CHIEF COMPLAINT: ICH

PRESENT ILLNESS: The pt is a   40 y/o man who presents as an OSH transfer after
being found to have a large right sided IPH.He showed up at
[**Hospital **] hospital around 10pm with complaints of headaceh and
left sided weakness. He was found to have left
hemiplegia and a Ct was done which showed a large IPH on the
right side. He was also noted to be hypertensive to at least 225
over 133. he was elactively intubated with fentanyl, succs. For
his hypertension he recieved labetolol. he also received lasix
and 50grams of mannitol. On transfer he was on a nipride gtt and
versed gtt intubated.No family at bedise at that time to get
more information.

MEDICAL HISTORY: HTN, Psoriasis, CVA?

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam:
Vitals: T:  P: 70 R: 18  BP: 165/118 SaO2:100%
General: Intubated. Not on sedation.
Pulm: Some light crackles bilaterally
CVL: RRR, with systolic flow murmum
Ext: no edema.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Unknown
Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Medullary sponge kidney,Obstructive hydrocephalus,Hemiplegia, unspecified, affecting nondominant side,Unspecified protein-calorie malnutrition,Unspecified essential hypertension,Dysphagia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Other disorders of calcium metabolism
Intracerebral hemorrhage,Compression of brain,Acute respiratry failure,Hyperosmolality,Medullary sponge kidney,Obstructiv hydrocephalus,Unsp hmiplga nondmnt sde,Protein-cal malnutr NOS,Hypertension NOS,Dysphagia NOS,Hx of past noncompliance,Dis calcium metablsm NEC
Admission Date:  [**2194-4-21**]              Discharge Date:   [**2194-5-9**]

Date of Birth:  [**2153-9-29**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
Right hemicraniectomy with evacuation of clot
L EVD placement
PEG placement

History of Present Illness:
The pt is a   40 y/o man who presents as an OSH transfer after
being found to have a large right sided IPH.He showed up at
[**Hospital **] hospital around 10pm with complaints of headaceh and
left sided weakness. He was found to have left
hemiplegia and a Ct was done which showed a large IPH on the
right side. He was also noted to be hypertensive to at least 225
over 133. he was elactively intubated with fentanyl, succs. For
his hypertension he recieved labetolol. he also received lasix
and 50grams of mannitol. On transfer he was on a nipride gtt and
versed gtt intubated.No family at bedise at that time to get
more information.

Past Medical History:
HTN, Psoriasis, CVA?

Social History:
Unknown

Family History:
Unknown

Physical Exam:
Physical Exam:
Vitals: T:  P: 70 R: 18  BP: 165/118 SaO2:100%
General: Intubated. Not on sedation.
Pulm: Some light crackles bilaterally
CVL: RRR, with systolic flow murmum
Ext: no edema.

Neurologic:
Intubated. Eyes closed not opening to voice or pain. Pupils
pinpoitn at 2mm with very very minimal reaction. Dolls present.
Positive corneals bilaterally. No gag noted, no cough noted. LUE
flacid. LLE triple flexion. RUE Postures. RLE spontaneous
flexion
at the knee.
upgoing toes bilaterally.

Physical Exam upon discharge:
eyes open to voice/minimal stimulation
alert to self
PERRL
following simple commands with R UE and LE. moves both
spontaneously.
L UE hemiparesis, extends to noxious stimuli
L LE withdraws

Incision- well healing. no sign of infection


Pertinent Results:
Laboratory Data:
135  97  15  168   AGap=16
2.5  25  0.8
7.45 pCO245 pO2368 HCO332
11.9  14.8  228
PT: 14.3  PTT: 22.3  INR: 1.2
Fibrinogen: 414
UA negative
Serum tox negative

Radiologic Data:
NCHCT [**2194-4-21**]:
Intraparenchymal hemorrhage centered in the R basal ganglia
measuring approx  7.3 x 4.1 cm, similar in size to the OSH
study.
Interval increase in the  intra-ventricular extension of the
bleed. Sub-falcine herniation, with stable  to minimal increase
in the leftward shift of midline structures. Mass-effect  on the
third ventricle with mild dilation of the lateral ventricles.

CT brain [**4-22**] - 1. Stable large hematoma centered in the right
basal ganglia, with stable
intraventricular extension. Stable mass effect. Stable size of
the
ventricles.
2. S/p right parietal craniectomy with a small right extraaxial
hematoma, as before.
3. Hypodensities in the left subinsular white matter could
represent chronic small vessel infarcts, unusual for age. Please
correlate with risk factors. If clinically indicated, they may
be further assessed by contrast-enhanced MRI to exlude other
etiologies, when the patient is stabilized.

CT brain [**4-23**] -
1. Large right basal ganglionic hematoma with intraventricular
extension and surrounding vasogenic edema, unchanged in size and
appearance from most recent
study, with stable size of ventricles.
2. Leftward shift of normally-midline structures appears
slightly worse when compared to the most recent study, some of
which may be due to differences in plane of scanning.
3. Status post right parietal craniectomy, with small right
extra-axial
hematoma is unchanged.

[**4-24**] Renal U/S - Bilateral renal calcifications. Overall, the
pattern is
suggestive of medullary nephrocalcinosis. In the right lower
pole, a
partially calcified cyst or stones within a caliceal
diverticulum are also
seen. No solid mass is identified.  Normal renal Doppler, with
resistive indices ranging from 0.64-0.69 in the right and
0.69-0.77 on the left.

[**4-26**] CT brain - 1. Right basal ganglia intraparenchymal
hematoma, surrounding edema and mass
with shift of midline structures similar to the prior study.
2. Left frontal approach EVD in stable position terminating in
the left
caudothalamic groove.
3. Mild interval decrease in the intraventricular
hemorrhage.Ventricular size not significantly changed.

[**2194-4-28**] CT OF THE ABDOMEN WITHOUT AND WITH INTRAVENOUS
CONTRAST:
Included lung bases are clear and there is no pleural or
pericardial effusion. No focal masses are noted within the
adrenal glands which display symmetrical, slightly increased
thickening bilaterally, which may reflect a component of
hyperplasia with no additional masses noted along the
sympathetic chain including in the expected location of the
organ of Zuckerkandl. Limited evaluation of the liver,
gallbladder, spleen, pancreas, stomach, and bowel appear
unremarkable.  A post-pyloric feeding tube is in place with its
tip terminating at the third portion of the duodenum. Dense
medullary calcification is present within the
kidneys. In addition to some cysts within the medulla, the
largest within the left lower pole measuring 14 x 14 mm. Normal
excretion of contrast is noted within the collecting systems. No
free air, free fluid, or pathologically enlarged lymph nodes are
present. No significant atherosclerotic plaque is noted near the
origins of the renal arteries to suggest any underlying
stenosis.
BONE WINDOWS: No aggressive osseous lesions are noted.
IMPRESSION:
1. No focal adrenal masses or findings of adrenal/extra-adrenal
paraganglioma. Mild symmetrical thickening to the adrenal glands
may suggest a component of underlying hyperplasia.

2. Bilateral medullary nephrocalcinosis with imaging appearance
most
suggestive of medullary sponge kidney, with differential
including renal
tubular acidosis or hyperparathyroidism.

[**2194-4-30**] BUE dopplers:
IMPRESSION: No DVT in either upper extremity

[**2194-4-30**] CTA Head:IMPRESSION:
1. Stable appearance of a right basal ganglia parenchymal
hemorrhage with
ventricular extension. Slight increase in anterior parenchymal
edema is seen, with suggestion of increased transcranial
herniation at the anterior aspect of the craniectomy site.
2. No vascular stenosis, aneurysm, dissection, or malformations
seen. There is no active contrast extravasation (so-called "CTA
spot sign").

[**5-1**] CT Head: IMPRESSION: No interval change of a right basal
ganglia hematoma, with neighboring edema or evolving infarction,
local mass effect, intraventricular extension, and mild
transgaleal herniation through the craniectomy site.

[**5-3**] CT Head: IMPRESSION: Status post removal of the ventricular
drain without change in ventricular size or brain compared with
the prior CT from [**2194-5-1**].

[**5-5**] LENIS: IMPRESSION: No evidence of deep vein thrombosis in
either leg.

[**2194-5-9**]  06:45a

138  103    57    104   AGap=14

4.3   25   1.0


Ca: 9.3 Mg: 2.7 P: 6.2



Brief Hospital Course:
Pt was brought immediately to the OR for hemicraniectomy and
evacuation of clot.  Post-operatively his exam showed localizing
on the right and left plegic.  He had EVD placed at bedside with
high ICP upon insertion.

[**4-22**] Records were obtained from a previous admission [**1-6**] to [**Hospital **]
hospital that indicated a previous hospitalization for
hypertensive emergency resulting in a  right [**Doctor First Name **] Ganglia
hemorrhage. Exam is somewhat improved on this mornings exam with
intermitant commands. EVD was raised to 15 after review of CT
that shows the left lateral ventricl to be collapsed. A fever
work up has been initiated for fevers and elevated WBC.

[**4-23**] Oral antihypertensive meds were increased to wean off the
IV nicardipine. Patient was febrile and was pancultured.
Overnight, he remained febrile and on [**4-24**] CSF cultures were
sent and were essentially negative for growth.  Sputum Culture
was positive for multiple organisms and as a result pt was
started on vanc/cef.  On [**4-25**] he was extubated without incident
and respiratory status has remained unchanged during his ICU
course.

He continued to remain stable during is ICU course and received
tPA through EVD daily.  He became febrile on [**4-28**] and CSF was
sent which showed some PMNs. Additionally, his EVD was increased
to 20 cm H20 and his ICPs continued to remain stable. Overnight
he remained afebrile. His serum NA was 150 and he was given free
water with good effect. Later in the day, it was noted that the
distal portion of the EVD tubing had air and his system was
changed out. On [**4-29**], his EVD was raised again to 25cm. His serum
NA was stable. He was afebrile overnight. Coreg was increased
and he was given a dose of Lasix 20mg. He underwent his PEG
placement on [**2194-4-29**]. His feeds were started on [**4-30**] and
tolerating. On [**5-1**], he remained stable with his EVD clamped. A
head CT was done whcih showed no evidence of ventricular
enlargement after clamping of his EVD. He remained stable
without ICP spikes and on 5.6 his EVD was removed and a stitch
placed. He was transferred to the SDU for further montioring ojn
the evening of [**5-2**]. he remained stable voernight and on [**5-3**] he
had a temperature of 101 and urine was sent for testing. On [**5-4**]
he was evalauted by renal medicine regarding his Sponge Kidney
and recommendations for 24 urine metanephrines and increasing
free water through his PEG were recieved. On [**5-5**] screening
LENI's were negative and free water was again increased per
renal. On [**5-6**] repeat 24hr urine revealed increased Na so his
free water was increased.  On [**5-7**] he was neurologically stable.
Free water was decreased and increased per renal recs and serum
Na's.
On [**5-8**] the patient's hypernatremia continued to resolve. His
IVF was discontinued and he was continued on 400ml of free
water. Overnight his tube feed residuals were high so tube feeds
were held. He was started on reglan to stimulate gastric
motility. Feeds were restarted at 6 AM on [**5-9**].
He remained neurologically stable overnight and was cleared for
discharge in the AM.




Medications on Admission:
unknown


Discharge Medications:
1. docusate sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
2. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. acetaminophen 650 mg/20.3 mL Solution Sig: One (1) Solution
PO Q6H (every 6 hours) as needed for pain or fever >100.4.
4. insulin regular human 100 unit/mL Solution Sig: per SS
Injection ASDIR (AS DIRECTED).
5. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection TID (3 times a day).
6. levetiracetam 100 mg/mL Solution Sig: Ten (10) ml PO BID (2
times a day).
7. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

8. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) as needed for puritis.
9. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

10. labetalol 100 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
11. senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
12. Reglan 5 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Left intraparenchymal hemorrhage
Obstructive Hydrocephalus
Intraventricular hemorrhage
Intracranial hypertension
Hypertension
Fever
Left hemipalegia
Dysphagia
Acute respiratory failure
Hypernatremia
Spongy renal disease


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Lethargic but arousable.
Activity Status: Bedbound.

Discharge Instructions:
General Instructions

??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	You may wash your hair only after sutures and/or staples have
been removed. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????	You may shower before this time using a shower cap to cover
your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	If you were on a medication such as Coumadin (Warfarin), or
Plavix (clopidogrel), or Aspirin, prior to your injury,do not
resume these until cleared by your surgeon.
??????You have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.


Followup Instructions:
*** Please follow up with Dr [**First Name (STitle) **] in 3 weeks with a
non-contrast head CT. This can be scheduled by calling
[**Telephone/Fax (1) 1669**].

*** Please call the [**Hospital 2793**] Clinic to make a follow up for your


Completed by:[**2194-5-9**]
{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Medullary sponge kidney,Obstructive hydrocephalus,Hemiplegia, unspecified, affecting nondominant side,Unspecified protein-calorie malnutrition,Unspecified essential hypertension,Dysphagia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Other disorders of calcium metabolism'}


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: ICH

PRESENT ILLNESS: The pt is a   40 y/o man who presents as an OSH transfer after
being found to have a large right sided IPH.He showed up at
[**Hospital **] hospital around 10pm with complaints of headaceh and
left sided weakness. He was found to have left
hemiplegia and a Ct was done which showed a large IPH on the
right side. He was also noted to be hypertensive to at least 225
over 133. he was elactively intubated with fentanyl, succs. For
his hypertension he recieved labetolol. he also received lasix
and 50grams of mannitol. On transfer he was on a nipride gtt and
versed gtt intubated.No family at bedise at that time to get
more information.

MEDICAL HISTORY: HTN, Psoriasis, CVA?

MEDICATION ON ADMISSION: unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Exam:
Vitals: T:  P: 70 R: 18  BP: 165/118 SaO2:100%
General: Intubated. Not on sedation.
Pulm: Some light crackles bilaterally
CVL: RRR, with systolic flow murmum
Ext: no edema.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Unknown 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Hyperosmolality and/or hypernatremia,Medullary sponge kidney,Obstructive hydrocephalus,Hemiplegia, unspecified, affecting nondominant side,Unspecified protein-calorie malnutrition,Unspecified essential hypertension,Dysphagia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Other disorders of calcium metabolism'}
