CHIEF COMPLAINT: headache/seizures

PRESENT ILLNESS: This is a 57 year old woman with PMH of migraines who presented
to the ED
today via EMS. The son recalls his mom having a headache 1 week
ago that was sudden onset in nature. The headaches have waxed
and waned over the past week until this AM when he found her
unresponsive in the bathroom. When EMS arrived she had came to
and was reportedly non-focal. In the ED, a head CT was delayed
while waiting for an HCG result. The patient suddenly began
seizing requiring intubation because of inability to protect
airway. Head CT/CTA was then performed revealing SAH and basilar
trunk aneurysm. Neurosurgery was consulted.

MEDICAL HISTORY: Migraines

MEDICATION ON ADMISSION: Advil prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]: 2  [**Doctor Last Name **]: 2          GCS  E:3 V:1  Motor 6
O: T:97.6  BP: 141/91  HR:90    R20     O2Sats 97%
Gen: intubated and sedated (prop held for exam)
HEENT: Pupils: 2mm +reactive b/l  +corneals
+ cough & gag. minimal eye opening
Extrem: Warm and well-perfused. following commands x4
extremities
and moving all with good strengths.

FAMILY HISTORY: NC

SOCIAL HISTORY: She lives with her son. She works as a floor manager for [**Company 89879**]. She smokes [**2-13**] cigarettes per day. She has a small amt
of alcohol at nigh. She does not use drugs.
Subarachnoid hemorrhage,Other disorders of neurohypophysis,Hemiplegia, unspecified, affecting unspecified side,Hypopotassemia,Tobacco use disorder,Other convulsions,Migraine with aura, without mention of intractable migraine without mention of status migrainosus
Subarachnoid hemorrhage,Neurohypophysis dis NEC,Unsp hemiplga unspf side,Hypopotassemia,Tobacco use disorder,Convulsions NEC,Mgrn w aura wo ntrc mgrn
Admission Date:  [**2183-4-15**]              Discharge Date:   [**2183-4-23**]

Date of Birth:  [**2125-9-5**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2183-4-15**]: Cerebral Angiogram with stent assisted coiling


History of Present Illness:
This is a 57 year old woman with PMH of migraines who presented
to the ED
today via EMS. The son recalls his mom having a headache 1 week
ago that was sudden onset in nature. The headaches have waxed
and waned over the past week until this AM when he found her
unresponsive in the bathroom. When EMS arrived she had came to
and was reportedly non-focal. In the ED, a head CT was delayed
while waiting for an HCG result. The patient suddenly began
seizing requiring intubation because of inability to protect
airway. Head CT/CTA was then performed revealing SAH and basilar
trunk aneurysm. Neurosurgery was consulted.


Past Medical History:
Migraines

Social History:
She lives with her son. She works as a floor manager for [**Company 89879**]. She smokes [**2-13**] cigarettes per day. She has a small amt
of alcohol at nigh. She does not use drugs.


Family History:
NC

Physical Exam:
On Admission:
PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]: 2  [**Doctor Last Name **]: 2          GCS  E:3 V:1  Motor 6
O: T:97.6  BP: 141/91  HR:90    R20     O2Sats 97%
Gen: intubated and sedated (prop held for exam)
HEENT: Pupils: 2mm +reactive b/l  +corneals
+ cough & gag. minimal eye opening
Extrem: Warm and well-perfused. following commands x4
extremities
and moving all with good strengths.

On Discharge:
O: AFVSS
Gen: AOx3, affect appropriate
HEENT: Pupils: 3 -> 2mm +reactive
Extrem: Warm and well-perfused. following commands x4
Full strength througout both upper and lower extremities.
Able to ambulate without assistance


Pertinent Results:
CTA Head [**2183-4-15**]
1. Subarachnoid hemorrhage in the basal cisterns with extension
into the
fourth ventricle.
2. 5-mm right-sided saccular aneurysm of the distal basilar
artery, proximal to the superior cerebellar artery origin, which
appears to be associated with the origin of a brainstem
perforator artery.
3. Slight contour prominence in the proximal superior division
of the right MCA, possibly related to the origin of a small
branch that is poorly
visualized, but a small aneurysm cannot be excluded. This may be
better
assessed by conventional angiography, which will presumably be
pursued for
evaluation of the basilar aneurysm.

CXR [**2183-4-15**]
Optimal position of endotracheal tube.

Cerebral Angiogram [**2183-4-15**]
[**Known firstname **] [**Known lastname 16462**] underwent cerebral angiography and coil embolization

of a right basilar trunk aneurysm, which was facilitated by the
use of a
stent. The procedure was uneventful and there were no
complications during
the procedure.

CXR [**2183-4-16**]
AP chest compared to [**4-15**] at 10:51 a.m. In the interim,
trachea has been extubated. Lungs are essentially clear aside
from mild left basal atelectasis. Mild cardiomegaly stable.
Mediastinal veins mildly
dilated but unchanged. No pneumothorax.

CT head [**2183-4-16**]
Status post basilar stenting and aneurysm coiling with no
complication visualized.

CXR [**2183-4-17**]
As compared to the previous radiograph, the lung volumes have
increased. There is minimal atelectasis at both lung bases but
no evidence of newly occurred focal parenchymal opacity
suggesting pneumonia. Unchanged size of the cardiac silhouette.
No pulmonary edema. No larger pleural effusions.  No
pneumothorax.

CTP/CTA [**2183-4-18**]
1. No evidence of new hemorrhage. Subtle subarachnoid hemorrhage
seen on the CT of the head.
2. CT perfusion demonstrates no evidence of abnormalities to
indicate
ischemia or infarction.
3. CT angiography of the head demonstrates stent-assisted
coiling of the
basilar artery aneurysm without evidence of significant
vasospasm.


Brief Hospital Course:
Ms. [**Known lastname 16462**] was taken to the angio suite for coiling and stenting
of the basilar aneurysm.  She was placed on a heparin drip until
the morning at which time heparin drip was discontinued and she
was started on Aspirin and Plavix.

She developed SIADH on [**4-19**] and was started on Florinef and
salt tabs, and also a prednisone taper for her headaches. TCDs
on [**4-18**] showed above normal velocities in the right middle
cerebral artery, right anterior cerebral artery, and
basilar artery, but none of the vessels had evidence of
vasospasm.

On [**4-20**] she was transferred to the floor. She still complained
of headaches. Her serum NA was 141 and she was on salt tabs and
they were decreased to 1 gm tid. She was on 1 liter fluid
restriction. On /11, her IV fluids were stopped. She was
orthostatic with PT. Her potassium was low to 3.1 and this was
repleted. She was seen again by PT on [**4-22**] and cleared for
discharge home with home physical therapy services.

She was discharged on [**2183-4-23**] with follow up with her surgeon.


Medications on Admission:
Advil prn

Discharge Medications:
1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for Pain.
Disp:*90 Tablet(s)* Refills:*0*
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: [**1-12**]
Tablets PO Q4H (every 4 hours) as needed for headache: MAx 4g
APAP (tylenol) in 24 hrs.
Disp:*90 Tablet(s)* Refills:*0*
6. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home with Service

Discharge Diagnosis:
SAH
Hyponatremia

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily.
??????	Take Plavix (Clopidogrel) 75mg once daily.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room!


Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] in one month with an MRI/MRa of
the brain. Please call [**Telephone/Fax (1) 1669**] to schedule this
appointment.
{'Subarachnoid hemorrhage,Other disorders of neurohypophysis,Hemiplegia, unspecified, affecting unspecified side,Hypopotassemia,Tobacco use disorder,Other convulsions,Migraine with aura, without mention of intractable migraine without mention of status migrainosus'}


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/seizures

PRESENT ILLNESS: This is a 57 year old woman with PMH of migraines who presented
to the ED
today via EMS. The son recalls his mom having a headache 1 week
ago that was sudden onset in nature. The headaches have waxed
and waned over the past week until this AM when he found her
unresponsive in the bathroom. When EMS arrived she had came to
and was reportedly non-focal. In the ED, a head CT was delayed
while waiting for an HCG result. The patient suddenly began
seizing requiring intubation because of inability to protect
airway. Head CT/CTA was then performed revealing SAH and basilar
trunk aneurysm. Neurosurgery was consulted.

MEDICAL HISTORY: Migraines

MEDICATION ON ADMISSION: Advil prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]: 2  [**Doctor Last Name **]: 2          GCS  E:3 V:1  Motor 6
O: T:97.6  BP: 141/91  HR:90    R20     O2Sats 97%
Gen: intubated and sedated (prop held for exam)
HEENT: Pupils: 2mm +reactive b/l  +corneals
+ cough & gag. minimal eye opening
Extrem: Warm and well-perfused. following commands x4
extremities
and moving all with good strengths.

FAMILY HISTORY: NC

SOCIAL HISTORY: She lives with her son. She works as a floor manager for [**Company 89879**]. She smokes [**2-13**] cigarettes per day. She has a small amt
of alcohol at nigh. She does not use drugs. 

### Response:
{'Subarachnoid hemorrhage,Other disorders of neurohypophysis,Hemiplegia, unspecified, affecting unspecified side,Hypopotassemia,Tobacco use disorder,Other convulsions,Migraine with aura, without mention of intractable migraine without mention of status migrainosus'}
