CHIEF COMPLAINT: headache

PRESENT ILLNESS: 65 year old male from [**State 4565**] on vacation with wife, was at
dinner when at 7:45 pm last evening when he complained of a
headache,
shortly after, attempted to stand and fell to the ground. The
patient was
amnestic to fall, but was responsive and oriented when
questioned
by his wife who is [**Name8 (MD) **] RN. The patient was taken to an outside
facility
via ambulance, mental status declined in the Ambulance but EMT
was unable to intubate him given his body habitus. He was
intubated at the outside facility and a head Ct showed a large
cerebellar hemorrhage with intraventricular extent ion and
herniation.

MEDICAL HISTORY: Gout, obstructive sleep apnea

MEDICATION ON ADMISSION: unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:PHYSICAL EXAM:
T:  BP:102/42  supported on Neo-Synephrine and Dopamine
HR: 82   R 16  ON CMV     O2 Sats 95%
Gen: Intubated, not sedated
HEENT: Pupils:  Right 5mm  NR, Left 6mm non reactive
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Cranial Nerves:
I: Not tested
II: Pupils as above
No cough/gag/corneals

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Married, lives with wife, here on vacation from [**Name (NI) 4565**]
Subarachnoid hemorrhage,Cerebral edema,Obstructive hydrocephalus,Subdural hemorrhage,Obstructive sleep apnea (adult)(pediatric),Gout, unspecified
Subarachnoid hemorrhage,Cerebral edema,Obstructiv hydrocephalus,Subdural hemorrhage,Obstructive sleep apnea,Gout NOS
Admission Date:  [**2127-6-22**]              Discharge Date:   [**2127-6-23**]

Date of Birth:  [**2061-5-19**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
headache

Major Surgical or Invasive Procedure:
none

History of Present Illness:
65 year old male from [**State 4565**] on vacation with wife, was at
dinner when at 7:45 pm last evening when he complained of a
headache,
shortly after, attempted to stand and fell to the ground. The
patient was
amnestic to fall, but was responsive and oriented when
questioned
by his wife who is [**Name8 (MD) **] RN. The patient was taken to an outside
facility
via ambulance, mental status declined in the Ambulance but EMT
was unable to intubate him given his body habitus. He was
intubated at the outside facility and a head Ct showed a large
cerebellar hemorrhage with intraventricular extent ion and
herniation.

Shortly after the CT the patients systolic blood pressure
dropped
to 60, non responsive to fluid bolus and the pt. was started
first on Dopamine and then Neo-Synephrine for support.


Past Medical History:
Gout, obstructive sleep apnea


Social History:
Married, lives with wife, here on vacation from [**Name (NI) 4565**]


Family History:
non contributory

Physical Exam:
On admission:PHYSICAL EXAM:
T:  BP:102/42  supported on Neo-Synephrine and Dopamine
HR: 82   R 16  ON CMV     O2 Sats 95%
Gen: Intubated, not sedated
HEENT: Pupils:  Right 5mm  NR, Left 6mm non reactive
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Cranial Nerves:
I: Not tested
II: Pupils as above
No cough/gag/corneals

Motor: ? flicker toe movement to deep noxious, likely reflexive.
Toes downgoing bilaterally

upon discharge: deceased


Pertinent Results:
Radiology Report CT HEAD W/O CONTRAST Study Date of [**2127-6-22**]
1:15 AM
IMPRESSION:
1. Diffuse subarachnoid hemorrhage with intraventricular
extension as
described above. A probable focus of left cerebellar
intraparenchymal
hemorrhage. Bilateral subdural hematoma layering along the
tentorium, left
more than right and blood in the thecal sac in the upper
cervical spine, lower extent not included.
2. Significant mass effect and diffuse cerebral edema with
bilateral uncal
herniation.





Brief Hospital Course:
This is a 65 year old male with sudden onset headache staus post
fall who was with decline in mental status.  He was intubated
and hypotensive transferred here on vasopressors to sustain his
blood pressure. Upon arrival the patient had no cough,corneal,
or gag reflex. He was admitted on [**2127-6-22**] to the intensive care
unit .His head Ct was consistent with Diffuse cerebral edema and
uncal
herniation.  On exam, his pupils were fixed and dilated.  The
wife made [**Name2 (NI) **] decision to awaiting family before making the
patient CMO.  The patient was left intubated but the ventialtor
was turned off per the wifes request at 415 am.  The pt stopped
breathing and was asystolic and expired at 430 am on [**2127-6-23**] with
the family atthe bedside. Organ bank was called and the patient
will be a tissue donor.


Medications on Admission:
unknown

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
expired

Discharge Condition:
expired

Discharge Instructions:
none

Followup Instructions:
none


Completed by:[**2127-6-23**]
{'Subarachnoid hemorrhage,Cerebral edema,Obstructive hydrocephalus,Subdural hemorrhage,Obstructive sleep apnea (adult)(pediatric),Gout, 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: headache

PRESENT ILLNESS: 65 year old male from [**State 4565**] on vacation with wife, was at
dinner when at 7:45 pm last evening when he complained of a
headache,
shortly after, attempted to stand and fell to the ground. The
patient was
amnestic to fall, but was responsive and oriented when
questioned
by his wife who is [**Name8 (MD) **] RN. The patient was taken to an outside
facility
via ambulance, mental status declined in the Ambulance but EMT
was unable to intubate him given his body habitus. He was
intubated at the outside facility and a head Ct showed a large
cerebellar hemorrhage with intraventricular extent ion and
herniation.

MEDICAL HISTORY: Gout, obstructive sleep apnea

MEDICATION ON ADMISSION: unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:PHYSICAL EXAM:
T:  BP:102/42  supported on Neo-Synephrine and Dopamine
HR: 82   R 16  ON CMV     O2 Sats 95%
Gen: Intubated, not sedated
HEENT: Pupils:  Right 5mm  NR, Left 6mm non reactive
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Cranial Nerves:
I: Not tested
II: Pupils as above
No cough/gag/corneals

FAMILY HISTORY: non contributory

SOCIAL HISTORY: Married, lives with wife, here on vacation from [**Name (NI) 4565**] 

### Response:
{'Subarachnoid hemorrhage,Cerebral edema,Obstructive hydrocephalus,Subdural hemorrhage,Obstructive sleep apnea (adult)(pediatric),Gout, unspecified'}
