CHIEF COMPLAINT: Transfer with right temporal IPH and subdural hematoma

PRESENT ILLNESS: 76 y/o female hx of Alzeihmers Disease was in usual state of
health until approximately 7pm on [**10-5**] when she complained of
severe headache to daugther.  Patient is watched 24 hours a day
and there is no known trauma according to the family.  Her
family
brought her to an outside hospital where she was found to have a
right sided IPH and subdural over the tentorium and transferred
here.

MEDICAL HISTORY: Alzheimers Disease, "Thyroid difficulty"
Hysterectomy

MEDICATION ON ADMISSION: Mirtazapine 15 HS
Aggrenox 1 cap [**Hospital1 **]
Namenda 10mg [**Hospital1 **]
Aricept 10mg QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T:96.7  BP:137/53     HR:65    R 18      O2Sats 100%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**2-12**]     EOMs full
Neck: Supple.
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, not to date.
Recall: 0/3 objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with daughter in [**Name (NI) 12415**] has 24 hour
supervision.  Recently moved in with her originally from
[**Location (un) **].
Non smoker, no alcohol
Intracerebral hemorrhage,Compression of brain,Amyloidosis, unspecified,Urinary tract infection, site not specified,Subarachnoid hemorrhage,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance
Intracerebral hemorrhage,Compression of brain,Amyloidosis NOS,Urin tract infection NOS,Subarachnoid hemorrhage,Alzheimer's disease,Dementia w/o behav dist
Admission Date:  [**2196-10-6**]              Discharge Date:   [**2196-10-15**]

Date of Birth:  [**2119-10-16**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Transfer with right temporal IPH and subdural hematoma


Major Surgical or Invasive Procedure:
Right temporal craniotomy, right subdural hematoma evacuation
and right temporal lobe resection.


History of Present Illness:
76 y/o female hx of Alzeihmers Disease was in usual state of
health until approximately 7pm on [**10-5**] when she complained of
severe headache to daugther.  Patient is watched 24 hours a day
and there is no known trauma according to the family.  Her
family
brought her to an outside hospital where she was found to have a
right sided IPH and subdural over the tentorium and transferred
here.


Past Medical History:
Alzheimers Disease, "Thyroid difficulty"
Hysterectomy


Social History:
Lives with daughter in [**Name (NI) 12415**] has 24 hour
supervision.  Recently moved in with her originally from
[**Location (un) **].
Non smoker, no alcohol


Family History:
NC

Physical Exam:
O: T:96.7  BP:137/53     HR:65    R 18      O2Sats 100%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**2-12**]     EOMs full
Neck: Supple.
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, not to date.
Recall: 0/3 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, 3 to 2
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 [**4-16**] throughout. No pronator drift

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

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

Toes downgoing bilaterally

Coordination: bilateral nystagmus


Pertinent Results:
[**2196-10-6**] 12:22AM BLOOD WBC-11.9* RBC-4.18* Hgb-12.9 Hct-39.3
MCV-94 MCH-30.9 MCHC-32.8 RDW-13.8 Plt Ct-342
[**2196-10-13**] 05:52AM BLOOD WBC-7.6 RBC-3.06* Hgb-9.5* Hct-28.4*
MCV-93 MCH-31.0 MCHC-33.4 RDW-13.3 Plt Ct-467*
[**2196-10-13**] 11:20AM BLOOD PT-11.9 PTT-23.4 INR(PT)-1.0
[**2196-10-12**] 04:30AM BLOOD Glucose-98 UreaN-12 Creat-0.9 Na-136
K-3.9 Cl-104 HCO3-22 AnGap-14
[**2196-10-6**] 07:57AM BLOOD ALT-11 AST-29 LD(LDH)-187 AlkPhos-70
TotBili-0.2
[**2196-10-13**] 06:00PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2196-10-10**] 12:35PM BLOOD Calcium-9.0 Phos-2.4* Mg-2.2
[**2196-10-8**] 08:30AM BLOOD Phenyto-14.5
[**2196-10-10**] 01:30PM URINE RBC-0-2 WBC-[**11-1**]* Bacteri-MANY
Yeast-NONE Epi-0
[**2196-10-12**] 09:15AM URINE RBC-[**2-15**]* WBC-0-2 Bacteri-NONE Yeast-NONE
Epi-0
[**2196-10-10**] 01:30PM URINE Blood-LG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2196-10-12**] 09:15AM URINE Blood-MOD Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG

[**2196-10-5**] CT-scan head.
IMPRESSION:
1.  Large,right parietal-temporal intraparenchymal hemorrhage
with adjacent subarachnoid component and a small-to-moderate
right subdural hematoma with blood tracking along the right
frontal hemisphere and right tentorium.  There is extension of
hemorrhage within the ventricles bilaterally.
2.  Significant leftward subfalcine herniation and probable
impending uncal herniation.
The differential diagnosis for this hemorrhage includes amyloid
angiopathy, metastatic or primary neoplastic tumor hemorrhage,
with a vascular malformation felt less likely but also
considered.  This diagnosis can be further refined with
dedicated MRI with gadolinium.

[**2196-10-6**] MRI/MRA BRain
IMPRESSION:
1.  Multiple scattered punctate foci in both hemispheres is
consistent with amyloid angiopathy.  There are stable
post-surgical changes and stable subarachnoid, subdural
hemorrhage, with some areas of pneumocephalus noted.
2.  There is no obvious pathological enhancement to suggest a
mass lesion
being responsible for the large hemorrhage.

[**2196-10-8**] EEG
IMPRESSION: This is an abnormal portable EEG due to the mild
voltage
asymmetry with decreased amplitudes noted over the right
frontotemporal
region; this finding can be seen in the setting of material
interposed between the skull and cortex (e.g. hemorrhage) or in
the
setting of a destructive or structural process affecting the
right
frontotemporal region. In addition, the background was slow,
disorganized and punctuated with bursts of generalized delta
frequency
slowing, consistent with a moderate global encephalopathy,
suggesting
bilateral subcortical or deep midline dysfunction. Medications,
metabolic disturbances, infections, and anoxia are among the
common
causes of encephalopathy. No clearly epileptiform features were
noted.
No electrographic seizures were noted.

[**2196-10-12**] CT-head
IMPRESSION:  No acute intracranial hemorrhage.  No significant
change in the right temporal intraparenchymal hemorrhage, with
stable subfalcine herniation and subdural hemorrhage.

[**2196-10-12**] Lower extremity ultrasound.
IMPRESSION:  No son[**Name (NI) 493**] evidence for DVT bilateral lower
extremity.

[**2196-10-13**] CT-abdomen and pelvis with contrast.
IMPRESSION:
1.  Small bilateral pleural effusions.
2.  Small hiatal hernia.
3.  1.5 cm left adnexal cyst for which further correlation with
ultrasound is recommended in 3 months to ensure stability.


Brief Hospital Course:
76F with hx of alzheimer's disease and thyroid difficulty
presented as a transfer for treatment of traumatic right
subdural hemorrhage.  The patient was taken to the operating
room on the day of admission for evacuation of the hematoma.  In
the operating it was determined that resection of the right
temporal lobe would be neccessary inorder to ensure hemostasis.
The patient recovered well from surgery and was able to leave
the intensive care unit on the second day of admission after an
easy extubation.  The patient was noted to be disoriented after
the surgery and despite stability of the intracranial lesions
after surgery her mental status remained quite different from
baseline.  She was perseverative and confused, sometimes noted
to be hallucinating.  She was not able to follow her own course
and frequently asked inappropriate questions.  An EEG did not
suggest epileptiform activity or seizure discharges.

The etiology of the patient's hemorrhage was worked up with an
MRI of the head that demonstrated numerous punctate hemorrhages.
 This likely represents amyloid angiopathy.  This was confirmed
by the stroke neurology consult team.  They recommended
restarting the patient's aggrenox as soon as it is safe from a
surgical perspective.  Presumably this is to abroggate the
patient's risk of ischemic stroke, which is high.

Her course on the floor was complicated by fever.  This was as
high as 102.4 degrees.  A very comprehensive examination for the
source of fever was undertaken including UA, Urine culture,
repeated blood cultures, chest x-rays, lower extremity
ultrasounds, an abdominal CT scan,  and  an ultrasound of an
incidentally found ovarian cyst on the left.  The only positive
laboratory result was a UA and culture on [**10-10**] for Pseudomonas
and E.coli.  She was given 7 days of ciprofloxacin.  The fever
persisted despite this treatment.  Repeat UA and culture were
negative.  The etiology of the fever was ultimately ascribed to
intracranial hemorrhage. Medicine was consulted regarding her
fever and agrees that most likely etiology of fever is central
fever.




Medications on Admission:
Mirtazapine 15 HS
Aggrenox 1 cap [**Hospital1 **]
Namenda 10mg [**Hospital1 **]
Aricept 10mg QD


Discharge Medications:
1. Donepezil 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

2. Namenda 10 mg Tablet Sig: One (1) Tablet PO QD ().
3. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
6. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
5000unit dose.  Injection TID (3 times a day).
7. Insulin Regular Human 100 unit/mL Solution Sig: One (1) dose
Injection ASDIR (AS DIRECTED): Per Sliding Scale. .
8. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
11. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for Pain/Fever.
12. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
13. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 3 days: to be completed [**10-16**].


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 979**] - [**Location (un) 246**]

Discharge Diagnosis:
intracerebral hemorrhage


Discharge Condition:
neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR HEAD INJURY

??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	You have been prescribed an anti-seizure medicine, take it as
prescribed

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication


Followup Instructions:
You will need a cat scan of the brain without contrast in 4
weeks and appt with Dr. [**Last Name (STitle) **] [**Telephone/Fax (1) **]
{"Intracerebral hemorrhage,Compression of brain,Amyloidosis, unspecified,Urinary tract infection, site not specified,Subarachnoid hemorrhage,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance"}


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 with right temporal IPH and subdural hematoma

PRESENT ILLNESS: 76 y/o female hx of Alzeihmers Disease was in usual state of
health until approximately 7pm on [**10-5**] when she complained of
severe headache to daugther.  Patient is watched 24 hours a day
and there is no known trauma according to the family.  Her
family
brought her to an outside hospital where she was found to have a
right sided IPH and subdural over the tentorium and transferred
here.

MEDICAL HISTORY: Alzheimers Disease, "Thyroid difficulty"
Hysterectomy

MEDICATION ON ADMISSION: Mirtazapine 15 HS
Aggrenox 1 cap [**Hospital1 **]
Namenda 10mg [**Hospital1 **]
Aricept 10mg QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: O: T:96.7  BP:137/53     HR:65    R 18      O2Sats 100%
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**2-12**]     EOMs full
Neck: Supple.
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, not to date.
Recall: 0/3 objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives with daughter in [**Name (NI) 12415**] has 24 hour
supervision.  Recently moved in with her originally from
[**Location (un) **].
Non smoker, no alcohol 

### Response:
{"Intracerebral hemorrhage,Compression of brain,Amyloidosis, unspecified,Urinary tract infection, site not specified,Subarachnoid hemorrhage,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance"}
