CHIEF COMPLAINT: "throbbing headache"

PRESENT ILLNESS: This is a 50 y.o. RH filipino male who was transferred from OSH
with SAH.  He reports that he had "passed out" for unknown
length of time and woke up with a headach. He describes the
headache as a dull, throbbing sensation located in bifrontal
region and was [**7-6**] on the pain scale.  He had some nause but
did
not vomit.  Now, after pain med, his headache is [**1-7**]. His wife
reports that she has a history of HTN but not currenlty on any
medications.  She takes his blood pressure periodically and it
runs aroun 140 Systolic.  He denies any photophobia, blurry
vision, weakness or paresthesia

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
Hunt and [**Doctor Last Name 9381**]:1  [**Doctor Last Name **]:  3     GCS 15  E:4 V:5 Motor: 6
O: T:96.8  BP: 221/104 174/96  HR: 68   R 18      O2Sats 97%
Gen: pleasant, cooperative, abrasion right forehead WD/WN,
comfortable, NAD.
HEENT: head: atraumatic, normocephalic, eyes: clear ears:
hearing
intact nose: patent throat: oropharynx pinck Pupils: 3-2mm

FAMILY HISTORY: Father history of aneurysm

SOCIAL HISTORY: RH, married with 1 child, unemployed, worked as a chemist, lives
in
[**Location (un) 3307**], no ETOH/Smoke
Subarachnoid hemorrhage,Anomalies of cerebrovascular system,Acute edema of lung, unspecified,Pneumonia, organism unspecified,Cerebral edema
Subarachnoid hemorrhage,Cerebrovascular anomaly,Acute lung edema NOS,Pneumonia, organism NOS,Cerebral edema
Admission Date:  [**2196-4-20**]              Discharge Date:   [**2196-5-2**]

Date of Birth:  [**2145-6-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
"throbbing headache"

Major Surgical or Invasive Procedure:
[**2196-4-21**] Cerebral angiogram with coiling of the basilar tip
aneurysm


History of Present Illness:
This is a 50 y.o. RH filipino male who was transferred from OSH
with SAH.  He reports that he had "passed out" for unknown
length of time and woke up with a headach. He describes the
headache as a dull, throbbing sensation located in bifrontal
region and was [**7-6**] on the pain scale.  He had some nause but
did
not vomit.  Now, after pain med, his headache is [**1-7**]. His wife
reports that she has a history of HTN but not currenlty on any
medications.  She takes his blood pressure periodically and it
runs aroun 140 Systolic.  He denies any photophobia, blurry
vision, weakness or paresthesia

Past Medical History:
none

Social History:
RH, married with 1 child, unemployed, worked as a chemist, lives
in
[**Location (un) 3307**], no ETOH/Smoke


Family History:
Father history of aneurysm


Physical Exam:
On Admission:
Hunt and [**Doctor Last Name 9381**]:1  [**Doctor Last Name **]:  3     GCS 15  E:4 V:5 Motor: 6
O: T:96.8  BP: 221/104 174/96  HR: 68   R 18      O2Sats 97%
Gen: pleasant, cooperative, abrasion right forehead WD/WN,
comfortable, NAD.
HEENT: head: atraumatic, normocephalic, eyes: clear ears:
hearing
intact nose: patent throat: oropharynx pinck Pupils: 3-2mm

EOMs full
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

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, 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 with mild
nasolabila
droop on the left.
VIII: Hearing intact to finger rub bilaterally.
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 [**3-31**] throughout. No pronator drift

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

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

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger intact

Discharge: Neurologically intact


Pertinent Results:
CT without contrast OSH [**4-20**] - diffuse SAH with basal and
mesencephalic cisterns and along the skull base.  There is mild
blood in the left posterior [**Doctor Last Name 534**].  There is a bilateral
intraventricular mass with calcified portion on the left.  There
is evidence of hydrocephalus with temporal horns are prominent.

Head CT-angiogram [**2196-4-20**] - 1. CT Head: SAH in the suprasellar,
perimesencephalic cisterns (R> L) and sylvian fissures.
Intraventricular hemorrhage in both occipital horns and the
fourth ventricle. Diffuse cerebral edema, with effacement of the
sulci. Hyperdense intraventricular mass with calcifications
occupying the body of both lateral ventricles. Dilation of the
occipital and temporal horns of both
lateral ventricles.
2. CTA Head: Large intraventricular AVM with the nidus in the
body of the left lateral ventricle, with dilated venous varix in
the body of the right lateral ventricle. Arterial feeders to the
AVM from a dilated left ACA and from the left MCA. Large vein
drains into the straight sinus.
3. Basilar tip aneurysm [**Last Name (un) **] 6 x 5 mm, directed superiorly and
to the right. Fusiform aneurysm at the ACOM / R ACA junction
measuring 8 x 5 mm. A third fusiform aneurysm in the left A3
segment [**Last Name (un) **] 4mm. 3 D recons pending at this time.

Echo [**4-20**] - Small LV cavity size with hyperdynamic LV systolic
function. Consequently there is a mild left ventricular outflow
tract gradient during systole. No pathologic valvular
abnormality seen.  EF >75%

[**4-21**] ANGIOGRAM******

[**2196-4-24**] ECHOCARDIOGRAM
Conclusions
There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity is small. Regional left ventricular wall
motion is normal. No left ventricular apical aneurysm is seen
Left ventricular systolic function is hyperdynamic (EF>75%). No
masses or thrombi are seen in the left ventricle. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion. There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve leaflets are
structurally normal. No mitral regurgitation is seen. There is
no pericardial effusion.
Conclusions: Focused study for LV assessment : Hyperdynamic LV
function. Not different from the previous study ([**2196-4-20**])

[**2196-4-26**] FRONTAL CHEST RADIOGRAPH
The cardiomediastinal silhouette is stable. Wide-spread
parenchymal opacity has mildly increased in extent. No pleural
effusions or pneumothorax.
IMPRESSION: Mild worsening of bilateral parenchymal opacities

CTA head [**2196-4-26**]
1. No evidence of flow-limiting stenosis or occlusion within the
anterior or posterior intracranial circulations. No evidence of
acute large vascular territorial infarction.
2. Interval resorption of the majority of the previously seen
subarachnoid
hemorrhage overlying the cerebral hemispheres and collecting in
the basal
cisterns. The degree of intraventricular hemorrhage layering in
the occipital horns of the lateral ventricles is not
significantly changed.
4. Unchanged appearance of the large intraventricular AVM,
fusiform
aneurysmal dilatation of the ACOM, and fusiform aneurysmal
dilatation of the A2 segment of the left ACA.

Chest X-ray [**2196-4-27**]
FINDINGS: As compared to the previous radiograph, there is no
relevant
change. Unchanged course and position of the right PICC line. No
newly
appeared focal parenchymal opacities. The known bilateral apical
parenchymal opacities are unchanged in extent and severity.
Unchanged moderate cardiomegaly. No pleural effusions. No
pneumothorax. No overt pulmonary edema. Moderate tortuosity of
the thoracic aorta.

Chest X-ray [**2196-4-29**]
Previous moderately severe pulmonary edema has largely resolved.
The residual consolidation in the axillary region of the right
upper lobe, a relatively constant feature throughout may well be
concurrent pneumonia, also improving.  Heart is normal size.
Thoracic aorta is generally large but not focally aneurysmal,
and pleural effusion is minimal if any. No pneumothorax. Right
PIC catheter ends in the upper right atrium approximately 2.5 cm
below the anticipated location of superior cavoatrial junction.
No pneumothorax.

BLE LENIS [**2196-4-29**]
IMPRESSION: No DVT in the right or left lower extremity.


Brief Hospital Course:
Mr. [**Known lastname **] [**Known lastname 652**] was admitted to neurosurgery ICU on [**2196-4-20**]
for further management.  A CT-Angiogram revealed multiple
aneuryms and a large intraventricular Arteriovenous malformation
with feeders from L MCA/ACA with drainage into straight sinus.
Subsequently, he was taken for a cerebral angiogram on [**4-21**] and
had a basilar tip aneurysm coiled. Although imaging may have
seen multiple aneurysm, the angio only identified this.
Post-angio he did well. On [**4-22**], he was having some trouble with
his respiratory status and a CXR showed pulmonary edema. He was
given Lasix. He was advanced to a regular diet, IVF were
heplocked for good PO intake, and he was OOB to chair.

[**Date range (1) 5833**] Patient remained neurologically stable was found to be
in Neurogenic pulmonary edema, he was started on/off on a lasix
gtt to keep him even for his lenght of stay. His gas showed him
to be hypoxic on [**4-24**] and he was placed on BIPAP for PP
ventilation.

On [**4-25**] he remained stable with a good exam. His SBP goal
continued to be less than 140. On [**4-27**] his lisinopril needed to
be increased to 20mg daily. He remained neurologically intact.
CXR showed no interval change.

On [**4-28**] he was transfered to the [**Hospital Ward Name **] for radiation
treatment planning with Dr. [**Last Name (STitle) 35885**]. He was febrile overnight
and a fever work-up was done on [**4-29**]. He was transferred to floor
status on [**4-29**] and discharged home on [**5-1**] with no interveral
events.

Medications on Admission:
none

Discharge Medications:
1. nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 9 days.
Disp:*108 Capsule(s)* Refills:*0*
2. levetiracetam 250 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*3*
3. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3 hours)
as needed for Pain.
Disp:*60 Tablet(s)* Refills:*0*
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*2*
5. labetalol 200 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
Disp:*90 Tablet(s)* Refills:*2*
6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*40 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Subarachnoid Hemorrhage
Cerebral Aneurysms
AVM

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


Discharge Instructions:
Angiogram with Embolization
Medications:
??????	Continue all other medications you were taking before
hospitalizaton, 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:
Please follow-up with Dr [**First Name (STitle) **] in 4 weeks with a MRI/MRA w/ &
w/o contrast ([**Doctor Last Name **] protocol). Please call [**Telephone/Fax (1) 4296**] to make
this appointment.

You will follow up with Dr. [**Last Name (STitle) 35885**] for radiation on
Wednesday, [**2196-5-4**] at 2pm

Your blood pressure needs to be monitored closely, please seek
guidence from your primary care provider for management and
adjustment of your medications as needed. Have your blood
pressure checked daily. A systolic blood pressure of 140 is
ideal for you.



Completed by:[**2196-5-2**]
{'Subarachnoid hemorrhage,Anomalies of cerebrovascular system,Acute edema of lung, unspecified,Pneumonia, organism unspecified,Cerebral edema'}


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: "throbbing headache"

PRESENT ILLNESS: This is a 50 y.o. RH filipino male who was transferred from OSH
with SAH.  He reports that he had "passed out" for unknown
length of time and woke up with a headach. He describes the
headache as a dull, throbbing sensation located in bifrontal
region and was [**7-6**] on the pain scale.  He had some nause but
did
not vomit.  Now, after pain med, his headache is [**1-7**]. His wife
reports that she has a history of HTN but not currenlty on any
medications.  She takes his blood pressure periodically and it
runs aroun 140 Systolic.  He denies any photophobia, blurry
vision, weakness or paresthesia

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: On Admission:
Hunt and [**Doctor Last Name 9381**]:1  [**Doctor Last Name **]:  3     GCS 15  E:4 V:5 Motor: 6
O: T:96.8  BP: 221/104 174/96  HR: 68   R 18      O2Sats 97%
Gen: pleasant, cooperative, abrasion right forehead WD/WN,
comfortable, NAD.
HEENT: head: atraumatic, normocephalic, eyes: clear ears:
hearing
intact nose: patent throat: oropharynx pinck Pupils: 3-2mm

FAMILY HISTORY: Father history of aneurysm

SOCIAL HISTORY: RH, married with 1 child, unemployed, worked as a chemist, lives
in
[**Location (un) 3307**], no ETOH/Smoke 

### Response:
{'Subarachnoid hemorrhage,Anomalies of cerebrovascular system,Acute edema of lung, unspecified,Pneumonia, organism unspecified,Cerebral edema'}
