CHIEF COMPLAINT: right sided weakness and tremor

PRESENT ILLNESS: History of present illness: Pt is a [**Age over 90 **] year old man with
dementia
with three days of intermittent right sided weakness and tremor.
By report, Pt's family reported right sided weakness at
breakfast
then again in the bathroom the afternoon of admission. Taken to
an OSH for
evaluation via EMS at ~2:45pm. Head CT revealed bilateral
subdural hemorrhages. Pt was transferred to [**Hospital1 18**] for further
evaluation.
.
Pt has had several falls recently due to the right sided
weakness. No known head trauma or loss of consciousness.
.
Review of systems (from patient): Denies recent fever, chills,
congestion, cough, chest pain, vomiting, diarrhea, rash. Denies
weakness, numbness, loss of consciousness, involuntary
movements.

MEDICAL HISTORY: Past medical history:
Dementia
s/p pacemaker placement for bradycardia
Diabetes mellitus
.
Allergies: NKDA

MEDICATION ON ADMISSION: Medications prior to admission (doses unknown):
Lisinopril
Metformin
Glyburide

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T 98.2  HR 61  BP 138/63  RR 20  O2sat 95%RA
Gen - WD/WN, comfortable, NAD.
HEENT - neck supple
Lungs - CTA bilaterally.
Cardiac - RRR
Abd - Soft, NT, BS+
Extremities - Warm and well-perfused.
Neuro:
Mental status - Awake and alert, cooperative with exam. Oriented
to person, hospital (but not [**Hospital1 18**]), "[**Hospital1 1559**]", "[**2043-5-4**]".
Registers [**3-6**] objects, 0/3 at one minute. Speech fluent without
errors. Somewhat inattentive. Follows simple commands but has
difficulty with more complex tasks. No dysarthria.
Cranial Nerves:
I - Not tested
II - PERRL 2.5 to 2mm bilaterally. Blinks to threat bilaterally.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Retired, lives with son; had worked until 2 weeks prior to
admission.
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Fall from other slipping, tripping, or stumbling,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Chronic kidney disease, unspecified,Subdural hemorrhage,Other persistent mental disorders due to conditions classified elsewhere,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Cardiac pacemaker in situ,History of fall
Subdural hem w/o coma,Fall from slipping NEC,Urin tract infection NOS,CHF NOS,Hyperosmolality,Acute kidney failure NOS,DMII unspf uncntrld,Chronic kidney dis NOS,Subdural hemorrhage,Mental disor NEC oth dis,Pseudomonas infect NOS,Status cardiac pacemaker,Personal history of fall
Admission Date:  [**2133-12-12**]              Discharge Date:   [**2133-12-26**]


Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
right sided weakness and tremor

Major Surgical or Invasive Procedure:
Burr holes with evacuation of SDH bilaterally


History of Present Illness:
History of present illness: Pt is a [**Age over 90 **] year old man with
dementia
with three days of intermittent right sided weakness and tremor.
By report, Pt's family reported right sided weakness at
breakfast
then again in the bathroom the afternoon of admission. Taken to
an OSH for
evaluation via EMS at ~2:45pm. Head CT revealed bilateral
subdural hemorrhages. Pt was transferred to [**Hospital1 18**] for further
evaluation.
.
Pt has had several falls recently due to the right sided
weakness. No known head trauma or loss of consciousness.
.
Review of systems (from patient): Denies recent fever, chills,
congestion, cough, chest pain, vomiting, diarrhea, rash. Denies
weakness, numbness, loss of consciousness, involuntary
movements.


Past Medical History:
Past medical history:
Dementia
s/p pacemaker placement for bradycardia
Diabetes mellitus
.
Allergies: NKDA


Social History:
Retired, lives with son; had worked until 2 weeks prior to
admission.

Family History:
noncontributory

Physical Exam:
PHYSICAL EXAM:
T 98.2  HR 61  BP 138/63  RR 20  O2sat 95%RA
Gen - WD/WN, comfortable, NAD.
HEENT - neck supple
Lungs - CTA bilaterally.
Cardiac - RRR
Abd - Soft, NT, BS+
Extremities - Warm and well-perfused.
Neuro:
Mental status - Awake and alert, cooperative with exam. Oriented
to person, hospital (but not [**Hospital1 18**]), "[**Hospital1 1559**]", "[**2043-5-4**]".
Registers [**3-6**] objects, 0/3 at one minute. Speech fluent without
errors. Somewhat inattentive. Follows simple commands but has
difficulty with more complex tasks. No dysarthria.
Cranial Nerves:
I - Not tested
II - PERRL 2.5 to 2mm bilaterally. Blinks to threat bilaterally.

III, IV, VI - Decreased upgaze, eye movements otherwise intact
without nystagmus.
V, VII - Slight left lower facial droop. Sensation intact to
light touch.
VIII - Hearing intact to snap (but not finger rub).
IX, X - Palatal elevation symmetric.
[**Doctor First Name 81**] - Sternocleidomastoid and trapezius normal bilaterally.
XII - Tongue midline without fasciculations.
Motor - Decreased bulk throughout, normal tone. Strength full
power [**5-8**] throughout. No pronator drift.
Sensation - Intact to light touch and pinprick; decreased
vibration at the toes bilaterally (improved at the ankles). No
extinction.
Reflexes - 2+ brisk at biceps, triceps, brachioradialis, patella
bilaterally. Unable to elicit at the ankles. Toes upgoing
bilaterally.
Coordination - mild intention tremor on finger to nose, rapid
alternating movements are symmetric.


Pertinent Results:
OSH:
CBC 7.4>32.6<285  60N 27L 11M
Na 137  K 4.8  Cl 101  CO2 27  BUN 24  Cr 1.5  Glu 389
U/A glucose >1000
CXR negative
OSH head CT - bilateral subdural hemorrhages, L>R, subacute
component on the left, chronic on the right.

[**Hospital1 18**]:
CBC 7.2>32.9<284
Na 140  K 4.2  K 103 CO2 28  BUN 23  Cr 1.3  Glu 101
PT 12.4  PTT 26.2  INR 1.1

BIHead CT [**12-11**] -  Large bilateral subdural hematomas, left
larger
than right, with shift of the septum pellucidum to the right by
9
mm


Brief Hospital Course:
Mr. [**Name13 (STitle) **] is a [**Age over 90 **]-year-old man with a history of dementia who
presented with R sided weakness and falls. His brief hospital
course is as follows:
.
1. Falls, Subdural Hematoma. He was found to have bilateral
subdural hematoma at the OSH and was transferred to [**Hospital1 18**] for
monitoring. He was initially admitted to the ICU. His neurologic
status declined and he was taken to the OR where under MAC
anesthesia he underwent left and right bilateral burr hole
evacuation for worsening mass effect from subdural hematomas. He
tolerated this procedure well and was transferred to the PACU
and then to neuro stepdown unit. He was followed with CT of head
which showed slightly less blood and less mass effect.
.
His post-operative course was complicated by poor recovery. He
showed some neurologic improvement 3 days post-op, opening his
eyes to command. However, he deteriorated again from that point,
becoming unresponsive on POD#5. He was transferred to medicine
at that point as there was no further indication for
neurosurgery: his Head CT was stable and he was no longer a
surgical candidate. Many discussions were held with his family
that culminated in the decision not to transfer him to the ICU
and to avoid any invasive maneuvers but to continue managing him
medically. His mental status waxed and waned slightly over the
next three days, but his peak functioning was to open his eyes
on command. Without evidence of significant progression and with
a poor overall prognosis even with optimal medical care, the
decision was made to change his status to comfort measures only
(CMO). This decision was made by his son in consultation with
the medical team; his son felt that he would not have wanted
further intervention. At this point, his NG tube was removed, no
further labs were checked, and the only medications administered
were those aimed at improving his immediate comfort. He
subsequently died comfortable.
.
2. Hypervolemia. On transfer from the Neurosurgery service to
the Medicine service, the primary assessment was a volume
overload impairing his respiratory status. He was consequently
diuresed with Lasix with good effect on his breathing, although
minimal effect on his mental status.
.
3. Hypernatremia. His sodium peaked at 150 after diuresis. This
improved with a small return of free water. Labs were no longer
followed after he was made CMO.
.
4. Nutritional status. Albumin 2.7. An NG tube was placed for
tube feeds. However, shortly after that, the family decided that
they definitely did not want him to receive a PEG tube and
instead would prefer to focus on comfort measures only.
.
5. UTI. Although there was some concern for infection and sepsis
at the time of transfer to Medicine, a urine culture positive
for pseudomonas was the only sign of a localizing infection. His
vitals were stable over the last several days. Therefore,
empiric antibiotic coverage was no longer indicated, and since
the pseudomonas in culture was sensitive to ciprofloxacin, he
was switched to this. Once the CMO status was established,
antibiotics were stopped. He received a total of three days of
Vancomycin and Zosyn and one day of Cipro.
.
6. Acute Renal Failure. This improved with diuresis and was
likely the result of decreased ECV. His labs were no longer
followed after CMO status was established.
.
7. DM2. He had reasonably good control with NPH and HISS.
Fingersticks were no longer checked after CMO status was
established.
.
8. HTN. His antihypertensive medications were held given
concerns of hypotension and an uncertain intracranial pressure.
.
9. Communication: His son [**Name (NI) **] [**Name (NI) **] ([**Telephone/Fax (1) 70358**]) was the
primary contact and decision-maker.
.
10. CODE: CMO. This was discussed many times at length.
Ultimately, the family decided to have comfort measures only.
.
11. Dispo: Transferred to a long-term care facility close to his
home in [**Hospital1 1559**] for palliative end-of-life care.

Medications on Admission:
Medications prior to admission (doses unknown):
Lisinopril
Metformin
Glyburide


Discharge Medications:
None

Discharge Disposition:
Extended Care

Discharge Diagnosis:
B/L SUBDURAL HEMATOMAS


Discharge Condition:
Expired

Discharge Instructions:
None

Followup Instructions:
None

                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Fall from other slipping, tripping, or stumbling,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Chronic kidney disease, unspecified,Subdural hemorrhage,Other persistent mental disorders due to conditions classified elsewhere,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Cardiac pacemaker in situ,History of fall'}


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: right sided weakness and tremor

PRESENT ILLNESS: History of present illness: Pt is a [**Age over 90 **] year old man with
dementia
with three days of intermittent right sided weakness and tremor.
By report, Pt's family reported right sided weakness at
breakfast
then again in the bathroom the afternoon of admission. Taken to
an OSH for
evaluation via EMS at ~2:45pm. Head CT revealed bilateral
subdural hemorrhages. Pt was transferred to [**Hospital1 18**] for further
evaluation.
.
Pt has had several falls recently due to the right sided
weakness. No known head trauma or loss of consciousness.
.
Review of systems (from patient): Denies recent fever, chills,
congestion, cough, chest pain, vomiting, diarrhea, rash. Denies
weakness, numbness, loss of consciousness, involuntary
movements.

MEDICAL HISTORY: Past medical history:
Dementia
s/p pacemaker placement for bradycardia
Diabetes mellitus
.
Allergies: NKDA

MEDICATION ON ADMISSION: Medications prior to admission (doses unknown):
Lisinopril
Metformin
Glyburide

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T 98.2  HR 61  BP 138/63  RR 20  O2sat 95%RA
Gen - WD/WN, comfortable, NAD.
HEENT - neck supple
Lungs - CTA bilaterally.
Cardiac - RRR
Abd - Soft, NT, BS+
Extremities - Warm and well-perfused.
Neuro:
Mental status - Awake and alert, cooperative with exam. Oriented
to person, hospital (but not [**Hospital1 18**]), "[**Hospital1 1559**]", "[**2043-5-4**]".
Registers [**3-6**] objects, 0/3 at one minute. Speech fluent without
errors. Somewhat inattentive. Follows simple commands but has
difficulty with more complex tasks. No dysarthria.
Cranial Nerves:
I - Not tested
II - PERRL 2.5 to 2mm bilaterally. Blinks to threat bilaterally.

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Retired, lives with son; had worked until 2 weeks prior to
admission. 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Fall from other slipping, tripping, or stumbling,Urinary tract infection, site not specified,Congestive heart failure, unspecified,Hyperosmolality and/or hypernatremia,Acute kidney failure, unspecified,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Chronic kidney disease, unspecified,Subdural hemorrhage,Other persistent mental disorders due to conditions classified elsewhere,Pseudomonas infection in conditions classified elsewhere and of unspecified site,Cardiac pacemaker in situ,History of fall'}
