CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 68 yo female w/ PMHx sig for pancreatic body cyst
s/p Whipple, TAH BSO, and HTN who presents with headache.  Pt
states that she was coughing a great deal two weeks ago b/c of
irritation in her airway.  Ten days ago she recalls coughing so
hard that she felt acute onset pain on the left side of her head
that was throbbing in nature.  She had a persistent headache
that
was relieved by Ibuprofen.  She was recently treated by her PCP
for bronchitis.  Based on her persistent headache symptoms an
MRI
was ordered and shows a left frontal SAH.  She was then sent to
[**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: Pancreatic body cyst s/p Whipple
Hypercholesterolemia
PSH: Lumbar spine surgery [**2161**]
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
[**2161**]
Endoscopic ultrasound and Colonoscopy in [**2166**] that showed no
polyps.

MEDICATION ON ADMISSION: None

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals: T 98.3; BP 151/79; P 76; RR 18; O2 sat 97%

FAMILY HISTORY: Mother had coronary artery disease
Father had malignancies of the esophagus and stomach.
Brother had lung cancer and another had non-Hodgkin's lymphoma.
No detailed history of any pancreatic condition including
pancreatic cancer or pancreatitis or gallstones.

SOCIAL HISTORY: Tobacco 1 pack a day for 50 years. Rare ETOH use.
No known environmental exposures.
Subarachnoid hemorrhage,Pure hypercholesterolemia,Unspecified essential hypertension
Subarachnoid hemorrhage,Pure hypercholesterolem,Hypertension NOS
Admission Date:  [**2173-2-23**]              Discharge Date:   [**2173-2-24**]

Date of Birth:  [**2104-6-3**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
[**2173-2-23**]: Cerebral angiogram

History of Present Illness:
68 yo female w/ PMHx sig for pancreatic body cyst
s/p Whipple, TAH BSO, and HTN who presents with headache.  Pt
states that she was coughing a great deal two weeks ago b/c of
irritation in her airway.  Ten days ago she recalls coughing so
hard that she felt acute onset pain on the left side of her head
that was throbbing in nature.  She had a persistent headache
that
was relieved by Ibuprofen.  She was recently treated by her PCP
for bronchitis.  Based on her persistent headache symptoms an
MRI
was ordered and shows a left frontal SAH.  She was then sent to
[**Hospital1 18**] for further evaluation.


Past Medical History:
Pancreatic body cyst s/p Whipple
Hypercholesterolemia
PSH: Lumbar spine surgery [**2161**]
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
[**2161**]
Endoscopic ultrasound and Colonoscopy in [**2166**] that showed no
polyps.

Social History:
Tobacco 1 pack a day for 50 years. Rare ETOH use.
No known environmental exposures.


Family History:
Mother had coronary artery disease
Father had malignancies of the esophagus and stomach.
Brother had lung cancer and another had non-Hodgkin's lymphoma.
No detailed history of any pancreatic condition including
pancreatic cancer or pancreatitis or gallstones.


Physical Exam:
Vitals: T 98.3; BP 151/79; P 76; RR 18; O2 sat 97%

General: lying in bed NAD
HEENT: NCAT, moist mucous membranes
Neck: supple, no carotid bruit
Pulmonary: CTA b/l
Cardiac: regular rate and rhythm, with no m/r/g
Carotids: no blood flow murmur
Abdomen: soft, nontender, non distended, normal bowel sounds
Extremities: no c/c/e.

Neurological Exam:
Mental status: A & O x3, relays coherent story.  Fluent speech
with no paraphasic or phonemic errors.  Adequate comprehension.
Follows simple and multi-step commands.

Cranial Nerves:
I: Not tested
II: PERRL, 4-->2mm with light. optic discs sharp.  VFF.
III, IV, VI: EOMI. no nystagmus.
V, VII: facial sensation intact, facial strength
VIII: hearing intact b/l to finger rubbing.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: SCM [**5-22**]
XII: Tongue midline without fasciculations.

Motor: Normal bulk. Normal tone. No pronator drift.

     Delt Tri [**Hospital1 **] WE WF FE FF IP QD Ham DF PF [**Last Name (un) 938**] EDB
RT:   5    5  5   5 5  5  5  5  5  5   5  5   5   5
LEFT: 5    5  5   5 5  5  5  5  5  5   5  5   5   5

Sensation: intact to pinprick, light touch, vibration, and
position sense.  Does not extinguish to double simultaneous
stimulation

Reflexes: Bic T Br Pa Ac
Right      2  2 2  2  2
Left       2  2 2  2  2
Toes downgoing bilaterally.

Coordination: FNF intact.


Brief Hospital Course:
Admitted to SICU for close monitoring. She was started on
Dilantin and Nimodipine.  Uneventful course. MRI head - evidence
of left frontal subarachnoid hemorrhage, as well as blood within
the left sylvian fissure.  possible small component of left
frontal subdural hematoma.  bilobed aneurysm seen at basilar
tip, in region of takeoff of left PCA. saccular portion of
aneurysm measures approx. 6mm, with neck measuring approx. 4mm.
no blood seen adjacent to aneurysm. it was difficult to relate
the left frontal and sylvian fissure blood to the aneurysm,
however, no 2nd aneurysm is identified.

HD2 AM went for cerebral angiogram that demonstrated 2
additional aneurysms near the carotid bifurcation that could not
be emoblized.  At this point it was decided to transfer patient
to [**Hospital1 2025**] for further care of her cerebral aneurysms.  Patient
agreed with this plan.

Medications on Admission:
None

Discharge Medications:
Phenytoin 100 mg PO TID
Labetalol HCl 10 mg IV Q6H:PRN SBP > 140
Nimodipine 30 mg PO Q2H Hold for SBP < 100 or HR < 55

Discharge Disposition:
Extended Care

Facility:
[**Hospital6 1129**]

Discharge Diagnosis:
Multiple cerebral aneurysms
Left frontal subarachnoid hemorrhage

Discharge Condition:
Stable

Discharge Instructions:
Being discharged to [**Hospital1 2025**] for further care of cerebral aneurysms.

Followup Instructions:
Care per [**Hospital1 2025**] team.

                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2173-2-23**]

Name:  [**Known lastname **],[**Known firstname 5210**]                 Unit No:   [**Numeric Identifier 11641**]

Admission Date:  [**2173-2-23**]              Discharge Date:   [**2173-2-24**]

Date of Birth:  [**2104-6-3**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1698**]
Addendum:
[**Hospital1 2239**] did not have bed available and pt was accepted to [**Hospital1 **] Neurosurgery dept - Dr. [**Last Name (STitle) **] service. Transfer will
be arranged.

Discharge Disposition:
Extended Care

                             [**Name6 (MD) **] [**Name8 (MD) 1041**] MD [**MD Number(2) 1709**]

Completed by:[**2173-2-24**]
{'Subarachnoid hemorrhage,Pure hypercholesterolemia,Unspecified essential hypertension'}


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: 68 yo female w/ PMHx sig for pancreatic body cyst
s/p Whipple, TAH BSO, and HTN who presents with headache.  Pt
states that she was coughing a great deal two weeks ago b/c of
irritation in her airway.  Ten days ago she recalls coughing so
hard that she felt acute onset pain on the left side of her head
that was throbbing in nature.  She had a persistent headache
that
was relieved by Ibuprofen.  She was recently treated by her PCP
for bronchitis.  Based on her persistent headache symptoms an
MRI
was ordered and shows a left frontal SAH.  She was then sent to
[**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: Pancreatic body cyst s/p Whipple
Hypercholesterolemia
PSH: Lumbar spine surgery [**2161**]
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
[**2161**]
Endoscopic ultrasound and Colonoscopy in [**2166**] that showed no
polyps.

MEDICATION ON ADMISSION: None

ALLERGIES: Penicillins

PHYSICAL EXAM: Vitals: T 98.3; BP 151/79; P 76; RR 18; O2 sat 97%

FAMILY HISTORY: Mother had coronary artery disease
Father had malignancies of the esophagus and stomach.
Brother had lung cancer and another had non-Hodgkin's lymphoma.
No detailed history of any pancreatic condition including
pancreatic cancer or pancreatitis or gallstones.

SOCIAL HISTORY: Tobacco 1 pack a day for 50 years. Rare ETOH use.
No known environmental exposures. 

### Response:
{'Subarachnoid hemorrhage,Pure hypercholesterolemia,Unspecified essential hypertension'}
