CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 69 year-old female
transferred from [**Hospital **] Hospital with an intraventricular
hemorrhage and an INR of 10.  The patient has a past medical
history of a left ischemic cerebrovascular accident, atrial
fibrillation, hypertension, hypothyroidism, rheumatid
arthritis.  She is on Coumadin at home and had a witnessed
fall on the day of admission.  There was a questionable loss
of consciousness and a confusion with headache.  The patient
is currently awake with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma scale at outside
hospital at 15.  There is also a question of a right wrist
avulsion fracture.  The patient has baseline right sided
weakness secondary to an old cerebrovascular accident.  The
patient is status post receiving 4 units of fresh frozen
platelets at an outside hospital and vitamin K.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke or drink alcohol.
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Unspecified fall,Anticoagulants causing adverse effects in therapeutic use
Brain hem NEC w/o coma,Atrial fibrillation,Urin tract infection NOS,Pneumonia, organism NOS,Fall NOS,Adv eff anticoagulants
Admission Date:  [**2175-9-8**]       Discharge Date:  [**2175-9-20**]

Date of Birth:                    Sex:  F

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  This is a 69 year-old female
transferred from [**Hospital **] Hospital with an intraventricular
hemorrhage and an INR of 10.  The patient has a past medical
history of a left ischemic cerebrovascular accident, atrial
fibrillation, hypertension, hypothyroidism, rheumatid
arthritis.  She is on Coumadin at home and had a witnessed
fall on the day of admission.  There was a questionable loss
of consciousness and a confusion with headache.  The patient
is currently awake with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma scale at outside
hospital at 15.  There is also a question of a right wrist
avulsion fracture.  The patient has baseline right sided
weakness secondary to an old cerebrovascular accident.  The
patient is status post receiving 4 units of fresh frozen
platelets at an outside hospital and vitamin K.

ADMISSION MEDICATIONS:
1.  Coumadin 10 mg po q day.
2.  Lopressor 100 mg po b.i.d.
3.  Aspirin 81 mg po q day.
4.  Timolol ophthalmic b.i.d.
5.  Synthroid 100 mcg q day.
6.  Hydroxychloroquine 200 mg b.i.d.
7.  Amiodarone 200 mg po b.i.d.
8.  Colace 100 mg b.i.d.

SOCIAL HISTORY:  The patient does not smoke or drink alcohol.

ALLERGIES:  No known drug allergies.

PAST SURGICAL HISTORY:  Thyroidectomy.

PHYSICAL EXAMINATION:  Vital signs 145/64.  Pulse 59.
Temperature 98.2.  Respirations 16.  O2 sat 97%.
Neurological examination the patient is awake, alert,
conversive, answers questions appropriately, follows
commands, oriented times three.  Pupils were 5 to 3.5.
Extraocular movements intact.  Visual fields full by
confrontation.  Positive slight pronator drift.  Grips were
full.  Biceps, triceps and deltoids were 4+ out of 5
bilaterally.  Lower extremities were 4+ out of 5 bilaterally
throughout.  Sensation was intact to light touch.

Head CT showed a large right ventricular intraventricular
hemorrhage with some hydrocephalus and old left
cerebrovascular accident.

ADMISSION LABORATORIES:  CBC white blood cell count 9.5,
hematocrit 32.7, platelets 277, sodium 137, potassium 3.9,
chloride 101, bicarb 23, BUN 14, 1.0 for creatinine, blood
sugar 94.  PT 21.1, PTT 42.6, INR was 3.0 on admission.

HOSPITAL COURSE:  The patient was admitted to NICU with q one
hour neurological checks.  Aggressive reversal of her INR to
keep the INR less then 1.3.  The patient is to receive
aggressive fresh frozen platelets, also aspirin was held.
Her blood pressure was kept less then 140.  Head CT on
[**9-8**] showed an intraventricular hemorrhage involving
mostly the right lateral ventricle, but also third ventricle
and left lateral ventricle, unchanged when compared with the
study from the outside hospital.  The sizes of the ventricle
are unchanged, overall mass effect was also unchanged.  There
was no intraparenchymal hemorrhage.  On the [**9-9**]
the patient's vital signs were blood pressures in the 116s to
150 range.  Her INR was 1.4.  She was awake, alert and
oriented times three.  Pupils were 3 to 2 symmetric and
reactive.  She had slight left facial asymmetry.  No drift.
She continued to be monitored in the Intensive Care Unit.
She received fresh frozen platelets to bring down her INR to
1.3.  She had a CTA performed.  CT showed a stable appearance
of the right intraventricular hemorrhage, stable appearance
of the left lateral ventricular hemorrhage.  CTA showed no
overt vascular abnormalities.  On the [**9-10**] the
patient remained neurologically stable, however, she had some
bilateral crackles one half to one third the way up her lung
fields.  She had received multiple transfusions and ended up
receiving Lasix 40 mg intravenously with an inch of
nitropaste.  The patient's respiratory status seemed to
improve after those interventions.  She was also ruled out
for an myocardial infarction.

On the [**9-11**] the patient appeared a little more
confused then she had previously.  We felt this was to be
expected given her large amount of blood and her hematocrits.
 She did have a repeat head CT, which showed slight.






                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern4) **]
MEDQUIST36

D:  [**2175-9-19**]  09:45
T:  [**2175-9-19**]  09:46
JOB#:  [**Job Number 50156**]


Admission Date:  [**2175-9-8**]       Discharge Date:  [**2175-9-20**]

Date of Birth:                    Sex:  F

Service: Neurosurgery

CONTINUATION OF HOSPITAL COURSE:  On the [**9-11**] the
patient appeared to be more confused.  A repeat head CT
showed a stable appearance of her hemorrhage and her
confusion was contributed to the amount of blood in her
ventricles.  Also on the [**9-12**] the patient did have
a nutrition screen and this recommended the patient to have
some assistance with eating.  On the [**9-13**] the
patient was found to have an INR of 1.5.  She was given 2
more units of fresh frozen platelets.  She was oriented to
person and place.  She remained in the Intensive Care Unit
for blood pressure control.  She has difficulty keeping her
blood pressure less then 170 without medications.  She also
did require 3% saline due to a sodium of 130, increased to
132 with 30 cc per hour of 3% saline.  She did have a central
line placed in order to administer the 3% saline and that was
put in without difficulty.  On the [**9-17**] the
patient was transferred to the surgical floor.  Her 3% saline
was discontinued and she was put on strict fluid of a
restriction of 750 cc a day.  Her sodium on transfer was 135.
 She was awake, alert, conversant, following commands, face
was symmetric.  The patient was also started on Boost t.i.d.
due to poor po intake.  We have discussed possibly giving her
tube feedings, however, we decided to push po food and
continue with supplements.  She was seen by occupational and
rehab therapy who recommended acute rehab therapy or gait
training, cognitive training and functional mobility.  The
patient had been started on Levofloxacin on the [**9-11**] for presumed urinary tract infection.  She should
complete Levofloxacin for a ten day course ending on the [**9-21**].

On the [**9-19**] the patient remained awake, alert and
oriented times three at this point with good strength
throughout with her grafts on the right side were 4 out of 5
and her IPs on her right side were 4 out of 5.  Discussed to
discontinue her peripheral line, continued to restrict any
free water, fluid restriction of 750 cc an hour.  Her sodium
on the [**9-19**] was 132, which had been stable from
the previous day.  The patient will be transferred to acute
rehab once her sodium remained stable.  She should follow up
with Dr. [**Last Name (STitle) 1132**] in one months time with repeat head CT.

DISCHARGE MEDICATIONS:
1.  Levothyroxine 100 mcg q day.
2.  Hydroxychloroquine 200 mg po b.i.d.
3.  Colace 100 mg po b.i.d.
4.  Propanolol 40 mg q 24.
5.  Amiodarone 400 mg po q day.
6.  Albuterol one to two puffs q 6.
7.  Prednisone 5 mg po q day.
8.  Timolol malate .25% drop OU b.i.d.
9.  Dipivefrin HCL .1 one drop OU q.s.
10.  Captopril 75 mg po q.i.d.
11.  Levofloxacin 250 mg po q 24 hours to end on [**9-21**].
12.  Metoprolol 50 mg po t.i.d.
13.  Salt tabs are to be determined.






                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern4) 26792**]
MEDQUIST36

D:  [**2175-9-19**]  10:07
T:  [**2175-9-19**]  10:19
JOB#:  [**Job Number 50157**]
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Unspecified fall,Anticoagulants causing adverse effects in therapeutic use'}


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 69 year-old female
transferred from [**Hospital **] Hospital with an intraventricular
hemorrhage and an INR of 10.  The patient has a past medical
history of a left ischemic cerebrovascular accident, atrial
fibrillation, hypertension, hypothyroidism, rheumatid
arthritis.  She is on Coumadin at home and had a witnessed
fall on the day of admission.  There was a questionable loss
of consciousness and a confusion with headache.  The patient
is currently awake with [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 2611**] coma scale at outside
hospital at 15.  There is also a question of a right wrist
avulsion fracture.  The patient has baseline right sided
weakness secondary to an old cerebrovascular accident.  The
patient is status post receiving 4 units of fresh frozen
platelets at an outside hospital and vitamin K.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient does not smoke or drink alcohol. 

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Unspecified fall,Anticoagulants causing adverse effects in therapeutic use'}
