CHIEF COMPLAINT: Intracranial hemorrhage

PRESENT ILLNESS: Pt is a 78yoF with HTN, AF on coumadin, CHF, hypothyroidism, and
hyperlipidemia transferred from [**Hospital3 **] with a large
left basal ganglia hemorrhage. There is midline shift and left
lateral ventricular compression.
She was in her USOH until last night when she acutely had
trouble stirring her coffee with her right hand.  Her speech
then became unintelligible and her family realized something was
wrong. They put her in bed and called 911.  She was taken to
[**Hospital3 **] where head CT showed above findings, with
greatest dimension being measured at 6.8 cm.  The midline shift
was measured at 4.5
mm.  Her initial INR was 4.0.  She was given Vitamin K 10 mg,
Mannitol 50 gm, and 2 Units FFP.  Repeat INR this am was 3.5.
Labetalol was used for BP control. She may have vomited at the
OSH ED, but this is unclear.
She was transferred to [**Hospital1 18**] for neurological management.
Per family and staff, she was not opening eyes at the OSH, but
did follow simple commands in Portuguese such as hand gripping.
She has been moving all extremities spontaneously, but right
side much greater than left.  She was intubated there after CT
findings and has been on vent since that time.
PMH:periventricular [**Male First Name (un) 4746**])

MEDICAL HISTORY: Osteoporosis
HTN
Hyperlipidemia
Hypothyroidism
CHF
AF on coumadin
Several old lacunar infarcts seen on CT(right lentiform nucleus
and bilateral

MEDICATION ON ADMISSION: Ativan 0.5 qhs
Cartia XT 240 mg daily
Coumadin 2 mg and 3 mg alternating
Lipitor 10
[**Doctor First Name **] 60 prn
Levoxyl 50 daily
Allopurinol 300 daily
Meclizine 25 prn
Fosamax 70 qweek
Oxytrol 3.9 (2 patches/wk)
Citracal 1260 daily
Ranitidine 150 [**Hospital1 **]
Potassium 30 mg [**Hospital1 **]

ALLERGIES: Codeine

PHYSICAL EXAM: On ADMISSION
.
Vitals:HR=80, 180-191/70s, 16, 98% on vent
Mental Status:Intubated and unresponsive
HEENT:MMM. Sclera clear. Op clear. Intubated
CV:Irreg irreg. No MRG
Pulm:CTAB. No wheezes
CN:Pupils 3->2 bilaterally
Nasal Tickle:Withdraw and grimace bilaterally.
Gag/Cough:+ gag
Corneal Reflex:Brisk bilaterally.
Face symmetric

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives with her son
Intracerebral hemorrhage,Atrial fibrillation,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Long-term (current) use of anticoagulants,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Intracerebral hemorrhage,Atrial fibrillation,CHF NOS,Urin tract infection NOS,Long-term use anticoagul,Hypothyroidism NOS,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2134-2-22**]              Discharge Date:   [**2134-3-5**]

Date of Birth:  [**2055-8-18**]             Sex:   F

Service: NEUROLOGY

Allergies:
Codeine

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
Intracranial hemorrhage

Major Surgical or Invasive Procedure:
Central line
Arterial line


History of Present Illness:
Pt is a 78yoF with HTN, AF on coumadin, CHF, hypothyroidism, and
hyperlipidemia transferred from [**Hospital3 **] with a large
left basal ganglia hemorrhage. There is midline shift and left
lateral ventricular compression.
She was in her USOH until last night when she acutely had
trouble stirring her coffee with her right hand.  Her speech
then became unintelligible and her family realized something was
wrong. They put her in bed and called 911.  She was taken to
[**Hospital3 **] where head CT showed above findings, with
greatest dimension being measured at 6.8 cm.  The midline shift
was measured at 4.5
mm.  Her initial INR was 4.0.  She was given Vitamin K 10 mg,
Mannitol 50 gm, and 2 Units FFP.  Repeat INR this am was 3.5.
Labetalol was used for BP control. She may have vomited at the
OSH ED, but this is unclear.
She was transferred to [**Hospital1 18**] for neurological management.
Per family and staff, she was not opening eyes at the OSH, but
did follow simple commands in Portuguese such as hand gripping.
She has been moving all extremities spontaneously, but right
side much greater than left.  She was intubated there after CT
findings and has been on vent since that time.
PMH:periventricular [**Male First Name (un) 4746**])


Past Medical History:
Osteoporosis
HTN
Hyperlipidemia
Hypothyroidism
CHF
AF on coumadin
Several old lacunar infarcts seen on CT(right lentiform nucleus
and bilateral

Social History:
Lives with her son

Family History:
Unknown

Physical Exam:
On ADMISSION
.
Vitals:HR=80, 180-191/70s, 16, 98% on vent
Mental Status:Intubated and unresponsive
HEENT:MMM. Sclera clear. Op clear. Intubated
CV:Irreg irreg. No MRG
Pulm:CTAB. No wheezes
CN:Pupils 3->2 bilaterally
Nasal Tickle:Withdraw and grimace bilaterally.
Gag/Cough:+ gag
Corneal Reflex:Brisk bilaterally.
Face symmetric

Motor:Moves left arm spont frequently. Moves LLE spont. No
movement of right side spont. No eye opening. Withdraws all exts
to nox stim, but left much more briskly than right.

Toes:Downgoing on left, up on right

DTRs:  [**Name2 (NI) **] Tri Br Pa [**Doctor First Name **]
     R 3  3    3  1  0
     L 3  3    3  1  0

Respiration:Pt is not overbreathing ventilator.
-
ON DISCHARGE
Neuro exam: Intubated. Grimaces to noxious stimuli. There is no
eye opening. The pupils are 4->2 bilateally. The cornel reflexes
are brisk. The OCRs are present. There is grimace to nasal
tickle. There is a cough reflex.
There is purposeful withdrawal of the left arm and leg. The
right arm exhibits extensor [**Doctor First Name 66959**] to stimulation and the
right leg exhibits triple flexion responses to stimulation. The
right toe is upgoing.





Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2134-3-1**] 03:03AM    13.3* 3.65* 11.3* 32.8* 90 31.0 34.5 14.3
286
[**2134-2-28**] 03:09AM    14.7* 3.69* 11.5* 33.4* 91 31.1 34.3 14.5
280
[**2134-2-27**] 04:02AM    13.8* 3.80* 11.7* 34.7* 91 30.8 33.8 14.7
271
[**2134-2-26**] 03:24AM    14.9* 3.67* 11.5* 33.0* 90 31.2 34.7 14.6
261
[**2134-2-25**] 03:02AM    16.7* 3.64* 11.3* 32.8* 90 31.0 34.5 14.8
227
[**2134-2-24**] 02:07AM    16.8* 3.78* 11.7* 33.8* 89 30.9 34.5 14.9
233
[**2134-2-23**] 04:36PM    16.4* 3.70* 11.5* 32.9* 89 31.2 35.1*
14.7 247
[**2134-2-23**] 03:10AM    16.1* 4.14* 12.9 36.6 89 31.1 35.1* 14.7
297
[**2134-2-22**] 08:33PM    13.3* 4.75 14.3 41.9 88 30.2 34.2 14.7
339
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2134-3-1**] 03:03AM        286
[**2134-3-1**] 03:03AM    14.9* 22.2   1.3*
[**2134-2-28**] 03:09AM        280
[**2134-2-28**] 03:09AM    14.5* 20.7*   1.3*
[**2134-2-27**] 04:02AM        271
[**2134-2-27**] 04:02AM    15.2* 22.4   1.4*
[**2134-2-26**] 03:24AM        261
[**2134-2-26**] 03:24AM    15.3* 22.2   1.4*
[**2134-2-25**] 03:02AM        227
[**2134-2-25**] 03:02AM    14.6* 22.4   1.3*
[**2134-2-24**] 05:44PM    14.0*     1.2*
[**2134-2-24**] 04:27AM    14.5* 22.7   1.3*
[**2134-2-24**] 02:07AM        233
[**2134-2-24**] 02:07AM    14.5* 21.9*   1.3*
[**2134-2-23**] 04:36PM        247
[**2134-2-23**] 04:36PM    12.4 22.1   1.1
[**2134-2-23**] 10:07AM    15.7* 22.6   1.4*
[**2134-2-23**] 05:00AM    16.1*     1.5*
[**2134-2-23**] 03:10AM        297
[**2134-2-23**] 03:10AM    18.0* 22.5   1.7*
[**2134-2-23**] 12:07AM    18.6*     1.8*
[**2134-2-22**] 08:33PM        339
[**2134-2-22**] 08:33PM    19.2* 24.0   1.8*

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2134-3-1**] 03:03AM    141* 30* 0.9 143 3.3 106 27 13
[**2134-2-28**] 09:05PM          144 3.6
[**2134-2-28**] 03:09AM    155* 30* 1.0 146* 4.0 109* 26 15
[**2134-2-27**] 02:46PM          147* 3.6
[**2134-2-27**] 04:02AM    146* 32* 1.1 148* 3.6 109* 26 17
[**2134-2-26**] 03:24AM    148* 37* 1.2* 149* 2.9* 109* 27 16
[**2134-2-25**] 03:02AM    147* 35* 1.2* 147* 3.2* 110* 25 15
[**2134-2-24**] 02:07AM    122* 29* 1.2* 146* 3.8 111* 23 16
[**2134-2-23**] 04:36PM    118* 25* 1.1 144 3.6 107 25 16
[**2134-2-23**] 03:10AM    149* 24* 1.2* 143 3.6 105 22 20
[**2134-2-22**] 08:33PM    128* 17 1.1 144 3.8 104 24 20
ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase
TotBili DirBili
[**2134-2-23**] 04:36PM          153*
CPK ISOENZYMES CK-MB cTropnT
[**2134-2-23**] 04:36PM    2 <0.01
  CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron

[**2134-3-1**] 03:03AM          8.4 4.5 2.0
[**2134-2-28**] 03:09AM          8.3* 4.1 2.1
[**2134-2-27**] 04:02AM          8.2* 4.2 2.0
[**2134-2-26**] 03:24AM          8.1* 4.2 2.0
[**2134-2-25**] 03:02AM          8.3* 3.4 1.9
[**2134-2-24**] 02:07AM          8.7 3.7 2.1
[**2134-2-23**] 04:36PM      3.7     3.5 2.1
[**2134-2-23**] 03:10AM          8.8 3.7# 1.4*
[**2134-2-22**] 08:33PM          9.6 2.1* 1.6

Blood Gas
  BLOOD GASES Type Temp Rates Tidal V PEEP FiO2 O2 Flow pO2 pCO2
pH calHCO3 Base XS   Intubat Vent
[**2134-3-1**] 11:49AM    ART             129* 39 7.47* 29 5
[**2134-3-1**] 03:15AM    ART             119* 42 7.50* 34* 8

  WHOLE BLOOD, MISCELLANEOUS CHEMISTRY Glucose Na K
[**2134-2-28**] 09:23PM    128*
  HEMOGLOBLIN FRACTIONS ( COOXIMETRY) O2 Sat
[**2134-3-1**] 03:15AM    98
  CALCIUM freeCa
[**2134-3-1**] 03:15AM    1.15

OTHER STUDIES

CT HEAD W/O CONTRAST  [**2134-2-23**] 12:08 AM
INDICATION: New left intracranial hemorrhage. Please evaluate
hemorrhage for size and changes.
TECHNIQUE: CT head without contrast.
The patient had an outside study which is not available for
comparison purposes.
There is a large intraaxial hemorrhage in the left hemisphere
with maximal dimensions of approximately 10 cm x 3 cm x 5 cm in
anteroposterior, lateromedial and craniocaudal dimensions
respectively. There is a moderate amount of surrounding edema.
The left lateral ventricle is not seen except part of the left
temporal [**Doctor Last Name 534**], which contains blood. Although the origin of the
hemorrhages is not clear, this is likely an intraparenchymal
hemorrhage with extension into the lateral ventricle. There is
shift of the centrally located normally midline structures of
approximately 8 mm to the contralateral side. Although there
appears to be some compression of the third ventricle, third
ventricle is still visible. There is some medial displacement of
the left uncus, but this is likely more due to a local mass
effect rather than generalized transtentorial herniation.
According to the neurology service who has reviewed the outside
study, there appears to be no significant interval expansion of
the amount of hemorrhage and mass effect. The surrounding soft
tissues and osseous structures appear unremarkable.

NC Head CT: FINDINGS: 10 AM [**2134-2-23**]: There is no change in the
extent of the large left-sided basal ganglia hemorrhage nor its
intraventricular component and surrounding edema, compared to
the prior examination performed only eleven hours previous to
the present examination. The degree of contralateral shift of
the third ventricle and septum pellucidum, contralateral
ventricular dilatation and small chronic infarct in the right
internal capsule/[**Doctor First Name **] ganglia regions are all unaltered in
appearance. No new osseous abnormalities are seen.

CT HEAD W/O CONTRAST  [**2134-2-27**] 9:57 AM
FINDINGS: There is no significant change from [**2134-2-24**].
Again demonstrated is a large left basal ganglia hemorrhage with
associated mass effect including subfalcine herniation and
contralateral ventricular dilation. The intraventricular
hemorrhage within both occipital horns is unchanged. No
additional abnormalities are identified, and the osseous
structures are unchanged.
IMPRESSION: Stable large left basal ganglia hemorrhage with
associated mass effect and intraventricular hemorrhage.

EEG Study Date of [**2134-2-24**]
FINDINGS:
TIME SAMPLES: Throughout the recording, the background over the
entire
left hemisphere is slow in the [**1-23**] Hz delta frequency range and
moderate
voltage. There are bursts of generalized slowing bifrontally
predominant and slowing in the delta frequency range over the
entire
left hemisphere. There are extremely frequent and high voltage,
semi-rhythmic sharp and slow wave discharges seen over the right
frontal
temporal region alternating with episodes of quiet background
activity.
Some sharp and slow wave discharges appear to be generalized
over the
entire right hemisphere. The majority appear to be in the right
fronto-central region.
PUSHBUTTONS: Two pushbutton events were recorded. The first
episode,
the nurse [**First Name (Titles) 13431**] [**Last Name (Titles) 66959**] on the right. The video is not
pointing to
the patient during this event. The EEG shows prolonged muscle
artifact
over the posterior left temporal region and intermittent
epileptiform
sharp and slow wave discharges as described in the time samples.
There
was no clear seizure activity recorded.
The second episode does not show seizure activity but
irregular sharp and slow wave discharges in the right
fronto-central
region, as described in Time Samples.
AUTOMATIC SEIZURE DETECTIONS: Captured 18 events. All of these
events
represent movement artifacts due to patient's examination for
the
resident or the nurse. There was no clear seizure activity
recorded.
AUTOMATIC SPIKE DETECTIONS: There were 792 algorithms captured.
The
majority of the events represent sharp and slow wave discharges
over the
right fronto-central region with phase reversing around C4 and
S4.
Additionally, there are bursts of sharp and slow wave discharges
over
the entire right hemisphere.
SLEEP: Revealed the time samples showed some evidence of slow
wave
sleep. The sharp and slow wave discharges seem to occur somewhat
more
often in wakefulness than in sleep.
CARDIAC MONITOR: An irregular heartbeat with a rate of 72 bpm.
IMPRESSION: This is an abnormal 24-hour discontinuous telemetry
obtained in wakefulness and slow wave sleep due to the presence
of slow
and disorganized background rhythm and low voltage background
with
diffuse delta frequency slowing over the entire left hemisphere.

Additionally, there are multiple episodes with frequent
extremely high
voltage sharp and slow wave discharges over the entire right
hemisphere
with sharp and slow wave discharges over the right
fronto-central
region. This appears to be semi-rhythmic with a maximum of 2 Hz
frequency range. The are episodes of quiet background activity.
This
finding represents an increased cortex irritability with a high
risk of
developing epileptiform seizures. The background suggests
diffuse, mild
encephalopathy. An arrhythmic heartbeat was noted.

CHEST (PORTABLE AP)  [**2134-2-23**] 10:15 AM
The patient is intubated, and the endotracheal tube is 3.5 cm
above the carina. Tip of the NG tube projects in the stomach
beyond the edge of the film. The heart is enlarged with an LV
configuration. There are bands of linear density at the base of
the left lung most consistent with atelectasis.








Brief Hospital Course:
The patient was admitted to the Neurology ICU for close
monitoring. Repeat head CT at [**Hospital1 18**] confirmed that the
intraparenchymal hemorrhage had increased significantly in size
and extended into the posterior [**Doctor Last Name 534**] of the left lateral
ventricle; there was >1cm midline shift and almost complete
compression of the left lateral ventricle. THere was no evidence
of herniation as the perimesencephalic cisterns appeared patent.
She was administered FFP and Proplex-T to drive her INR below
1.5. Neurosurgery was consulted - no intervention was
recommended. A repeat head CT 10hours later was stable. Her exam
is remarkable for obtunded mental status, left gaze preference
which can be overcome with head movement, right hemiparesis,
preserved brainstem reflexes and purposeful movement of the left
side. Anti-epleptic medications were held because the bleed is
primarily subcortical and thought to have a low risk of
provoking seizure.
Repeat head CT [**2-27**] - slightly worsening midline shift.
Neurological exam slightly worsened with less purposeful
movement of the left arm. Brainstem reflexes remain intact.
There is no response to voice.

On [**2134-3-3**], after many conversations with the patient's family,
the decision was made to withdraw intensive care, extubate, and
administer comfort measures only.
The patient expired [**2134-3-5**] at 1:45am from respiratory failure.

REVIEW OF HOSPITAL COURSE
CVS - the patient had atrial fibrillation. Her HRs have dropped
to the high 40s but spontanouesly returned to the 60s. BP had
been controlled with PO diltiazem (home med), IV labetalol, IV
hydralazine. Because of intermittent bradycardia, this was
changed to a Nicardipine drip while PO Captopril was started.
Afib not requiring rate control.
Captopril at 100 TID.
RESP - extubated on [**2134-3-3**]
FEN/GI - TF stopped withi extubation
ID - tempearture rising. Advocate euthermia 0 actaminophen as
necessary. No Abx for now. Culture if spikes > 101.
s/p Levaquin for UTI.
RENAL - good solute exchange.
ENDOCRINE - normoglycemia was achieved with insulin sliding
scale
PROPHYLAXIS - patient placed on lansoprazole, pneumo boots. SC
heparin started [**3-1**].


Medications on Admission:
Ativan 0.5 qhs
Cartia XT 240 mg daily
Coumadin 2 mg and 3 mg alternating
Lipitor 10
[**Doctor First Name **] 60 prn
Levoxyl 50 daily
Allopurinol 300 daily
Meclizine 25 prn
Fosamax 70 qweek
Oxytrol 3.9 (2 patches/wk)
Citracal 1260 daily
Ranitidine 150 [**Hospital1 **]
Potassium 30 mg [**Hospital1 **]


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Intracerebral hemorrhage


Discharge Condition:
Expired

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{'Intracerebral hemorrhage,Atrial fibrillation,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Long-term (current) use of anticoagulants,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}


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: Intracranial hemorrhage

PRESENT ILLNESS: Pt is a 78yoF with HTN, AF on coumadin, CHF, hypothyroidism, and
hyperlipidemia transferred from [**Hospital3 **] with a large
left basal ganglia hemorrhage. There is midline shift and left
lateral ventricular compression.
She was in her USOH until last night when she acutely had
trouble stirring her coffee with her right hand.  Her speech
then became unintelligible and her family realized something was
wrong. They put her in bed and called 911.  She was taken to
[**Hospital3 **] where head CT showed above findings, with
greatest dimension being measured at 6.8 cm.  The midline shift
was measured at 4.5
mm.  Her initial INR was 4.0.  She was given Vitamin K 10 mg,
Mannitol 50 gm, and 2 Units FFP.  Repeat INR this am was 3.5.
Labetalol was used for BP control. She may have vomited at the
OSH ED, but this is unclear.
She was transferred to [**Hospital1 18**] for neurological management.
Per family and staff, she was not opening eyes at the OSH, but
did follow simple commands in Portuguese such as hand gripping.
She has been moving all extremities spontaneously, but right
side much greater than left.  She was intubated there after CT
findings and has been on vent since that time.
PMH:periventricular [**Male First Name (un) 4746**])

MEDICAL HISTORY: Osteoporosis
HTN
Hyperlipidemia
Hypothyroidism
CHF
AF on coumadin
Several old lacunar infarcts seen on CT(right lentiform nucleus
and bilateral

MEDICATION ON ADMISSION: Ativan 0.5 qhs
Cartia XT 240 mg daily
Coumadin 2 mg and 3 mg alternating
Lipitor 10
[**Doctor First Name **] 60 prn
Levoxyl 50 daily
Allopurinol 300 daily
Meclizine 25 prn
Fosamax 70 qweek
Oxytrol 3.9 (2 patches/wk)
Citracal 1260 daily
Ranitidine 150 [**Hospital1 **]
Potassium 30 mg [**Hospital1 **]

ALLERGIES: Codeine

PHYSICAL EXAM: On ADMISSION
.
Vitals:HR=80, 180-191/70s, 16, 98% on vent
Mental Status:Intubated and unresponsive
HEENT:MMM. Sclera clear. Op clear. Intubated
CV:Irreg irreg. No MRG
Pulm:CTAB. No wheezes
CN:Pupils 3->2 bilaterally
Nasal Tickle:Withdraw and grimace bilaterally.
Gag/Cough:+ gag
Corneal Reflex:Brisk bilaterally.
Face symmetric

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Lives with her son 

### Response:
{'Intracerebral hemorrhage,Atrial fibrillation,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Long-term (current) use of anticoagulants,Unspecified acquired hypothyroidism,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
