CHIEF COMPLAINT: Transfer from OSH with SAH

PRESENT ILLNESS: 56 yo female with PMH of HLP and spontaneous pneumothorax
presents with new onset headache and neck stiffness.  Patient
states that she woke up this morning at 3:30 am was speaking to
her son when she developed a sudden onset of a [**8-26**] headache.
Pain was located along the bifrontal region of the head and was
associated with neck stiffness and some blurry vision.  NO
diplopia, nausea, vomiting, dsyarthria, or dysphagia.

MEDICAL HISTORY: Spontaneous pneumothorax [**2068**] s/p chest tube

MEDICATION ON ADMISSION: MVI
1 gram of fish oil PO daily
Vit D [**2092**] units q day
co enzyme q 10
gingko

ALLERGIES: Penicillins

PHYSICAL EXAM: PHYSICAL EXAM:
O: T:98.9  BP: 121/58 HR:59 R 14 O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:PERRL EOMI
Neck: Supple. negative kernig sign
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-17**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Stroke - father in his 50s

SOCIAL HISTORY: social EtOH.  Ex smoker 20 years ago.  No illicit drug
use. Not sexually active.
Subarachnoid hemorrhage,Acute venous embolism and thrombosis of superficial veins of upper extremity,Fever, unspecified
Subarachnoid hemorrhage,Ac embl suprfcl up ext,Fever NOS
Admission Date:  [**2103-8-2**]              Discharge Date:   [**2103-8-14**]

Date of Birth:  [**2046-12-29**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Transfer from OSH with SAH

Major Surgical or Invasive Procedure:
[**2103-8-1**]: Cerebral Angiogram- Diagnostic


History of Present Illness:
56 yo female with PMH of HLP and spontaneous pneumothorax
presents with new onset headache and neck stiffness.  Patient
states that she woke up this morning at 3:30 am was speaking to
her son when she developed a sudden onset of a [**8-26**] headache.
Pain was located along the bifrontal region of the head and was
associated with neck stiffness and some blurry vision.  NO
diplopia, nausea, vomiting, dsyarthria, or dysphagia.


Past Medical History:
Spontaneous pneumothorax [**2068**] s/p chest tube


Social History:
social EtOH.  Ex smoker 20 years ago.  No illicit drug
use. Not sexually active.


Family History:
Stroke - father in his 50s


Physical Exam:
PHYSICAL EXAM:
O: T:98.9  BP: 121/58 HR:59 R 14 O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:PERRL EOMI
Neck: Supple. negative kernig sign
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-17**] objects at 5 minutes.
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, to
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 [**3-21**] throughout. No pronator drift

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

Reflexes: B T Br Pa Ac
Right     2 2 2  2  2
Left      2 2 2  2  2

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger

DISCHARGE EXAM:
Intact

Pertinent Results:
[**2103-8-2**] 04:07PM URINE  RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0
[**2103-8-2**] 04:07PM   PT-12.0 PTT-24.3 INR(PT)-1.0
[**2103-8-2**] 04:07PM   PLT COUNT-268
[**2103-8-2**] 04:07PM   WBC-7.5 RBC-4.35 HGB-12.8 HCT-37.4 MCV-86
MCH-29.3 MCHC-34.2 RDW-12.8

[**2103-8-2**] CT head
SAH with question of small R posterior AVM

[**2103-8-2**] Angiogram: IMPRESSION: Fetal configuration of the right
PCA, which supplies the vascular malformation in the right
posterior parietal lobe. This is consistent with an AV fistula
which has a single dilated vein which has significant stenosis
distally.

Ultrasound:

Acute thrombus seen in distal left cephalic vein in the region
of the antecubital fossa, without extension proximally into the
mid-to-upper portion of the cephalic vein, nor into the deep
veins of the right arm.



Brief Hospital Course:
[**8-2**] Pt admitted to neurosurgery service and underwent emergent
diagnostic cerebral angiogram to evaluate for AVM or aneurysm.
She was transferred to the ICU for q1 neurochecks and strict
blood pressure control less than 140. Upon post op examination
she was doing well. Her groin site was clean and dry with no
hematoma and she had good distal pulses. She remained
neurologically intact with full strength and orientation. She
was kept on flat bed rest for 4 hours after sheath removal and
her diet was advanced.

[**8-3**] -[**8-5**] She remained neurologically intact and was closely
monitored hemodynamically. Pain was controlled and planning was
initiated for treatment.

On [**8-6**] She was cleared for transfer to the stepdown. Dr [**First Name (STitle) **]
requested a second opinion from a physician at [**Name9 (PRE) 2025**] per the
patient's request.
On [**8-7**] the patient was pre-op'd for angiogram and embolization.
ON [**8-8**] patient went to Angio with Dr. [**First Name (STitle) **] for attempted
embolization of her AVM, but the angiogram did not reveal a
draining vein in the complex and hence embolization was not
possible, patient was transferred back to the floor.

On [**8-10**] patient developed a fever of 101.6 and as part of the
fever work up a Chest Xray and UA was ordered. Upon examination
on [**8-11**] we noted a tender right upper extremity with a cord like
vein in the right anti cubital fossa from an old IV. A right
upper extremity Ultrasound was obtained. Patient is refusing a
CXR at this time. Right upper extremity US revealed a
superficial cephalic vein thrombosis which does not require
anticoagulation; she has been advised to use warm compresses and
NSAIDs for treatment.

After review of her case and images with Dr. [**Last Name (STitle) 87594**] from [**Hospital1 2025**],
Dr. [**First Name (STitle) **] offered the patient a coiling on [**8-13**] and the patient
opted to seek a second open ion and think over the procedure.

The patient is afebrile and is being taken off of her Keppra
since she has been seizure free and discharged home with follow
up appointments.

Medications on Admission:
MVI
1 gram of fish oil PO daily
Vit D [**2092**] units q day
co enzyme q 10
gingko


Discharge Medications:
.
1. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: One
(1) Tablet PO Q4H (every 4 hours) as needed for Headaches.
Disp:*30 Tablet(s)* Refills:*0*
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Omega-3 Fatty Acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
4. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
SAH, Arteriovenous malformation


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


Discharge Instructions:
Angiogram
??????	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
> You were taking Keppra for siezure propholaxis during your
hospitalization since you had no seizures after your initial
hemorrhage you will not need to continue to take this
medication. Given your the Short duration which you were on this
medication you do not require a taper. you can just stop this
medication.

Followup Instructions:
Follow-Up Appointment Instructions
Please see Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13014**] on [**8-17**] at 9am.  Location:
[**Hospital Ward Name 332**] Basement ( Radiation Specialist)
You are scheduled to see Dr. [**Last Name (STitle) 1132**] on [**8-17**] at 3pm. You need
to arrive at [**State 83674**], Proger building.
Registration is located on the [**Location (un) 448**] on the Proger
Building. Once you are  finished, proceed to the  [**Hospital 4695**]
clinic which is located on the [**Location (un) 436**].
Your images have been uploaded to a disk. Once you are
discharged, you need to pick up the cds at West Clinical Ctr,
[**Location (un) 470**], film library (across from radiology dept).

Please return our office to see Dr. [**First Name (STitle) **] on in 2 weeks. Call
[**Telephone/Fax (1) 1669**]



Completed by:[**2103-8-14**]
{'Subarachnoid hemorrhage,Acute venous embolism and thrombosis of superficial veins of upper extremity,Fever, 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: Transfer from OSH with SAH

PRESENT ILLNESS: 56 yo female with PMH of HLP and spontaneous pneumothorax
presents with new onset headache and neck stiffness.  Patient
states that she woke up this morning at 3:30 am was speaking to
her son when she developed a sudden onset of a [**8-26**] headache.
Pain was located along the bifrontal region of the head and was
associated with neck stiffness and some blurry vision.  NO
diplopia, nausea, vomiting, dsyarthria, or dysphagia.

MEDICAL HISTORY: Spontaneous pneumothorax [**2068**] s/p chest tube

MEDICATION ON ADMISSION: MVI
1 gram of fish oil PO daily
Vit D [**2092**] units q day
co enzyme q 10
gingko

ALLERGIES: Penicillins

PHYSICAL EXAM: PHYSICAL EXAM:
O: T:98.9  BP: 121/58 HR:59 R 14 O2Sats 99
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils:PERRL EOMI
Neck: Supple. negative kernig sign
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-17**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Stroke - father in his 50s

SOCIAL HISTORY: social EtOH.  Ex smoker 20 years ago.  No illicit drug
use. Not sexually active. 

### Response:
{'Subarachnoid hemorrhage,Acute venous embolism and thrombosis of superficial veins of upper extremity,Fever, unspecified'}
