CHIEF COMPLAINT: 66F with hx of [**Hospital **] transferred from [**Location (un) 620**] after having
worst HA of life at 4p while at church.

PRESENT ILLNESS: HPI:66F with hx of [**Hospital **] transferred from [**Location (un) 620**] after having
worst HA of life at 4p while at church. She denied N/V, CP, SOB,
LOC. Was found to have SAH at OSH, Dilantin loaded and started
on
Nimodipine. She was then transferred here for further
evaluation.

MEDICAL HISTORY: HTN

MEDICATION ON ADMISSION: Diovan 80mg/12.5, Omeprazole 20mg,
Lexapro?, Calcium, ASA 81mg'.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:98.1  BP:132/74     HR:61   RR 16      O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT:atraumatic, normocephalic Pupils: PERRL      EOMs full
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, 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: Hx of embolic stroke, no hx aneurysm

SOCIAL HISTORY: Quit smoking years ago, drinks glass wine/[**Doctor Last Name 6654**]/night
Subarachnoid hemorrhage,Urinary tract infection, site not specified,Unspecified transient cerebral ischemia,Benign essential hypertension,Personal history of tobacco use,Anemia, unspecified
Subarachnoid hemorrhage,Urin tract infection NOS,Trans cereb ischemia NOS,Benign hypertension,History of tobacco use,Anemia NOS
Admission Date:  [**2175-5-6**]              Discharge Date:   [**2175-5-17**]

Date of Birth:  [**2108-8-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
66F with hx of [**Hospital **] transferred from [**Location (un) 620**] after having
worst HA of life at 4p while at church.

Major Surgical or Invasive Procedure:
Endovascular coiling of 3mm Acom aneurysm

History of Present Illness:
HPI:66F with hx of [**Hospital **] transferred from [**Location (un) 620**] after having
worst HA of life at 4p while at church. She denied N/V, CP, SOB,
LOC. Was found to have SAH at OSH, Dilantin loaded and started
on
Nimodipine. She was then transferred here for further
evaluation.

Past Medical History:
HTN

Social History:
Quit smoking years ago, drinks glass wine/[**Doctor Last Name 6654**]/night


Family History:
Hx of embolic stroke, no hx aneurysm


Physical Exam:
T:98.1  BP:132/74     HR:61   RR 16      O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT:atraumatic, normocephalic Pupils: PERRL      EOMs full
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, 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 reactive to light, 3 to 2
mm 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 [**4-25**] throughout. No pronator drift

Sensation: Intact to light touch, proprioception, pinprick and
vibration bilaterally.

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger


Pertinent Results:
CTA HEAD W&W/O C & RECONS Study Date of [**2175-5-6**] 8:37 PM:
1. 3-mm anterior communicating artery aneurysm with projection
of
the aneurysmatic sac inferiorly. With associated previously
identified
perimesencephalic subarachnoid hemorrhage.

2. Slightly more prominent occipital ventricular horns compared
to 3.5 hours
prior, continued close followup is recommended. Trace of
intraventricular
hemorrhage layering in the occipital ventricular horns,
apparently new since
the prior study.

3. Unchanged 11 x 7 mm right orbital intracoronal soft tissue
mass, the
differential for this lesion includes hemangioma, varix,
lymphangioma.

CT HEAD W/O CONTRAST Study Date of [**2175-5-7**] 4:28 AM:
1. Diffuse subarachnoid hemorrhage centered in the
perimesencephalic space
appears similar to that seen initially. However, since then
there has been
interval slight increase in the occipital and temporal horns
bilaterally
consistent with mild hydrocephalus, as seen on later CTA head.
Also mild
bilateral intraventricular hemorrhage.

2. The right intraconal soft tissue nodule appears separate from
the optic
nerve. Differential again include hemangioma, varix, or
lymphangioma.

CAROT/CEREB [**Hospital1 **] Study Date of [**2175-5-7**] 9:23 AM:

CT HEAD W/O CONTRAST Study Date of [**2175-5-8**] 10:20 AM:
Unchanged extensive subarachnoid hemorrhage. Unchanged moderate
ventricular dilatation.

CTA [**5-12**]
IMPRESSION:

1. Findings consistent with interval evolution of extensive
subarachnoid
hemorrhage with decrease in blood products layering sulci,
basilar cistern as well as intraventricular blood products.
Stable ventricular size and
configuration.

2. Possible mild left posterior cerebral artery and A1 and A2
segment of left anterior cerebral arteries vasospasm without
definite correlate on CT
perfusion. Recommend clinical and Transcranial Doppler
correlation.

3. Unchanged 11-mm right orbital intraconal soft tissue nodule,
differential continues to include hemangioma, varix, or
lymphangioma.





Brief Hospital Course:
Pt. admitted to the neurosurgical service on [**5-6**] for [**9-30**]
headache that was the result of a ruptured 3mm ACOM aneurysm. On
[**5-7**] three coils were placed in the aneurysm endovascularly. The
procedure was uncomplicated and the patient was extubated in the
ICU.

[**5-8**] suvalience CT was negative for the development of
hydrocephalus.

[**5-9**]: Head CT negative for hydrocephalus. Continuing to monitor
for development of hydrocephalus or vassospasm.

[**5-10**]: Patient's diet was advanced as tolerated and neuro checks
were decreased to every two hours.

On [**5-12**] she had a CTA which showed Possible mild left posterior
cerebral artery and A1 and A2 segment of left anterior cerebral
arteries vasospasm without definite correlate on CT perfusion.
She was then transferred to the floor.

She continued to do well neurologically and worked well with
PT/OT.

On [**5-16**] she denied diplopia and HA and has not clinical findings
of diplopia. She was then cleared by PT to go home. Her son
[**Name (NI) 39664**] will stay with her on [**Location (un) **] for a couple of days and
then bring her back to [**State 760**] with him.

Upon discharge she was neurologically intact without deficit.


Medications on Admission:
Diovan 80mg/12.5, Omeprazole 20mg,
Lexapro?, Calcium, ASA 81mg'.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**12-23**]
Tablets PO Q4H (every 4 hours) as needed for Headache: Please do
not take Tylenol with this medication.
Disp:*80 Tablet(s)* Refills:*0*
3. Valsartan 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


Discharge Disposition:
Home With Service

Facility:
VNA Assoc. of [**Hospital3 **]

Discharge Diagnosis:
3mm Anterior Communicating Artery Aneurysm
UTI


Discharge Condition:
Neurologically stable


Discharge Instructions:
Angiogram with Embolization
Medications:
??????	Take Aspirin 325mg (enteric coated) 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 1 month. You will need a
cerebral angio at that time. Please call the office at
[**Telephone/Fax (1) 1669**] to schedule an appointment.



Completed by:[**2175-5-17**]
{'Subarachnoid hemorrhage,Urinary tract infection, site not specified,Unspecified transient cerebral ischemia,Benign essential hypertension,Personal history of tobacco use,Anemia, unspecified'}


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: 66F with hx of [**Hospital **] transferred from [**Location (un) 620**] after having
worst HA of life at 4p while at church.

PRESENT ILLNESS: HPI:66F with hx of [**Hospital **] transferred from [**Location (un) 620**] after having
worst HA of life at 4p while at church. She denied N/V, CP, SOB,
LOC. Was found to have SAH at OSH, Dilantin loaded and started
on
Nimodipine. She was then transferred here for further
evaluation.

MEDICAL HISTORY: HTN

MEDICATION ON ADMISSION: Diovan 80mg/12.5, Omeprazole 20mg,
Lexapro?, Calcium, ASA 81mg'.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:98.1  BP:132/74     HR:61   RR 16      O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT:atraumatic, normocephalic Pupils: PERRL      EOMs full
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, 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: Hx of embolic stroke, no hx aneurysm

SOCIAL HISTORY: Quit smoking years ago, drinks glass wine/[**Doctor Last Name 6654**]/night 

### Response:
{'Subarachnoid hemorrhage,Urinary tract infection, site not specified,Unspecified transient cerebral ischemia,Benign essential hypertension,Personal history of tobacco use,Anemia, unspecified'}
