CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 69 year old
male who fell one day prior to admission.  He was found
unresponsive by emergency medical technicians, bleeding from
the face.  The fall was witnessed by his family apparently.
The patient was walking from the house to his car, got dizzy
and fell.  Per emergency medical technicians, the patient was
awake, alert and oriented times two at the scene.  He was
taken to [**Hospital3 4527**] Hospital.  A CT scan of the head
there demonstrated a small right frontal intracranial
hemorrhage and possibly an epidural hematoma.  A Dilantin
load was given and he was transferred to [**First Name4 (NamePattern1) 3867**]
[**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for further treatment.

MEDICAL HISTORY: 1.  The patient has frequent falls.
2.  Hereditary hemorrhagic telangiectasia with recurrent
epistaxis.  3.  Hypertension.  4.  Mild dementia.  5.  Status
post pacemaker.

MEDICATION ON ADMISSION: Premarin 5 mg p.o.q.d., Prilosec
20 mg p.o.q.d., nadolol 40 mg p.o.q.d., Zoloft 250 mg
p.o.q.d., lithium 150 mg p.o.b.i.d., magnesium 400 mg
p.o.q.d., ferrous sulfate 50 mg p.o.t.i.d., Mavik 2 mg
p.o.q.d., Desipramine 50 mg p.o.q.d., Zyprexa 10 mg p.o.q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Hereditary hemorrhagic telangiectasia,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ
Brain hem NEC-coma NOS,Heredit hemorr telangiec,Hypertension NOS,Status autm crd dfbrltr
Admission Date:  [**2134-8-7**]     Discharge Date:  [**2134-8-10**]

Date of Birth:   [**2064-10-1**]     Sex:  M

Service:  Trauma Surgery

HISTORY OF PRESENT ILLNESS:  The patient is a 69 year old
male who fell one day prior to admission.  He was found
unresponsive by emergency medical technicians, bleeding from
the face.  The fall was witnessed by his family apparently.
The patient was walking from the house to his car, got dizzy
and fell.  Per emergency medical technicians, the patient was
awake, alert and oriented times two at the scene.  He was
taken to [**Hospital3 4527**] Hospital.  A CT scan of the head
there demonstrated a small right frontal intracranial
hemorrhage and possibly an epidural hematoma.  A Dilantin
load was given and he was transferred to [**First Name4 (NamePattern1) 3867**]
[**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for further treatment.

On arrival to our Emergency Room, the patient was awake,
alert and oriented to person and place, amnestic to the
events, but remembers what people tell him happened.  He
denied any chest pain, shortness of breath or abdominal pain.
He did complain of neck discomfort with movement and
turning, and a cervical collar was placed.  He also
complained of face pain secondary to bruising and lacerations
where he fell.  He denied any headache, vision changes,
weakness or dizziness.  He denied any numbness anywhere and
denied any nausea.

PAST MEDICAL HISTORY:  1.  The patient has frequent falls.
2.  Hereditary hemorrhagic telangiectasia with recurrent
epistaxis.  3.  Hypertension.  4.  Mild dementia.  5.  Status
post pacemaker.

MEDICATIONS ON ADMISSION:  Premarin 5 mg p.o.q.d., Prilosec
20 mg p.o.q.d., nadolol 40 mg p.o.q.d., Zoloft 250 mg
p.o.q.d., lithium 150 mg p.o.b.i.d., magnesium 400 mg
p.o.q.d., ferrous sulfate 50 mg p.o.t.i.d., Mavik 2 mg
p.o.q.d., Desipramine 50 mg p.o.q.d., Zyprexa 10 mg p.o.q.d.

ALLERGIES:  The patient has no known drug allergies.

PHYSICAL EXAMINATION:  On physical examination on admission,
the patient had a temperature of 97, heart rate 70, blood
pressure 220/104, respiratory rate 21 and oxygen saturation
95% in room air.  Fingerstick was 124.  General:  Elderly man
breathing unlabored.  Head, eyes, ears, nose and throat:
Right side of face with periorbital zygoma in chin with
swelling and ecchymosis, superficial abrasion, sutured
laceration around 2.5 cm along the right brow, pupils equal,
round, and reactive to light and accommodation, extraocular
movements intact, anicteric sclerae, tympanic membranes clear
without hemotympanum, moist mucous membranes, no oral lesions
noted.  Neck:  Supple, no cervical spine tenderness, no
step-off or deformity, cervical collar in place.  Chest:
Slightly decreased breath sounds at bilateral bases,
otherwise clear to auscultation bilaterally.  Cardiovascular:
Regular S1 and S2.  Abdomen:  Soft, nontender, nondistended,
without palpable masses.  Rectal:  Normal tone, guaiac
negative.  Extremities:  Warm and well perfused, no cyanosis,
clubbing or edema, abrasion noted on left forearm, dressed
with Tegaderm.  Neurologic examination:  Alert and oriented
to person and place, amnestic to events which brought him to
the hospital and there is some confusion about the events at
the outside hospital and transfer to this hospital, cranial
nerves II through XII intact but there is a slight decrease
in the left nasolabial fold which may be secondary to
swelling on the right side of the face; patient has good
strength throughout, [**4-24**], and sensation is intact to light
touch; patient follows commands appropriately.

LABORATORY DATA:  Admission white blood cell count was 9.5
with 87 neutrophils 1 band and 3 lymphocytes, hematocrit
31.2, platelet count 183,000, sodium 141, potassium 4.1,
chloride 104, bicarbonate 25, BUN 16, creatinine 1.4, glucose
181, lithium level 0.5, prothrombin time 11.3, INR 0.8,
partial thromboplastin time 24.3, CK 27, no MB, no troponin.
Urinalysis:  Specific gravity 1.012, otherwise negative.
Electrocardiogram:  Demand pacing at 70 beats per minute,
left axis deviation, no acute ST-T wave changes noted.  CT
scan of the head at outside hospital:  Small right frontal
area with high intensity, representing blood; unclear whether
this is an intraparenchymal or epidural hematoma secondary to
atrophy of the brain.  Cervical spine:  Negative for
fracture, normal alignment, degenerative joint disease
throughout.

HOSPITAL COURSE:  Neurosurgery was consulted.  They reviewed
the patient's history and films.  They recommended that he be
loaded with Dilantin and then start oral Dilantin 100 mg
three times a day, and repeat CT scan in 24 hours.

The patient was admitted to the Surgical Intensive Care Unit
for frequent neurological assessment and management.  A
repeat CT scan demonstrated interval decrease in the size of
previously described extra-axial hemorrhage with possible
intra-axial component along the anterior aspect of the right
frontal lobe, no new areas of hemorrhage were identified.

The patient's blood pressure throughout his hospital was well
controlled with continuation of his nadolol and the addition
of hydralazine as needed.

Neurosurgery signed off care of this patient as there were no
acute neurosurgical issues.  They will follow him as an
outpatient once discharged.

The patient remained stable throughout the duration of his
hospital stay.  He was evaluated by physical therapy.  It was
deemed at this time that he would benefit from acute
rehabilitation.  The patient is to be transferred to a
skilled nursing facility with rehabilitation potential.

DISCHARGE MEDICATIONS:
As above, in addition to,
Dilantin 100 mg p.o.t.i.d.

FOLLOW-UP:  The patient is to follow up with neurosurgery,
Dr. [**Last Name (STitle) 32969**], in two weeks.  The patient is also to follow up in
the trauma clinic with Dr. [**Last Name (STitle) **] in two weeks after
discharge, and with his primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5292**], as
soon as possible after discharge.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DIAGNOSIS:
Right frontal intracranial hemorrhage.
Dementia.
Hypertension.
Hereditary hemorrhagic telangiectasia with recurrent
epistaxis.
Status post pacemaker implant.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 6066**]

Dictated By:[**Last Name (NamePattern1) 9333**]

MEDQUIST36

D:  [**2134-8-10**]  09:16
T:  [**2134-8-10**]  10:18
JOB#:  [**Job Number 12954**]


Name:  [**Known lastname 5738**], [**Known firstname 33**]                       Unit No:  [**Numeric Identifier 5739**]

Admission Date:  [**2134-8-7**]     Discharge Date:  [**2134-8-18**]

Date of Birth:   [**2064-10-1**]     Sex:  M

Service:

ADDENDUM:  Since the last dictation, the patient remained
stable, was screened for rehabilitation and was awaiting a
bed.  He had no events until [**2134-8-16**], when he spiked a
temperature of 101??????F.  There were no localizing signs of
infection.  His blood and urine were cultured.  A urinalysis
was negative.  A chest x-ray was clear.  His blood and urine
cultures have had no growth to date.  The cross-covering
trauma surgery intern noted that an abscess fluid culture
specimen was logged into the patient's chart on the
computers, so he was empirically started on Levaquin 250 mg
p.o. q.d., receiving one dose.  It was later realized that
this specimen was not from this patient had been logged in as
an error.

At the same time that the fever occurred, the patient's
creatinine was found to be elevated at 1.8, up from 1.4 on
admission.  The patient was given some fluid after his FENa
was found to be 0.5%.  On the following day, his creatinine
was back to baseline at 1.5.

Given the fever spike and the transiently elevated
creatinine, the patient was transferred from the trauma
surgery team to the medicine service for further evaluation.

The medicine service evaluated the issue of renal failure and
it was felt to be due to prerenal causes based on the FENa
and the improvement in the creatinine after fluid
resuscitation.  His creatinine then remained stable.

The fever was also a transient issue, as the patient
defervesced after the one incident of fever spike.  No
apparent source of fever was discovered.  A repeat chest
x-ray was done, which had no infiltrates or effusions.  The
Levaquin that had been initiated by the trauma surgery team
was discontinued.

The most striking issue with the patient was his continued
depressed mental status, lethargy and disorientation.  The
neurology service was consulted, as the patient was quite
frequently somnolent, although easily arousable, and
tangential in his speech and thoughts.  A
electroencephalogram was performed, although neurology did
not feel that seizure activity was responsible for his mental
status.  The electroencephalogram results are pending at this
time.  The family added that he had been somnolent at times
throughout his hospital course.

The neurology service thought that the patient's
supratherapeutic Dilantin level was contributing to his
mental status changes.  They recommended that the Dilantin
level be held on [**2134-8-18**] in the evening and on [**2134-8-19**] in
the morning and then resume it at a lower dose of 250 mg per
day instead of 300 mg per day.  They also recommended that
free Dilantin levels be followed, keeping these levels
between 1 and 2.  The patient should follow up with Dr.
[**Last Name (STitle) **] of the neurobehavioral unit upon discharge from
rehabilitation.

The patient's AICD was interrogated on [**2134-8-18**] and was
found to be functioning properly.  The underlying rhythm was
sinus.  A right sided PICC line was placed at the request of
the trauma surgery team before transfer to the medicine
service.  This was confirmed to be in proper position in the
superior vena cava.  This was placed for administration of
intravenous fluids and blood draws.  This should be removed
after one or two weeks at rehabilitation.  He had no further
events during the course of his stay and is being discharged
to rehabilitation.

DISCHARGE DIAGNOSES:
1.  Right frontal intracranial hemorrhage.
2.  Possible mental status depression secondary to
supratherapeutic Dilantin level.
3.  Status post PICC line placement on [**2134-8-17**].
4.  Dementia.
5.  Hereditary hemorrhagic telangiectasia with recurrent
epistaxis.
6.  AICD for primary prevention in the setting of septal
hypertrophy/hypertrophic obstructive cardiomyopathy.
7.  Transient episodes of prerenal azotemia.

DISCHARGE MEDICATIONS:
Premarin 5 mg p.o. q.d.
Prilosec 20 mg p.o. q.d.
Labetalol 40 mg p.o. q.d.
Zoloft 250 mg p.o. q.d.
Lithium 300 mg p.o. q.a.m. and 150 mg p.o. q.p.m.
Desipramine 50 mg p.o. q.d.
Zyprexa 10 mg p.o. q.d.
Iron sulfate 50 mg p.o. t.i.d.
Dilantin, hold doses on [**2134-8-18**] in the evening and
[**2134-8-19**] in the morning, then 50 mg p.o. q.a.m. and 100 mg
p.o. b.i.d.

DISCHARGE DIET:  Cardiac.

SPECIAL INSTRUCTIONS:
1.  Physical therapy for range of motion, ambulation and
strengthening.
2.  Check free Dilantin level q.o.d. and adjust Dilantin dose
to achieve therapeutic free Dilantin level of 1 to 2.
3.  Check lithium level in week one and adjust dose to
achieve therapeutic level of 0.5 to 1.5 mg.

FOLLOW UP:  Upon the patient's discharge from rehabilitation,
the patient's family should call [**Telephone/Fax (1) 5740**] to schedule an
appointment with Dr. [**Last Name (STitle) **] of [**Hospital1 **] Center's behavioral neurology unit.  They should also
call the patient's primary care physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 5741**], at
[**Telephone/Fax (1) 4015**] for a follow up appointment as well as Dr.
[**Last Name (STitle) 86**] at [**Telephone/Fax (1) 5742**] for follow up on his cardiac
issues.




                          [**Name6 (MD) **] [**Last Name (NamePattern4) 424**], M.D.  [**MD Number(1) 425**]

Dictated By:[**Last Name (NamePattern1) 4267**]

MEDQUIST36

D:  [**2134-8-19**]  07:34
T:  [**2134-8-21**]  22:31
JOB#:  [**Job Number 5743**]
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Hereditary hemorrhagic telangiectasia,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ'}


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: The patient is a 69 year old
male who fell one day prior to admission.  He was found
unresponsive by emergency medical technicians, bleeding from
the face.  The fall was witnessed by his family apparently.
The patient was walking from the house to his car, got dizzy
and fell.  Per emergency medical technicians, the patient was
awake, alert and oriented times two at the scene.  He was
taken to [**Hospital3 4527**] Hospital.  A CT scan of the head
there demonstrated a small right frontal intracranial
hemorrhage and possibly an epidural hematoma.  A Dilantin
load was given and he was transferred to [**First Name4 (NamePattern1) 3867**]
[**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] for further treatment.

MEDICAL HISTORY: 1.  The patient has frequent falls.
2.  Hereditary hemorrhagic telangiectasia with recurrent
epistaxis.  3.  Hypertension.  4.  Mild dementia.  5.  Status
post pacemaker.

MEDICATION ON ADMISSION: Premarin 5 mg p.o.q.d., Prilosec
20 mg p.o.q.d., nadolol 40 mg p.o.q.d., Zoloft 250 mg
p.o.q.d., lithium 150 mg p.o.b.i.d., magnesium 400 mg
p.o.q.d., ferrous sulfate 50 mg p.o.t.i.d., Mavik 2 mg
p.o.q.d., Desipramine 50 mg p.o.q.d., Zyprexa 10 mg p.o.q.d.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration,Hereditary hemorrhagic telangiectasia,Unspecified essential hypertension,Automatic implantable cardiac defibrillator in situ'}
