pupils equal round and reactive to
light.  Extraocular movements intact with end gaze nystagmus
bilaterally.  Visual fields full to confrontation.  Facial
sensation intact. He does have a lower motor neuron cranial
nerve 7 palsy on the right.  The tongue protrudes in the
midline without fasciculation.  Sternocleidomastoid is intact
bilaterally.  Shoulder shrug intact bilaterally.  Motor:
Normal bulk and tone throughout. No fasciculations.  No
pronator drift.  Full strength in upper and lower extremities
bilaterally. Reflexes symmetric throughout with toes down
going bilaterally.  Sensation intact bilaterally to light
touch, temperature, pin prick and vibration in all
extremities.  Coordination:  Finger to nose, rapid
alternating movements and fine finger movements intact
bilaterally.  Gait deferred.

LABORATORY DATA:  On [**1-28**], white count was 7.7; hematocrit was
40.2.  Platelet count was 567. INR of 1.1.  The patient did
have a urinary tract infection transiently and grew group B
strep; however, most recent urinalysis on [**12/2035**] was negative.
Cerebrospinal fluid showed 92 white cells, 139 red cells,
positive xanthochromia. Sodium of 135; potassium of 4.4;
creatinine of 0.6; BUN 16; chloride 103; bicarbonate 23;
glucose 121; ALT 32; AST 22; alkaline phosphatase of 115;
total bilirubin of 0.2; lipase of 42; calcium 8.6; phosphate
3.0; magnesium 1.9.  Phenytoin was discontinued.
Cerebrospinal fluid protein was 63 and glucose was 66.  Blood
cultures revealed no growth in several sets of blood culture.
Urine culture grew some coagulase negative staphylococcus
10,000 to 100,000 colonies and beta strep group B over
100,000 organisms per ml.  Cerebrospinal fluid was negative.

CT on admission on [**2111-1-13**] showed subarachnoid in the
intrapeduncular cistern; left sylvian fissure and a few
frontal sulci.  There is bifrontal contusion, left greater
than right and probably subdural blood.  There is a
parenchymal hemorrhage measuring 10 by 19 mm in the left
temporal lobe and a small, adjacent subdural hemorrhage along
the course of the greater sphenoid [**Doctor First Name 362**].  Tentorium is dense
and thickened, suggestive of a subdural hematoma under the
tentorium.  There is a slight rightward shift of structures
but no sub false herniation. The ventricular size is not
significantly changed since the prior study.  There has been
intraventricular blood, [**Doctor Last Name 352**] white matter differentiation is
otherwise preserved.  In the comparison images, extra axial
hemorrhage is seen around the frontal lobes but the region of
parenchymal hemorrhage is not present.  Also, the thickness
of the tentorium on this study is more prominent than the
study from four days prior at the outside hospital.
Therefore, there was evolution of the parenchymal hemorrhages
with probable subdural under the tentorium and subarachnoid
and intraventricular hemorrhage.

Magnetic resonance scan of the cervical spine showed at C3-4
intervertebral osteophyte formation and no canal stenosis.
C4-5 osteophytic changes, especially on the right at C5-6;
again osteophytic changes, resulting in mild canal narrowing
and mild foraminal narrowing at this level as well, C5-6.
There is left sided intravertebral osteophytic changes and
moderate left sided foraminal narrowing.  In addition, there
may be a left sided lateral disc protrusion at this level.
At C7-T1, there is a midline disc protrusion which is focal;
however, it does not touch the cord.  Question artifact
limits full evaluation for ligamentous injury but none is
seen.

Repeat head CT most recently on [**2111-1-25**] showed no change,
simply evolution of the hemorrhage.  Chest x-ray on [**2111-1-25**]
showed only some left base atelectasis.  Magnetic resonance
scan of the thoracic spine showed no acute fractures but
compression fracture at T12 with a possible signal change to
suggest an acute component.  There are also compression
fractures of L1 and L3 but no signal changes in the vertebral
bodies to suggest acute fractures.  The alignment is
maintained at L3-L4.  There is a mild paracentral disc
protrusion, left greater than right, with mild indentation of
the thecal sac. There is a right sided foraminal narrowing at
this level; however, no impingement on the exiting nerve root
sleeve.  There are numerous compression fractures in the
thoracic spine, most of which are old.

HOSPITAL COURSE:  The patient was admitted to the neurology
service. He received a head CT upon arrival and after the
discovery that there was new blood on his head CT, he was
briefly admitted to the Intensive Care Unit.  He remained
stable there and repeat head CT on discharge was unchanged.
He required no medications to control his blood pressure.
During his hospital course, he became very lethargic and
unmotivated which was attributed namely to the bifrontal
hemorrhages; however, there was a point when he started
having temperature spikes to 102 and once as high as 103.  It
was discovered that he was growing group B strep in his
urine.  Infectious disease consult was called, who did not
feel that the urine was causing this high of a fever but did
suggest antibiotic regimen.  The patient received a course of
Clindamycin and Aztreonam and eventually the Aztreonam was
discontinued, as the patient stopped having fevers and there
was no other evidence of infection found.

The patient also continued to have severe head pain due to
the blood, as well as due to his occipital skull fracture and
perhaps also due to compression fractures in the spine.  Pain
control remained an issue.  We attempted not to place him on
any ANSAID.  He was started on scheduled Tylenol plus
Oxy-Contin around the clock and prn Oxycodone.  He did well
on that, yet became quite somnolent and, as this was
decreased, he began to awake.  Pain consult was called and
suggested continuing the Oxy-Contin 10 mg q. 8 hours with prn
Oxycodone.  They also suggested starting Clonidine .1 mg
twice a day as well as Vioxx 25 mg q. day.  The Vioxx should
not have any affect on platelet function or cause any chance
of increased hemorrhage.

In respect to his seizures, the patient did have several
seizures during the admission. Initially, he was on Dilantin
and when his Dilantin level dropped to 6.8, he was reloaded
on the Dilantin.  He had no further seizures until we
attempted to decrease the Dilantin.  The patient's outpatient
neurologist who had wanted, prior to this hospitalization, to
stop the Dilantin all together, had increased his Zonegran
and so this was done as an inpatient.  The patient was
gradually tapered off the Dilantin and increased on the
Zonegran.  The patient's most recent seizure was a very brief
seizure on [**2110-1-28**] in the evening, generalized tonic/clonic,
lasting for less than 30 seconds, which quickly resolved
without incident.  The patient was given just prn Ativan for
seizures at this point, while waiting for his blood levels of
Zonegran to rise.  The patient was also kept on EEG 24 hour
monitoring for several days.  The EEG showed a push-button
event on [**2111-1-30**] where there was a generalized fashion and
progression and prominent generalized Delta frequency
slowing; no clear epileptiform changes that appeared to be a
generalized seizure, although there were no frank spike
discharge seen at the time of the push-button event.  The
background was mildly slow, suggestive of encephalopathy. In
addition, there was right more than left bifrontal mixed
Delta and Beta frequency slowing seen.  There were some sharp
features in the right frontal region as well.

The patient also had a lower motor neuron cranial nerve 7
palsy.  The etiology of thought to be secondary to his trauma
and skull fracture. However, the patient did seem to sustain a
corneal abrasion perhaps and he was placed on Lacrilube ointment
was well as eye patch for his right eye.  The cranial nerve 7
palsy did not change throughout the admission.  The patient also
seemed to have no other focal neurologic deficits.  The patient
was also seen by physical therapy who recommended acute
rehabilitation. The patient was otherwise well and says that his
pain is now much better controlled.

DISCHARGE MEDICATIONS:
1.  Colace 100 mg p.o. twice a day.
2.  Dulcolax 10 mg p.o. q. day prn.
3.  Calcium carbonate 500 mg three times a day.
4.  Vitamin D 400 i.u. p.o. q. day.
5.  Phenobarbital 120 mg p.o. q h.s.
6.  Salt tabs, one gram p.o. three times a day.
7.  Senna one tablet p.o. twice a day.
8.  Protonix 40 mg p.o. q. day.
9.  Polyvinyl alcohol 1.4% eye drops, one to two drops prn
o.d.
10. Oxycodone 10 to 15 mg q. four to six hours as needed for
pain.
11. Zonegran 500 mg p.o. q h.s.
12. Tylenol 650 mg p.o. q. four hours.
13. Oxycodone 10 mg p.o. q. eight hours.
14. Erythromycin 5 mg per gram ointment, one drop o.d. four
times a day.
15. Clonidine 0.1 mg p.o. twice a day.
16. Vioxx 25 mg p.o. q. day.
17. Artificial tear ointment, one drop o.d. prn.
18. Ativan 2 mg intravenous prn for seizure more than two
minutes and please keep an eye patch on his right eye at all
times.

FOLLOW-UP:
The patient has follow-up appointments with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 856**]
in the neurology office on [**2111-3-20**] at 11:15 a.m. and with Dr.
[**Last Name (STitle) 851**] on [**2111-9-24**] at 11:15 a.m.  The patient is
discharged in good condition to rehabilitation.






                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD  [**MD Number(1) 32505**]

Dictated By:[**Last Name (NamePattern1) 10034**]
MEDQUIST36

D:  [**2111-1-29**]  03:26
T:  [**2111-1-30**]  15:52
JOB#:  [**Job Number 32506**]
{'Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Superficial injury of cornea,Osteoporosis, unspecified,Fall from other slipping, tripping, or stumbling,Other disorders of neurohypophysis,Epilepsy, unspecified, without mention of intractable epilepsy'}


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: This is a 60 year old man with a
past medical history significant for generalized tonic/clonic
seizures since age 7 (has never been seizure free).  He now
presents from an outside hospital after seizure on [**2111-1-9**]
and subsequently hitting his head on concrete and developing
a subarachnoid hemorrhage.  He states that his typical
seizures come on without warning and he is not sure how long
they last but is told that both his arms and legs shake and
he recalls having bitten his tongue on occasion and loss of
control of his bladder/bowel.  He states that his seizures
are all typically the same and he has about one per month but
some are at night and he is not sure how often these occur
(His wife has told him about them before.).  He said that
several days before admission, he was walking ([**2111-1-9**]) down
the street to his daughter's house and suddenly had one of
these seizures, without warning, and hit his head on the
concrete.  He doesn't recall what happened after that but
apparently someone called 911 and brought him to the
hospital.  The next thing he remembers is awakening in the
hospital and he says that was his longest post ictal period.
He does mention that on the day of the seizure, he had been
having a sore throat and a dry cough.  He had gone to his
primary care physician who diagnosed him with a upper
respiratory infection.  Since then, he has had some low grade
temperatures but no congestion.  He said that he has a
throbbing headache in the bitemporal region currently, not
relieved by Tylenol and not accompanied by photophobia,
nausea or vomiting.  He has had this headache only since
being hospitalized and it has moved from the bifrontal region
to the bitemporal region over the last couple of days.  He
states that he has had no visual changes, no numbness or
weakness and no other pain.  He says that at home, he is on
Dilantin 100 mg three times a day, Phenobarbital 120 mg q
h.s. and Zonegran 300 mg q h.s.  Per a note by Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **]
in [**Month (only) 404**], Mr. [**Name14 (STitle) 32504**] has imbalance and osteoporosis from
long term Dilantin therapy and the plan at that time was to
decrease the Dilantin and gradually increase the Zonegran.
At the outside hospital, Mr. [**Name14 (STitle) 32504**] was on Dilantin 100 mg
four times a day, Phenobarbital 60 mg q h.s. and Zonegran 200
mg q h.s. It is unclear how or why his medications were
changed in this way.

MEDICAL HISTORY: Seizure disorder.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: No seizures.

SOCIAL HISTORY: He is retired.  Audiovisual technician. He
is married.  He quit smoking ten years ago.  No alcohol. 

### Response:
{'Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Pneumonitis due to inhalation of food or vomitus,Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury,Superficial injury of cornea,Osteoporosis, unspecified,Fall from other slipping, tripping, or stumbling,Other disorders of neurohypophysis,Epilepsy, unspecified, without mention of intractable epilepsy'}
