CHIEF COMPLAINT: headache

PRESENT ILLNESS: Mr. [**Known lastname 31624**] is an 81-year-old right-handed man with PMH
significant for mitral valve replacement and CAD s/p stenting
presents with acute onset headache. He reports that he awoke at
2am c/o dull headache, localized to the right parietal region.
He felt nauseous (per call-in, he denies). He took a taxi into
the hospital and was given tylenol in the ED with improvement of
the headache. He
denies weakness, numbness, tingling, gait abnormalities, change
in vision, difficulty performing daily tasks, change in speech,
memory problems, difficulty concentrating, chest pain, dyspnea,
abdominal pain, vomiting, bowel/bladder symptoms, fevers,
chills, night sweats, weight loss, anorexia, or change in
energy.  He has had occasional "pain in [his] head from time to
time" recently, unsure if just a mild headache or similar to his
current
headache.

MEDICAL HISTORY: Aortic Stenosis s/p Aortic valve replacement [**3-/2132**] with porcine
valve
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping
CAD s/p stenting [**3-/2132**]

MEDICATION ON ADMISSION: metoprolol 25mg daily
simvastatin 20mg daily
NO aspirin or coumadin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.2, HR 58, BP 127/54, RR 14, SaO2 97%/RA
Genl: NAD, lying in bed
HEENT: NCAT, MMM, OP clear
Neck: no bruits, radiating murmur
CV: RRR, nl S1, S2, II/VI systolic murmur
Chest: CTAB
Abd: soft, NTND, BS+
Ext: warm and dry
<br>
Neurologic examination:
Mental status: Awake and [**Name (NI) 3584**], cooperative with exam, normal
affect. Oriented to person, place (from a list, cannot find name
"[**Hospital3 **]", and year, but not month ("[**Month (only) **]"). Speech is
fluent with normal comprehension and repetition; naming intact
except hammock (can get with phonemic cue). No dysarthria.
[**Location (un) **] intact except misses the first word of every sentence -
corrects when cued with finger in front of sentence. Registers
[**1-16**], recalls 0/3 in 5 minutes (1 with syntactic cue, 2 others
from list). No right-left confusion. No evidence of apraxia or
visual neglect. In line bisection, lines are bisected correctly
but misses the lines in his left superior visual field. Can
identify an "A" made out of small "B"'s. Describes cookie jar
picture initially as a woman at a bathroom sink with
stockingshanging out, but describes the left side of the picture
correctly and then identifies it as in a kitchen.
<br>
Cranial Nerves: Pupils equally round and minimally reactive to
light, 4mm bilaterally. Visual fields are notable for left
homonymous hemianopia, notable with visualization of red
stimulus, worse with left eye. Extraocular movements intact
bilaterally without nystagmus. Sensation intact V1-V3. Facial
movement symmetric. Hearing intact to finger rub bilaterally.
Palate elevation symmetric. Sternocleidomastoid and trapezius
full strength bilaterally. Tongue midline, movements intact.
<br>
Motor: Normal bulk and tone bilaterally. No observed myoclonus,
asterixis, or tremor. No pronator drift.
  [**Doctor First Name **] Tri [**Hospital1 **]  WE FE FF  IP  H  Q DF PF TE
R  5   5   5  5  5  5   5   5  5  5  5  5
L  5   5   5  5  5  5   5   5  5  5  5  5
<br>
Sensation: Intact to light touch, cold sensation throughout, and
position sense at big toes, decreased vibration at toes
bilaterally. No extinction to DSS. Identifies nickel in right
hand as a quarter, identifies dime in left hand as a button.
Able
to say the nickel is heavier. Decreased graphesthesia
bilaterally, with 1/3 numbers identified correctly on right and
[**12-19**] on left. Able to point to the correct touched spot on arm
but
overshoots the arm (especially when using the left hand to
identify spot on right hand).
<br>
Reflexes: 2+ and symmetric throughout. Toes downgoing
bilaterally.
<br>
Coordination: finger-nose-finger, finger-to-nose, fine finger
movements, and [**Doctor First Name **] normal.
<br>
Gait: Narrow based, steady.

FAMILY HISTORY: No coagulopathy, aneurysms, stroke. No known cardiopulmonary
disease. His parents lived until they reached ages greater than
90.

SOCIAL HISTORY: No tobacco, very rare and limited alcohol, no drug use. Widowed,
used to work as a research physicist at [**University/College **]. HCP - [**Name (NI) **] and
[**Name (NI) 31626**] [**Name (NI) 31627**] (sister-in-law and brother-in-law) in [**Name (NI) 31628**],
CT (does not know phone or street #).
Full code.
Intracerebral hemorrhage,Heart valve replaced by transplant,Other amyloidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status
Intracerebral hemorrhage,Heart valve transplant,Amyloidosis NEC,Crnry athrscl natve vssl,Hypertension NOS,Pure hypercholesterolem,Status-post ptca
Admission Date:  [**2134-7-5**]              Discharge Date:   [**2134-7-10**]

Date of Birth:  [**2052-11-16**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
headache


Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname 31624**] is an 81-year-old right-handed man with PMH
significant for mitral valve replacement and CAD s/p stenting
presents with acute onset headache. He reports that he awoke at
2am c/o dull headache, localized to the right parietal region.
He felt nauseous (per call-in, he denies). He took a taxi into
the hospital and was given tylenol in the ED with improvement of
the headache. He
denies weakness, numbness, tingling, gait abnormalities, change
in vision, difficulty performing daily tasks, change in speech,
memory problems, difficulty concentrating, chest pain, dyspnea,
abdominal pain, vomiting, bowel/bladder symptoms, fevers,
chills, night sweats, weight loss, anorexia, or change in
energy.  He has had occasional "pain in [his] head from time to
time" recently, unsure if just a mild headache or similar to his
current
headache.


Past Medical History:
Aortic Stenosis s/p Aortic valve replacement [**3-/2132**] with porcine
valve
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping
CAD s/p stenting [**3-/2132**]


Social History:
No tobacco, very rare and limited alcohol, no drug use. Widowed,
used to work as a research physicist at [**University/College **]. HCP - [**Name (NI) **] and
[**Name (NI) 31626**] [**Name (NI) 31627**] (sister-in-law and brother-in-law) in [**Name (NI) 31628**],
CT (does not know phone or street #).
Full code.


Family History:
No coagulopathy, aneurysms, stroke. No known cardiopulmonary
disease. His parents lived until they reached ages greater than
90.

Physical Exam:
VS: T 98.2, HR 58, BP 127/54, RR 14, SaO2 97%/RA
Genl: NAD, lying in bed
HEENT: NCAT, MMM, OP clear
Neck: no bruits, radiating murmur
CV: RRR, nl S1, S2, II/VI systolic murmur
Chest: CTAB
Abd: soft, NTND, BS+
Ext: warm and dry
<br>
Neurologic examination:
Mental status: Awake and [**Name (NI) 3584**], cooperative with exam, normal
affect. Oriented to person, place (from a list, cannot find name
"[**Hospital3 **]", and year, but not month ("[**Month (only) **]"). Speech is
fluent with normal comprehension and repetition; naming intact
except hammock (can get with phonemic cue). No dysarthria.
[**Location (un) **] intact except misses the first word of every sentence -
corrects when cued with finger in front of sentence. Registers
[**1-16**], recalls 0/3 in 5 minutes (1 with syntactic cue, 2 others
from list). No right-left confusion. No evidence of apraxia or
visual neglect. In line bisection, lines are bisected correctly
but misses the lines in his left superior visual field. Can
identify an "A" made out of small "B"'s. Describes cookie jar
picture initially as a woman at a bathroom sink with
stockingshanging out, but describes the left side of the picture
correctly and then identifies it as in a kitchen.
<br>
Cranial Nerves: Pupils equally round and minimally reactive to
light, 4mm bilaterally. Visual fields are notable for left
homonymous hemianopia, notable with visualization of red
stimulus, worse with left eye. Extraocular movements intact
bilaterally without nystagmus. Sensation intact V1-V3. Facial
movement symmetric. Hearing intact to finger rub bilaterally.
Palate elevation symmetric. Sternocleidomastoid and trapezius
full strength bilaterally. Tongue midline, movements intact.
<br>
Motor: Normal bulk and tone bilaterally. No observed myoclonus,
asterixis, or tremor. No pronator drift.
  [**Doctor First Name **] Tri [**Hospital1 **]  WE FE FF  IP  H  Q DF PF TE
R  5   5   5  5  5  5   5   5  5  5  5  5
L  5   5   5  5  5  5   5   5  5  5  5  5
<br>
Sensation: Intact to light touch, cold sensation throughout, and
position sense at big toes, decreased vibration at toes
bilaterally. No extinction to DSS. Identifies nickel in right
hand as a quarter, identifies dime in left hand as a button.
Able
to say the nickel is heavier. Decreased graphesthesia
bilaterally, with 1/3 numbers identified correctly on right and
[**12-19**] on left. Able to point to the correct touched spot on arm
but
overshoots the arm (especially when using the left hand to
identify spot on right hand).
<br>
Reflexes: 2+ and symmetric throughout. Toes downgoing
bilaterally.
<br>
Coordination: finger-nose-finger, finger-to-nose, fine finger
movements, and [**Doctor First Name **] normal.
<br>
Gait: Narrow based, steady.

Romberg -> sway, no fall.


Pertinent Results:
Labs:
WBC-5.5 RBC-3.77* HGB-12.2* HCT-35.3* MCV-94 MCH-32.3* MCHC-34.5
RDW-14.0
PLT COUNT-145*
PT-13.1 PTT-28.3 INR(PT)-1.1
GLUCOSE-93 UREA N-27* CREAT-1.5* SODIUM-139 POTASSIUM-4.1
CHLORIDE-106 TOTAL CO2-24 ANION GAP-13
GLUCOSE-90 UREA N-22* CREAT-1.4* SODIUM-137 POTASSIUM-4.4
CHLORIDE-104 TOTAL CO2-25 ANION GAP-12
CALCIUM-9.4 PHOSPHATE-3.0 MAGNESIUM-2.1
CK(CPK)-134 CK-MB-5 cTropnT-<0.01

<br>

Imaging:
Head CT:
1. Acute right parieto-occipital intraparenchymal hemorrhage
with mild surrounding edema but no significant midline shift.
There is associated intraventricular and subarachnoid
hemorrhage. Differential diagnosis includes amyloid, hemorrhagic
primary or metastatic lesion, or AVM.
2. Chronic appearing sinus disease involving the left maxillary
sinus.

<br>
MRI/MRA Head:
1. Right posterotemporal/occipital intraparenchymal hematoma
with adjacent subarachnoid hemorrhage and intraventricular blood
within the occipital horns of the lateral ventricles
bilaterally.
2. No underlying enhancing lesions or vascular malformations are
seen.
3. Superficial siderosis of the right frontal lobe.

<br>
CT Torso:
1. No site of possible malignancy was identified.
2. Multiple simple cysts of both kidneys.
3. Fibrotic changes of both lung apices are noted.
4. Fecal impaction noted.

<br>
ECHO: The left atrium is mildly dilated. There is mild symmetric
left ventricular hypertrophy with normal cavity size and
systolic function (LVEF>55%). Right ventricular chamber size and
free wall motion are normal. A bioprosthetic aortic valve
prosthesis is present. The aortic valve prosthesis appears well
seated, with normal leaflet/disc motion and transvalvular
gradients. No masses or vegetations are seen on the aortic
valve. The mitral valve leaflets are mildly thickened. There is
mild mitral valve prolapse. Moderate (2+) mitral regurgitation
is seen. There is borderline pulmonary artery systolic
hypertension. There is no pericardial effusion.

Compared with the report of the prior study (images unavailable
for review) of [**2132-1-22**], a bioprosthetic aortic valve is now
present. Mild bileaflet mitral valve prolapse is now
appreciated. The severity of mitral regurgitation is unchanged.
Estimated pulmonary artery systolic pressures are higher. No
vegetations are visualized on the valves. If clinically
indicated, a TEE may better assess for prosthetic valve
endocarditis.


Brief Hospital Course:
Mr. [**Known lastname 31624**] is an 81-year-old man with a history of CAD and
aortic valve relacement who presented with a headache and was
found to have a right parieto-occipital hemorrhage. His hospital
course was as follows:

1. Neuro: Intraparenchymal hemorrhage. This was seen on CT and a
repeat CT was stable. MRI showed superficial siderosis,
suggesting amyloid angiopathy as the etiology. A CT torso was
negative for malignancy. He was admitted to the Neuro ICU for
close observation and blood pressure control. His MAP stayed
under 130 and he was called out to the floor. He was continued
on an insulin sliding scale and Tylenol to maintain euglycemia
and euthermia. He was not given anti-epileptics as they would
not be indicated unless he had a seizure.

2. CAD. He had his beta blocker increased to 25 [**Hospital1 **] for better
BP control. His statin was increased to 40 following an LDL
result of 121. Aspirin was held until his follow-up Neurology
appointment.

3. Full code

4. Dispo: He was evaluated by PT and OT; OT felt he would
benefit from rehab.

Medications on Admission:
metoprolol 25mg daily
simvastatin 20mg daily
NO aspirin or coumadin

All: NKDA


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for fever or pain.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
4. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 2558**] - [**Location (un) **]

Discharge Diagnosis:
Primary:
1. Intraparenchymal hemorrhage, right parieto-temporal

Secondary:
1. Coronary artery disease


Discharge Condition:
Good condition, ambulating and eating independently. Neuro exam
notable for disorientation, impaired attention, impaired recall;
4/5 strength in left deltoid, triceps, wrist extension; VF
defect in left upper quadrant. Otherwise normal.


Discharge Instructions:
You have been evalauted for a headache. You were found to have a
hemorrhage in your brain. This has impacted your cognitive
function. You have had your Lopressor and Zocor increased to
better control your blood pressure and cholesterol. Please take
all medications as directed and keep all follow-up appointments.

If you develop new vision changes, difficulty swallowing,
difficulty speaking, facial droop, dizziness, seizure activity,
specific muscle weakness, loss of sensation, chest pain,
shortness of breath, palpitations, or any other symptom that is
concerning to you, please call your PCP or your neurologist or
go to the nearest hospital emergency department.

Followup Instructions:
You will be called to set up an appointment with Dr. [**Last Name (STitle) **] in
Neuro-Ophthalmology.

Please call your PCP ([**Last Name (LF) **],[**First Name3 (LF) **] A. [**Telephone/Fax (1) 250**]) to
schedule an appointment in [**11-17**] weeks.

You have the following appointments scheduled:
1. NEUROLOGY Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 162**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2134-8-9**] 2:00

2. Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2134-9-20**] 11:00


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]

Completed by:[**2134-7-10**]
{'Intracerebral hemorrhage,Heart valve replaced by transplant,Other amyloidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status'}


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

PRESENT ILLNESS: Mr. [**Known lastname 31624**] is an 81-year-old right-handed man with PMH
significant for mitral valve replacement and CAD s/p stenting
presents with acute onset headache. He reports that he awoke at
2am c/o dull headache, localized to the right parietal region.
He felt nauseous (per call-in, he denies). He took a taxi into
the hospital and was given tylenol in the ED with improvement of
the headache. He
denies weakness, numbness, tingling, gait abnormalities, change
in vision, difficulty performing daily tasks, change in speech,
memory problems, difficulty concentrating, chest pain, dyspnea,
abdominal pain, vomiting, bowel/bladder symptoms, fevers,
chills, night sweats, weight loss, anorexia, or change in
energy.  He has had occasional "pain in [his] head from time to
time" recently, unsure if just a mild headache or similar to his
current
headache.

MEDICAL HISTORY: Aortic Stenosis s/p Aortic valve replacement [**3-/2132**] with porcine
valve
s/p Pneumonia [**2130**]
s/p Bilat. Inguinal hernia repair
s/p Deviated septum repair
s/p Tonsillectomy
s/p Bilat. saphenous vein stripping
CAD s/p stenting [**3-/2132**]

MEDICATION ON ADMISSION: metoprolol 25mg daily
simvastatin 20mg daily
NO aspirin or coumadin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 98.2, HR 58, BP 127/54, RR 14, SaO2 97%/RA
Genl: NAD, lying in bed
HEENT: NCAT, MMM, OP clear
Neck: no bruits, radiating murmur
CV: RRR, nl S1, S2, II/VI systolic murmur
Chest: CTAB
Abd: soft, NTND, BS+
Ext: warm and dry
<br>
Neurologic examination:
Mental status: Awake and [**Name (NI) 3584**], cooperative with exam, normal
affect. Oriented to person, place (from a list, cannot find name
"[**Hospital3 **]", and year, but not month ("[**Month (only) **]"). Speech is
fluent with normal comprehension and repetition; naming intact
except hammock (can get with phonemic cue). No dysarthria.
[**Location (un) **] intact except misses the first word of every sentence -
corrects when cued with finger in front of sentence. Registers
[**1-16**], recalls 0/3 in 5 minutes (1 with syntactic cue, 2 others
from list). No right-left confusion. No evidence of apraxia or
visual neglect. In line bisection, lines are bisected correctly
but misses the lines in his left superior visual field. Can
identify an "A" made out of small "B"'s. Describes cookie jar
picture initially as a woman at a bathroom sink with
stockingshanging out, but describes the left side of the picture
correctly and then identifies it as in a kitchen.
<br>
Cranial Nerves: Pupils equally round and minimally reactive to
light, 4mm bilaterally. Visual fields are notable for left
homonymous hemianopia, notable with visualization of red
stimulus, worse with left eye. Extraocular movements intact
bilaterally without nystagmus. Sensation intact V1-V3. Facial
movement symmetric. Hearing intact to finger rub bilaterally.
Palate elevation symmetric. Sternocleidomastoid and trapezius
full strength bilaterally. Tongue midline, movements intact.
<br>
Motor: Normal bulk and tone bilaterally. No observed myoclonus,
asterixis, or tremor. No pronator drift.
  [**Doctor First Name **] Tri [**Hospital1 **]  WE FE FF  IP  H  Q DF PF TE
R  5   5   5  5  5  5   5   5  5  5  5  5
L  5   5   5  5  5  5   5   5  5  5  5  5
<br>
Sensation: Intact to light touch, cold sensation throughout, and
position sense at big toes, decreased vibration at toes
bilaterally. No extinction to DSS. Identifies nickel in right
hand as a quarter, identifies dime in left hand as a button.
Able
to say the nickel is heavier. Decreased graphesthesia
bilaterally, with 1/3 numbers identified correctly on right and
[**12-19**] on left. Able to point to the correct touched spot on arm
but
overshoots the arm (especially when using the left hand to
identify spot on right hand).
<br>
Reflexes: 2+ and symmetric throughout. Toes downgoing
bilaterally.
<br>
Coordination: finger-nose-finger, finger-to-nose, fine finger
movements, and [**Doctor First Name **] normal.
<br>
Gait: Narrow based, steady.

FAMILY HISTORY: No coagulopathy, aneurysms, stroke. No known cardiopulmonary
disease. His parents lived until they reached ages greater than
90.

SOCIAL HISTORY: No tobacco, very rare and limited alcohol, no drug use. Widowed,
used to work as a research physicist at [**University/College **]. HCP - [**Name (NI) **] and
[**Name (NI) 31626**] [**Name (NI) 31627**] (sister-in-law and brother-in-law) in [**Name (NI) 31628**],
CT (does not know phone or street #).
Full code. 

### Response:
{'Intracerebral hemorrhage,Heart valve replaced by transplant,Other amyloidosis,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status'}
