CHIEF COMPLAINT: found down

PRESENT ILLNESS: HPI: 61F had episode of vomiting this morning, remembers going
to
the bathroom, does not remember if she fell but says she hit her
forehead.  Her son heard a noise and found her on the floor
outside of the bathroom and was unresponsive.  He called EMS and
she was taken to [**Hospital3 **].  She was found to have a SAH and
was transferred to [**Hospital1 18**] ED for further management.  She is
currently complaining of neck pain and a headache.

MEDICAL HISTORY: PMHx: DM, HTN, sleep apnea

MEDICATION ON ADMISSION: All: NKDA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 99.5 BP: 177/81  HR: 88    R  18     O2Sats 99% 2L NC
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 1.5mm b/l min reactive      EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT,
Extrem: Warm and well-perfused.
Neuro:
Mental status: Drowsy, had to keep asking patient to open her
eyes, cooperative with exam, normal affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: nc

SOCIAL HISTORY: Social Hx: lives with son
Subarachnoid hemorrhage,Pneumonia, organism unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other postprocedural status
Subarachnoid hemorrhage,Pneumonia, organism NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Obstructive sleep apnea,Post-proc states NEC
Admission Date:  [**2140-1-4**]              Discharge Date:   [**2140-1-21**]

Date of Birth:  [**2078-9-6**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Coil embolization of left middle cerebral
artery aneurysm with vascular neck reconstruction device.

Angiogram


History of Present Illness:
HPI: 61F had episode of vomiting this morning, remembers going
to
the bathroom, does not remember if she fell but says she hit her
forehead.  Her son heard a noise and found her on the floor
outside of the bathroom and was unresponsive.  He called EMS and
she was taken to [**Hospital3 **].  She was found to have a SAH and
was transferred to [**Hospital1 18**] ED for further management.  She is
currently complaining of neck pain and a headache.


Past Medical History:
PMHx: DM, HTN, sleep apnea

Social History:
Social Hx: lives with son


Family History:
nc

Physical Exam:
PHYSICAL EXAM:
O: T: 99.5 BP: 177/81  HR: 88    R  18     O2Sats 99% 2L NC
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 1.5mm b/l min reactive      EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT,
Extrem: Warm and well-perfused.
Neuro:
Mental status: Drowsy, had to keep asking patient to open her
eyes, cooperative with exam, normal affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and minimally reactive to light, 1.5mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-11**] throughout. No pronator drift

Sensation: Intact to light touch

Coordination: normal on finger-nose-finger

Pertinent Results:
CT/CTA:Left MCA aneurysm

[**2140-1-4**] 10:05AM   WBC-8.8 RBC-3.98* HGB-12.5 HCT-36.6 MCV-92
MCH-31.3 MCHC-34.0 RDW-13.3
[**2140-1-4**] 10:05AM   NEUTS-85.8* LYMPHS-10.8* MONOS-2.9 EOS-0.4
BASOS-0.1
[**2140-1-4**] 10:05AM   PLT COUNT-245
[**2140-1-4**] 10:05AM   PT-11.9 PTT-21.0* INR(PT)-1.0
[**2140-1-4**] 10:05AM   GLUCOSE-198* UREA N-14 CREAT-0.9 SODIUM-140
POTASSIUM-3.4 CHLORIDE-101 TOTAL CO2-25 ANION GAP-17
[**2140-1-4**] 10:05AM   CALCIUM-9.3 PHOSPHATE-2.1* MAGNESIUM-2.0
[**2140-1-4**] 10:08AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.030
[**2140-1-4**] 10:08AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-30
GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2140-1-4**] 10:08AM URINE  RBC-21-50* WBC-0-2 BACTERIA-RARE
YEAST-NONE EPI-0

CT [**2140-1-19**]:
FINDINGS: Comparison is made to [**2140-1-16**].

The previously seen right frontal ventricular shunt has been
removed and the shunt tract is still visible. There may be
minimal increase in size of the ventricles diffusely.

Again seen are subarachnoid hemorrhage predominantly along the
sulci of the left cerebrum. The previously seen hemorrhage
involving the left temporal lobe is no longer visualized,
although the hypodensity persists. There is a left-sided coil
pack in the sylvian fissure and the streak artifact limits
evaluation of the adjacent brain.

The basal cisterns are patent.

There are scattered small hypodensities of the deep and
periventricular white matter which likely represent chronic
microangiopathic changes.

A right frontal burr hole is again seen. No suspicious bony
abnormalities are noted.

There is fluid/soft tissue change of the right mastoid air
cells.

IMPRESSION:
1. Since [**2140-1-16**], removal of right ventricular shunt with
minimal increase in size of the ventricles diffusely.
2. Persistent predominantly left-sided subarachnoid hemorrhage
and edema of the anterior left temporal lobe.

CT [**2140-1-4**]:
FINDINGS: The patient has undergone interval coiling of the
previously demonstrated left MCA aneurysm. Streak artifact from
the coils somewhat obscures visualization at this level.
Redemonstrated is diffuse subarachnoid hemorrhage not
appreciably changed compared to [**2140-1-4**] at 10:47 a.m. There
has been interval placement of a ventriculostomy catheter via a
right frontal craniotomy which enters the frontal [**Doctor Last Name 534**] of the
right lateral ventricle and terminates near the third ventricle.
The ventricular system is slightly smaller compared to the prior
study, although it remains symmetric. Slight shift of the septum
pellucidum to the right by approximately 4 mm has not
appreciably changed. The paranasal sinuses and mastoid air cells
remain clear.

IMPRESSION: Interval coiling of left MCA aneurysm. Diffuse
subarachnoid hemorrhage not appreciably changed. Interval
placement of ventriculostomy catheter which enters frontal [**Doctor Last Name 534**]
of right lateral ventricle to a termination near the third
ventricle. Slight interval decrease in size of ventricular
system. No change in slight rightward subfalcine herniation by
about 4 mm.


Brief Hospital Course:
The patient was admitted to the ICU on [**2140-1-4**]. She had a
non-traumatic SAH. She had a CTA which revealed a left MCA
aneurysm. The patient had an angio with a coiling on the day of
admission as well as an EVD placement. She was started on
aspirin and plavix after the angio. On [**2140-1-5**] she was
extubated. She had a CTA/CTP on [**1-6**] which showed no vasospam
and she remained neurologically stable. The patient was more
somnolent on [**2140-1-8**] and after a family meeting a CTA was
obtained. It showed no vasospasm. On [**1-9**] CSF was sent because
the patient spiked a fever to 103.4. She was started on
antibiotics by the ICU team for a presumed pneumonia. She had
LENIs which were negative on [**2140-1-10**].

On [**1-10**] the patient was neurologically stable and her drain was
raised to 20 cm H2O.
She had a repeat CTA/CTP on [**1-12**] which showed no change and she
also had a PICC line placed for her antibiotics. On [**2140-1-15**] her
CSF came back which showed no micro-organisms with 2+ polys. We
tried clamping her drain but she failed with ICPs > 25.
On [**2140-1-16**] her CT showed increased size of temporal horns. On
[**2140-1-17**] one antibiotic was stopped. When her drain was clamped
on [**2140-1-17**], she did well. Her ICPs were < 20.
The drain was removed on [**2140-1-19**]. The patient was also
transferred to the floor that day. On [**2140-1-20**] she passed her
speech and swallow evaluation and her vanco was discontinued.

Physical therapy and occupational therapy recommended rehab. The
patient was neurologically stable and was deemed ready for
discharge on [**2140-1-21**]. Her PICC line was removed prior to
discharge. She was afebrile. Neurologically: she was oriented x
3 and full strength in all extremities; no pronator drift; face
symmetric.

Medications on Admission:
All: NKDA

Medications prior to admission: Lisinopril

Discharge Medications:
1. Metoprolol Tartrate 5 mg/5 mL Solution Sig: One (1)
Intravenous Q4-6H () as needed for HR > 110.
2. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed.
3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
4. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain/fever.
5. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Metoprolol Tartrate 50 mg Tablet Sig: 1.5 Tablets PO BID (2
times a day): hold for SBP < 100 or HR < 60.
8. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
9. Levetiracetam 100 mg/mL Solution Sig: One (1)  PO BID (2
times a day).
10. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical PRN
(as needed).
11. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
12. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Five (5)
 Subcutaneous once a day: please give prior to breakfast.
13. Insulin Lispro 100 unit/mL Cartridge Sig: One (1)
Subcutaneous AS DIRECTED: Please follow sliding scale.
14. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every
4 hours) for 5 days: Today is day 17 of 21. Please stop on [**1-25**], [**2139**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Left MCA aneurysm rupture


Discharge Condition:
Neurologically Stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????	Have a 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,
excessive bending
??????	You may wash your hair only after sutures have been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, drainage
??????	Fever greater than or equal to 101?????? F

Followup Instructions:
PLEASE HAVE YOUR SUTURES REMOVED ON [**2140-1-24**].

PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR
[**First Name (STitle) **] TO BE SEEN IN 4 WEEKS.

YOU WILL NEED AN MRA OF THE BRAIN WITH/WITHOUT GADOLIDIUM



Completed by:[**2140-1-21**]
{'Subarachnoid hemorrhage,Pneumonia, organism unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other postprocedural status'}


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: found down

PRESENT ILLNESS: HPI: 61F had episode of vomiting this morning, remembers going
to
the bathroom, does not remember if she fell but says she hit her
forehead.  Her son heard a noise and found her on the floor
outside of the bathroom and was unresponsive.  He called EMS and
she was taken to [**Hospital3 **].  She was found to have a SAH and
was transferred to [**Hospital1 18**] ED for further management.  She is
currently complaining of neck pain and a headache.

MEDICAL HISTORY: PMHx: DM, HTN, sleep apnea

MEDICATION ON ADMISSION: All: NKDA

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 99.5 BP: 177/81  HR: 88    R  18     O2Sats 99% 2L NC
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 1.5mm b/l min reactive      EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT,
Extrem: Warm and well-perfused.
Neuro:
Mental status: Drowsy, had to keep asking patient to open her
eyes, cooperative with exam, normal affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: nc

SOCIAL HISTORY: Social Hx: lives with son 

### Response:
{'Subarachnoid hemorrhage,Pneumonia, organism unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obstructive sleep apnea (adult)(pediatric),Other postprocedural status'}
