CHIEF COMPLAINT: Worst headache of life

PRESENT ILLNESS: 52 year-old man with a 5 day history of severe
headache presenting following evaluation at the [**Hospital3 **] ER
with findings suggestive of non-traumatic subarachnoid
hemorrhage. On Sunday he was engaged in intercourse, nearing
orgasm, when he felt he had been hit in the back of the head by
a
large object. He suffered immediate onset of [**9-29**] throbbing
headache. He was immediately photosensitive. He denies any
nausea or vomiting. Within a few hours of HA onset he recalls
feelin numbness from his occiput to his lower back - this has
since resolved. He has intermittently felt unsteady on his feet
(not vertigo) since onset, but does not complain of this at the
present time. Since onset his pain has continued at the same
intensity, unchecked until receiving Morphine at the OSH. He
describes the pain initially as throbbing, but later devolving
into a constant cramping pain. He saw his PCP on each of the two

MEDICAL HISTORY: R. cataract, lens replacement
Recent colonoscopy - normal
No hx of migraines or other HA syndromes

MEDICATION ON ADMISSION: Motrin prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Appearance: WDWN, NAD
Skin: No rashes or bruising.
HEENT: Significant scleral injection. NCAT, MMM, OP clear.
Neck: Moderate pain with flexion. Supple, No Thyromegaly,
No LAD, No bruits
Chest: CTAB with good flow.
CVS: RRR, Nl S1/S2. No M/G/R. No JVD.
Abd: Full, NT, ND. Pos BS
Ext: No CCE. DP 2+. Lifting L. ileopsoas produces L
paraspinal low-lumbar pain

FAMILY HISTORY: Negative for early stroke, no known cerebral hemorrhage or
aneurism.

SOCIAL HISTORY: Social History: The patient lives with his wife and children and
Subarachnoid hemorrhage,Meningismus,Alkalosis,Tobacco use disorder,Tachycardia, unspecified
Subarachnoid hemorrhage,Meningismus,Alkalosis,Tobacco use disorder,Tachycardia NOS
Admission Date:  [**2148-2-3**]              Discharge Date:   [**2148-2-13**]

Date of Birth:  [**2095-12-12**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Worst headache of life

Major Surgical or Invasive Procedure:
Coiling of P-Comm Aneurysm


History of Present Illness:
52 year-old man with a 5 day history of severe
headache presenting following evaluation at the [**Hospital3 **] ER
with findings suggestive of non-traumatic subarachnoid
hemorrhage. On Sunday he was engaged in intercourse, nearing
orgasm, when he felt he had been hit in the back of the head by
a
large object. He suffered immediate onset of [**9-29**] throbbing
headache. He was immediately photosensitive. He denies any
nausea or vomiting. Within a few hours of HA onset he recalls
feelin numbness from his occiput to his lower back - this has
since resolved. He has intermittently felt unsteady on his feet
(not vertigo) since onset, but does not complain of this at the
present time. Since onset his pain has continued at the same
intensity, unchecked until receiving Morphine at the OSH. He
describes the pain initially as throbbing, but later devolving
into a constant cramping pain. He saw his PCP on each of the two

following days and was given "pain killers" for
his headache with minimal relief.
Tonight he presented to the [**Hospital3 **] ER and was evaluated by
a moonlighting member of the [**Hospital1 18**] faculty. CT was unremarkable.

LP showed normal protein, glucose, and WBC ratios, but RBCs of
20K in both tubes 1 and 4. Xanthocromia was judged negative, but

we are uncertain how this OSH evaluates xanthocromia - if it is
an eyeball test, the large RBC burden would likely obscure the
state change. As these results were very concerning for a
non-traumatic SAH, he was transferred to [**Hospital1 18**] for further
evaluation.
Prior to arrival at OSH, his pain was [**9-29**] and constant.
With morphine there it improved to a [**8-30**], and with a 4mg dose
in
our ER it is now at a [**5-30**] and "manageable".


Past Medical History:
R. cataract, lens replacement
Recent colonoscopy - normal
No hx of migraines or other HA syndromes

Social History:
Social History: The patient lives with his wife and children and

is unemployed due to a failed business. He was born in [**Country 2045**] but

has lived in [**Hospital1 8**] MA for >30 years. His last travel outside

the US was 6y ago.
He smokes 1/2ppd cigarettes and drinks a half pint of whiskey
over a weekend, rarely during the week. He denies illicit drug
use.


Family History:
Negative for early stroke, no known cerebral hemorrhage or
aneurism.


Physical Exam:
Appearance: WDWN, NAD
Skin: No rashes or bruising.
HEENT: Significant scleral injection. NCAT, MMM, OP clear.
Neck: Moderate pain with flexion. Supple, No Thyromegaly,
No LAD, No bruits
Chest: CTAB with good flow.
CVS: RRR, Nl S1/S2. No M/G/R. No JVD.
Abd: Full, NT, ND. Pos BS
Ext: No CCE. DP 2+. Lifting L. ileopsoas produces L
paraspinal low-lumbar pain

MS:
Gen: Rouses easily, appropriately interactive, normal affect.
Orientation: Full.
Attention: Attends fully to questions, stream of conversation
without difficulty
Speech/[**Doctor Last Name **]: Fluent w/o paraphasic errors; Follows simple
commands without L/R confusion.

The patient was fully alert and oriented, and was following
all commands and appropriately interactive. There was complete
fluency without paraphasic errors. The concentration, and
attention were intact.

CN:
I: Not tested.
II: VFFC. PERRL 2mm and minimally responsive. No RAPD.
Unable to visualize optic discs.
III,IV,VI: EOMI w/o nystagmus, no diplopia. No ptosis.
V: Sensation intact to LT.
VII: Face symmetric without weakness.
VIII: Hears finger rub equally and bilaterally.
IX,X: Voice normal. Palate elevates symmetrically.
[**Doctor First Name 81**]: SCM and trapezii full.
XII: Tongue protrudes midline.

Motor:
Normal bulk and tone; no tremor, rigidity, or bradykinesia. No
pronator drift.
[**Doctor First Name **] [**Hospital1 **] Tri FE IP Quad Hamst TibAnt Gastro
C5 C6 C7 C8/T1 L2 L3 L4-S1 L4 S1
R 5 5 5 5 5 5 5 5 5
L 5 5 5 5 5 5 5 5 5

Reflexes: (shortly after receiving morphine)

[**Hospital1 **] Tri Bra Pat [**Doctor First Name **] Toes
C6 C7 C6 L4 S1
R - - - - 1 mute
L 1 - - - 1 mute

[**Last Name (un) **]:
LT and temperature intact. Sharp vs dull intact in LEs.

Gait:
Not assessed


Pertinent Results:
[**2148-2-13**] 02:56AM BLOOD WBC-4.8 RBC-3.94* Hgb-11.3* Hct-34.1*
MCV-86 MCH-28.6 MCHC-33.1 RDW-13.6 Plt Ct-405
[**2148-2-3**] 01:20AM BLOOD Neuts-67.3 Lymphs-26.5 Monos-4.8 Eos-1.1
Baso-0.4
[**2148-2-13**] 02:56AM BLOOD Plt Ct-405
[**2148-2-13**] 02:56AM BLOOD Glucose-110* UreaN-11 Creat-1.0 Na-138
K-4.0 Cl-105 HCO3-28 AnGap-9
[**2148-2-11**] 02:07PM BLOOD CK(CPK)-84
[**2148-2-11**] 02:07PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2148-2-13**] 02:56AM BLOOD Calcium-9.1 Phos-4.0 Mg-2.0

Brief Hospital Course:
Mr [**Known lastname 86815**] was admitted to the Neurosurgery service after
outside LP was positive for 20K RBC in both tubes 1 and 4.
Xanthocromia was negative a CTA here showed a consistent with a
right supraclinoid aneurysm. He was admitted started on
Nimodipine and SBP<140. On [**2-3**] he underwent a cerebral
angiogram which showed right P-Comm anuerysm for which one lobe
was coiled and considered secure. A follow up CTA on [**2-5**] showed
no vasospasm and secured anueryms. He was transferred to the
neuro surgery floor on [**2-5**]. He remained neurologically intact,
PT/OT recommended.....

On [**2-7**] he exhibited mild nuchal rigidity but his exam was
nonfocal. Plavix was started on this day. Nimodipine was
discontinued. On [**2-9**] he had an angiogram with Dr. [**First Name (STitle) **] which
he tolerated well. He had a post op headache, but his
neurological exam remained non focal and unchanged.

On the evening of [**2-10**], the patient became acute taachycardic
into the 140s, tachypnic, and dropped his O2 saturation to the
low 90s.  There was high suspicion for a Pulmonary Embolism, but
he had a negative chest CT. He was given a 500cc fluid bolus,
and his HR and breathing both subsequently decreased.

The patient remained in the ICU due to lack of beds. He was
tolerating a regular diet, voiding and had a minimal headache.
His blood pressure was less than 140 on Lopressor. He was
discharged home on [**2-13**] after nursing walked the patient and he
was felt to be stable on his feet. He had no further respiratory
issues.


Medications on Admission:
Motrin prn

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours) as needed for pain or fever.
2. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for severe pain.
Disp:*30 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): Use while taking Dilaudid.
Disp:*40 Capsule(s)* Refills:*0*
4. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
5. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
SAH with rupture of Right P-Comm Aneurysm


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


Discharge Instructions:
Angiogram with Stent Assisted Coiling of Aneurysm:
- YOU WERE PRESCRIBED PLAVIX / YOU WILL TAKE IT FOR A TOTAL OF
30 DAYS / MAKE SURE YOU TAKE THE REMAINING DOSES AS PRESCIRBED
??????	Take Aspirin 325mg (enteric coated) once daily. (YOU WILL TAKE
THIS UNTIL FOLLOW UP
??????	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


Followup Instructions:
Follow up with Dr [**First Name (STitle) **] in [**3-14**] at 1100 with Dr [**First Name (STitle) **] in
[**Hospital Unit Name **] [**Hospital Unit Name **] call for any question [**Telephone/Fax (1) 4296**].
We recommend following up with you primary care physician
regarding your blood pressure. We have to start medication
(Lopressor) to keep it in a normal range. You should follow up
with your PCP [**Last Name (NamePattern4) **] [**12-23**] weeks for a BP check



Completed by:[**2148-2-13**]
{'Subarachnoid hemorrhage,Meningismus,Alkalosis,Tobacco use disorder,Tachycardia, 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: Worst headache of life

PRESENT ILLNESS: 52 year-old man with a 5 day history of severe
headache presenting following evaluation at the [**Hospital3 **] ER
with findings suggestive of non-traumatic subarachnoid
hemorrhage. On Sunday he was engaged in intercourse, nearing
orgasm, when he felt he had been hit in the back of the head by
a
large object. He suffered immediate onset of [**9-29**] throbbing
headache. He was immediately photosensitive. He denies any
nausea or vomiting. Within a few hours of HA onset he recalls
feelin numbness from his occiput to his lower back - this has
since resolved. He has intermittently felt unsteady on his feet
(not vertigo) since onset, but does not complain of this at the
present time. Since onset his pain has continued at the same
intensity, unchecked until receiving Morphine at the OSH. He
describes the pain initially as throbbing, but later devolving
into a constant cramping pain. He saw his PCP on each of the two

MEDICAL HISTORY: R. cataract, lens replacement
Recent colonoscopy - normal
No hx of migraines or other HA syndromes

MEDICATION ON ADMISSION: Motrin prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Appearance: WDWN, NAD
Skin: No rashes or bruising.
HEENT: Significant scleral injection. NCAT, MMM, OP clear.
Neck: Moderate pain with flexion. Supple, No Thyromegaly,
No LAD, No bruits
Chest: CTAB with good flow.
CVS: RRR, Nl S1/S2. No M/G/R. No JVD.
Abd: Full, NT, ND. Pos BS
Ext: No CCE. DP 2+. Lifting L. ileopsoas produces L
paraspinal low-lumbar pain

FAMILY HISTORY: Negative for early stroke, no known cerebral hemorrhage or
aneurism.

SOCIAL HISTORY: Social History: The patient lives with his wife and children and 

### Response:
{'Subarachnoid hemorrhage,Meningismus,Alkalosis,Tobacco use disorder,Tachycardia, unspecified'}
