CHIEF COMPLAINT: ICH

PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname 33858**] (ED alias: EU CRITICAL, [**Male First Name (un) 80647**] [**Numeric Identifier 80648**]) is
an
83 year old male with unclear previous medical history who now
presents as a transfer to this hospital with large left
hemispheric hemorrhage. There is scant history available from
outside records, there is not family available at present. Per
outside hospital records the patient was last seen well last
night. He was found this afternoon ~1300hrs by his granddaughter
who climbed through a window in his home. He was noted to have
right sided weakness and unable to speak. Outside hospital CT
scan revealed a large left hemispheric hemorrhage with midline
shift. He was intubated and given Mannitol 100gm IV and sent to
[**Hospital1 18**] for further care.

MEDICAL HISTORY: Per limited chart notes available from outside records:

MEDICATION ON ADMISSION: Aricept
Flomax
Omeprazole
Doxycycline

ALLERGIES: Morphine / Demerol

PHYSICAL EXAM: T 98, BP 172/89, HR 82, R 16, 100% on CMV
Gen- critically ill, intubated, off propofol for 15min prior to
exam
HEENT: NCAT, MMM, anicteric sclera
NECK: no carotid bruits, no nuchal rigidity
CV: RRR, no MRG
Pulm: scattered rales
Abd- soft, nd, bs+
Extrem- no CCE

FAMILY HISTORY: unavailable

SOCIAL HISTORY: unavailable
Intracerebral hemorrhage,Compression of brain,Other amyloidosis,Flaccid hemiplegia and hemiparesis affecting unspecified side,Urinary tract infection, site not specified,Alzheimer's disease,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension
Intracerebral hemorrhage,Compression of brain,Amyloidosis NEC,Flccd hmiplga unspf side,Urin tract infection NOS,Alzheimer's disease,Esophageal reflux,BPH w/o urinary obs/LUTS,Dementia w/o behav dist,Hypertension NOS
Admission Date:  [**2172-3-12**]              Discharge Date:   [**2172-3-25**]

Date of Birth:  [**2089-2-11**]             Sex:   M

Service: NEUROLOGY

Allergies:
Morphine / Demerol

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
ICH

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known firstname **] [**Known lastname 33858**] (ED alias: EU CRITICAL, [**Male First Name (un) 80647**] [**Numeric Identifier 80648**]) is
an
83 year old male with unclear previous medical history who now
presents as a transfer to this hospital with large left
hemispheric hemorrhage. There is scant history available from
outside records, there is not family available at present. Per
outside hospital records the patient was last seen well last
night. He was found this afternoon ~1300hrs by his granddaughter
who climbed through a window in his home. He was noted to have
right sided weakness and unable to speak. Outside hospital CT
scan revealed a large left hemispheric hemorrhage with midline
shift. He was intubated and given Mannitol 100gm IV and sent to
[**Hospital1 18**] for further care.

On arrival the patient was unable to provide a ROS.


Past Medical History:
Per limited chart notes available from outside records:

PMH:
Alzheimers
GERD
BPH


Social History:
unavailable

Family History:
unavailable

Physical Exam:
T 98, BP 172/89, HR 82, R 16, 100% on CMV
Gen- critically ill, intubated, off propofol for 15min prior to
exam
HEENT: NCAT, MMM, anicteric sclera
NECK: no carotid bruits, no nuchal rigidity
CV: RRR, no MRG
Pulm: scattered rales
Abd- soft, nd, bs+
Extrem- no CCE

NEUROLOGIC EXAM:
MS- unresponsive to voice, does not follow commands. localizes
sternal rub with his left hand.

CN- pupils miotic 1mm, unreactive to light bilaterally, strong
left conjugate gaze preference. no blink to visual threat.
slight
right NL effacement. corneals weakly present. intact gag. intact
oculocephalics.

Motor- dense right hemiparesis, no withdrawal to noxious. left
arm and leg move spontaneously. left arm reaches for ET tube.

[**Name (NI) 80649**] pt winces to nailbed in each extremity. no withdrawal
on
the right.

Reflexes- 3+ right patellar, [**Last Name (un) **], tri, [**Hospital1 **], 2+ left patellar,
[**Hospital1 **], tri, [**Last Name (un) **].


Pertinent Results:
[**2172-3-15**] 02:40AM BLOOD WBC-10.6 RBC-3.91* Hgb-11.2* Hct-33.1*
MCV-85 MCH-28.7 MCHC-34.0 RDW-14.6 Plt Ct-200
[**2172-3-14**] 02:19AM BLOOD WBC-13.7* RBC-4.30* Hgb-12.1* Hct-36.0*
MCV-84 MCH-28.2 MCHC-33.7 RDW-14.8 Plt Ct-215
[**2172-3-13**] 03:02AM BLOOD WBC-19.0* RBC-4.33* Hgb-12.6* Hct-36.0*
MCV-83 MCH-29.2 MCHC-35.0 RDW-14.8 Plt Ct-233
[**2172-3-12**] 06:00PM BLOOD WBC-16.1* RBC-UNABLE TO  Hgb-12.6*
Hct-39.5* MCV-UNABLE TO  MCH-UNABLE TO  MCHC-33.2 RDW-UNABLE TO
Plt Ct-229
[**2172-3-12**] 06:00PM BLOOD Neuts-89.1* Bands-0 Lymphs-7.1* Monos-2.9
Eos-0.5 Baso-0.4
[**2172-3-14**] 02:19AM BLOOD PT-13.0 PTT-30.2 INR(PT)-1.1
[**2172-3-13**] 03:02AM BLOOD PT-13.1 PTT-29.4 INR(PT)-1.1
[**2172-3-12**] 06:00PM BLOOD PT-12.5 PTT-26.7 INR(PT)-1.1
[**2172-3-15**] 02:40AM BLOOD Glucose-116* UreaN-14 Creat-0.7 Na-143
K-3.5 Cl-110* HCO3-24 AnGap-13
[**2172-3-14**] 02:19AM BLOOD Glucose-122* UreaN-14 Creat-0.8 Na-143
K-3.5 Cl-108 HCO3-26 AnGap-13
[**2172-3-13**] 03:02AM BLOOD Glucose-137* UreaN-12 Creat-0.9 Na-138
K-3.9 Cl-106 HCO3-25 AnGap-11
[**2172-3-12**] 06:00PM BLOOD Glucose-118* UreaN-15 Creat-0.8 Na-132*
K-4.2 Cl-100 HCO3-23 AnGap-13
[**2172-3-13**] 03:02AM BLOOD CK(CPK)-92
[**2172-3-13**] 03:02AM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2172-3-15**] 02:40AM BLOOD Calcium-8.4 Phos-2.0* Mg-1.8
[**2172-3-14**] 02:19AM BLOOD Calcium-8.8 Phos-2.5* Mg-2.1
[**2172-3-13**] 03:02AM BLOOD Calcium-8.7 Phos-2.8 Mg-1.9
[**2172-3-13**] 03:02AM BLOOD Osmolal-297
[**2172-3-12**] 10:57PM BLOOD Osmolal-299
[**2172-3-15**] 03:20AM BLOOD Type-ART pO2-199* pCO2-40 pH-7.40
calTCO2-26 Base XS-0
[**2172-3-14**] 02:26AM BLOOD Type-ART pO2-103 pCO2-38 pH-7.42
calTCO2-25 Base XS-0
[**2172-3-13**] 03:16AM BLOOD Type-ART pO2-137* pCO2-43 pH-7.39
calTCO2-27 Base XS-1
[**2172-3-12**] 11:00PM BLOOD Type-ART pO2-420* pCO2-45 pH-7.38
calTCO2-28 Base XS-1
[**2172-3-12**] 11:00PM BLOOD Glucose-167* Lactate-1.0
[**2172-3-12**] 11:00PM BLOOD freeCa-1.20

NCHCT [**2172-3-12**]:
IMPRESSION: Large left hemispheric parenchymal hemorrhage with
edema, mass
effect on the left lateral ventricle and 5mm rightward shift of
midline
structures.

CXR [**2172-3-12**]:
IMPRESSION: AP chest reviewed in the absence of prior chest
radiographs:

Endotracheal tube tip ends at the thoracic inlet. Cuff inflates
the trachea
distal to which there is luminal narrowing. Whether this is due
to
surrounding mass or just a configurational deformity of COPD is
radiographically indeterminant. Lungs are fully expanded and
clear, and could
be emphysematous. Heart size is normal. Nasogastric tube passes
below the
diaphragm and out of view. No pneumothorax or pleural effusion.

CXR [**2172-3-13**]:
Comparison is made with prior study performed a day earlier.

New faint bibasilar opacities right greater than left consistent
with
aspiration. ET tube is in standard position 6.3 cm above the
carina. NG tube
tip is out of view below the diaphragm.

There is no pneumothorax or pleural effusion. Cardiomediastinal
silhouette is
unchanged.

NCHCT [**2172-3-13**]:
IMPRESSION:

No significant change in the large left frontal hematoma.

CXR [**2172-3-13**]:
AP PORTABLE CHEST: There has been interval placement of a left
subclavian
venous catheter with tip in the upper-to-mid SVC. No
pneumothorax. ET and
nasogastric tubes remain in satisfactory positions. Suspected
aspiration at
the lung bases, less conspicuous on the current radiograph.



Brief Hospital Course:
This 83 yo man was admitted with a large left ICH as outlined in
the HPI. His blood pressure was controlled to maintain SBP <
160. He was unarousable on neuro examination and had minimal
brainstem reflexes. Given the poor prognosis, the goals of care
were discussed with his daughter and wife and they decided to
make him [**Name (NI) 3225**]. On [**3-25**] at around 6:55 am, he passed away
peacefully.

Medications on Admission:
Aricept
Flomax
Omeprazole
Doxycycline

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
ICH

Discharge Condition:
deceased

Discharge Instructions:
none

Followup Instructions:
none

                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

Completed by:[**2172-3-25**]
{"Intracerebral hemorrhage,Compression of brain,Other amyloidosis,Flaccid hemiplegia and hemiparesis affecting unspecified side,Urinary tract infection, site not specified,Alzheimer's disease,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension"}


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: ICH

PRESENT ILLNESS: Mr. [**Known firstname **] [**Known lastname 33858**] (ED alias: EU CRITICAL, [**Male First Name (un) 80647**] [**Numeric Identifier 80648**]) is
an
83 year old male with unclear previous medical history who now
presents as a transfer to this hospital with large left
hemispheric hemorrhage. There is scant history available from
outside records, there is not family available at present. Per
outside hospital records the patient was last seen well last
night. He was found this afternoon ~1300hrs by his granddaughter
who climbed through a window in his home. He was noted to have
right sided weakness and unable to speak. Outside hospital CT
scan revealed a large left hemispheric hemorrhage with midline
shift. He was intubated and given Mannitol 100gm IV and sent to
[**Hospital1 18**] for further care.

MEDICAL HISTORY: Per limited chart notes available from outside records:

MEDICATION ON ADMISSION: Aricept
Flomax
Omeprazole
Doxycycline

ALLERGIES: Morphine / Demerol

PHYSICAL EXAM: T 98, BP 172/89, HR 82, R 16, 100% on CMV
Gen- critically ill, intubated, off propofol for 15min prior to
exam
HEENT: NCAT, MMM, anicteric sclera
NECK: no carotid bruits, no nuchal rigidity
CV: RRR, no MRG
Pulm: scattered rales
Abd- soft, nd, bs+
Extrem- no CCE

FAMILY HISTORY: unavailable

SOCIAL HISTORY: unavailable 

### Response:
{"Intracerebral hemorrhage,Compression of brain,Other amyloidosis,Flaccid hemiplegia and hemiparesis affecting unspecified side,Urinary tract infection, site not specified,Alzheimer's disease,Esophageal reflux,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Dementia in conditions classified elsewhere without behavioral disturbance,Unspecified essential hypertension"}
