CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 86 year-old
male transferred from [**Hospital3 1280**] Emergency Department for
management of subdural hematoma.  The patient was previously
well until [**6-26**] when he sustained a fall at home resulting
in a subdural hematoma for which he was treated
well for two weeks until the morning of admission when he
noted difficulty getting out of bed.  At baseline he has a
right upper limb paresis secondary to a distal infarct from
[**2133**] and he uses his left arm to aid in his mobilization.  He
was unable to do so on the morning of admission.  The
patient's daughter also reports that he was falling to his
left.  The patient denies headache, diplopia, dysarthria or
well.

MEDICAL HISTORY: 1.  Cerebrovascular accident in [**2133**]
resulting in right upper extremity weakness.  2.  Zenker's
diverticulum.  3.  Glaucoma.  4.  Hypertension.  5.  Benign
prostatic hypertrophy.

MEDICATION ON ADMISSION: Cozaar 50 mg po q day,
Hydrochlorothiazide 75 mg po q day, potassium chloride 20
milliequivalents po q day, baby aspirin, Pilocarpine eye
drops, Cosopt eye drops.

ALLERGIES: Bactrim and sulfa drugs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Occasional alcohol.  No smoking.
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Pneumonitis due to inhalation of food or vomitus,Unspecified fall,Unspecified essential hypertension,Unspecified glaucoma,Diverticulum of esophagus, acquired
Traumatic subdural hem,Food/vomit pneumonitis,Fall NOS,Hypertension NOS,Glaucoma NOS,Acq esophag diverticulum
Admission Date:  [**2137-7-10**]     Discharge Date:  [**2137-7-17**]


Service:
HISTORY OF PRESENT ILLNESS:  The patient is an 86 year-old
male transferred from [**Hospital3 1280**] Emergency Department for
management of subdural hematoma.  The patient was previously
well until [**6-26**] when he sustained a fall at home resulting
in a subdural hematoma for which he was treated
well for two weeks until the morning of admission when he
noted difficulty getting out of bed.  At baseline he has a
right upper limb paresis secondary to a distal infarct from
[**2133**] and he uses his left arm to aid in his mobilization.  He
was unable to do so on the morning of admission.  The
patient's daughter also reports that he was falling to his
left.  The patient denies headache, diplopia, dysarthria or
well.

PAST MEDICAL HISTORY:  1.  Cerebrovascular accident in [**2133**]
resulting in right upper extremity weakness.  2.  Zenker's
diverticulum.  3.  Glaucoma.  4.  Hypertension.  5.  Benign
prostatic hypertrophy.

MEDICATIONS ON ADMISSION:  Cozaar 50 mg po q day,
Hydrochlorothiazide 75 mg po q day, potassium chloride 20
milliequivalents po q day, baby aspirin, Pilocarpine eye
drops, Cosopt eye drops.

ALLERGIES:  Bactrim and sulfa drugs.

SOCIAL HISTORY:  Occasional alcohol.  No smoking.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 97.3.
Breathing at 72.  Blood pressure 175/96.  O2 sat 97% on room
air.  In general he is a thin elderly male lying in bed in no
acute distress.  HEENT no evidence of trauma.  Oropharynx is
clear.  Pulmonary clear to auscultation bilaterally.
Cardiovascular regular.  Abdomen is benign.  Extremities 2+
pulses.  Neurologically he is alert and oriented times three.
Knows the months of the year backward and forward.
Calculation is intact.  Naming is intact.  Language is
fluent. Good repetition, slight slurring, which is reportedly
old per daughter.  Registration, coding and recall are all
intact.  Right optic disc is blurred.  No venous pulsations.
Left optic disc could not be assessed.  Visual acuity is
good.  No field cuts.  Extraocular movements intact.  Right
pupil 4 to 3, left pupil 2 to 1.5.  No nystagmus.  Facial
sensation is intact.  He has a right facial droop of a motor
neuron type.  Palpebral elevation is symmetrical.  Right
trapezius is weak on the left.  Sternocleidomastoids are
equal.  Motor examination there is decreased bulk throughout,
increased tone in right arm.  Strength in the right upper
extremity, deltoid 2, bicep 2, tricep 3, wrist flexors 2,
wrist extensor 2, finger flexors 2+, finger extension 3.
Left upper extremity deltoid 4+, biceps 5, triceps 5, wrist
flexors 5, wrist extensors 5, finger flexors 4+, finger
extensors 4+.  Lower extremity on the right hip flexors 4,
knee flexors 4, knee extensor 4+, dorsiflexion 5, plantar
flexion 5, [**Last Name (un) 938**] is 4+.  Lower extremity on the left hip flexor
5, knee flexor 5, knee extensor 5, dorsiflexion 5, plantar
flexion 5, [**Last Name (un) 938**] 5.  The right toe is equivocal.  The left toe
is down going.  Right biceps and triceps have 3+ deep tendon
reflexes.  All other deep tendon reflexes are 2.  Sensation
is intact to vibration and pin prick throughout.  Finger to
nose the patient could not do on the right, some pass
pointing on the left as the patient nears target.

LABORATORIES ON ADMISSION:  White blood cell count 7,
hematocrit 36.5, platelets 266, PT 12.2, INR 1, PTT 26.5,
sodium 146, potassium 4.3, chloride 106, bicarb 31, BUN 18,
creatinine 1.1, glucose 94.  Head CT showed right sided
subdural hematoma increased from last CT of [**6-26**].  There
is positive subfossi herniation.

HOSPITAL COURSE:  The patient was admitted to the
Neurosurgery Service.  A subdural drain was placed in the
Intensive Care Unit.  Repeat head CT demonstrated resolution
of the subdural hematoma and the returned of normal midline
structures to the midline.  The patient was continued on
Cozaar.  He also received Hydralazine for blood pressure
control acutely.  Aspirin was discontinued.  No heparin or
other anticoagulants were given.  The patient's Pilocarpine
was discontinued as it may have impaired observation of his
pupils.  This did not become an issue.  The patient had neuro
checks q two hours.  The patient continued to do well. The
patient was noted to have
difficulty swallowing on [**7-13**].  He received a swallow
evaluation to further study this.  This demonstrated that the
patient had problems related to his [**Name (NI) 42755**] diverticulum,
which are known.  After discussion with the patient and his
daughter extensively the patient has decided not to proceed
with a PEG tube or with surgical intervention on the
Zenker's diverticulum.  They have been informed of the risk
of aspiration, but have decided to chose this path.  The
patient is taking po at this point.

On the evening of [**7-16**] the patient had an aspiration event.
He became acutely short of breath and he sated to 84%.
Suctioning was successful.  The patient's O2 sats returned to
[**Location 213**].  He also spiked a fever to 101.9.  He was therefore
started on Levaquin 500 mg po q.d. for presumed aspiration
pneumonia, although aspiration pneumonitis is also likely.

DISCHARGE DIAGNOSES:
1.  Subdural hematoma.
2.  Hypertension.
3.  Past cerebrovascular accident.

MEDICATIONS ON DISCHARGE:  Percocet one to two tabs po q 4 to
6 hours prn.  Losartan 50 mg po q day.  Colace 100 mg po
b.i.d., Zantac 150 mg po b.i.d., Cosopt one drop to each eye
b.i.d., Pilocarpine one drop to the left eye t.i.d.,
Levaquin 500 mg po q day until [**7-23**].  The patient should
be on aspiration precautions.  He will require extensive
rehabilitation.  The patient will follow up with his primary
care physician [**Last Name (NamePattern4) **]. [**First Name (STitle) 7325**] [**Name (STitle) 42756**].






                          [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D.  [**MD Number(1) 343**]

Dictated By:[**Last Name (NamePattern1) 5476**]

MEDQUIST36

D:  [**2137-7-17**]  09:08
T:  [**2137-7-17**]  09:20
JOB#:  [**Job Number 17875**]



Admission Date:  [**2137-7-10**]       Discharge Date:  [**2137-7-24**]



HISTORY OF PRESENT ILLNESS:  The patient is an 86 year old
gentleman transferred from [**Hospital6 3872**] for
further management of his subdural hematoma.  The patient was
previously well until [**6-26**], when he sustained a fall which
conservatively.  The patient was discharged from the hospital
and did well until the morning of admission when he noted
difficulty getting out of bed.  At baseline, he has a right
hemiparesis secondary to a stroke in [**2133**] and uses his left
side for all his mobilization.  He was unable to mobilize out
of bed on the morning of admission.

He denied headache, diplopia, dysarthria, or any other
weakness or sensory changes.

PAST MEDICAL HISTORY:
1.  Cerebrovascular accident in 11/98, which resulted in a
right upper extremity weakness.
2.  Zenker's's diverticula.
3.  Glaucoma.
4.  Hypertension.
5.  Benign prostatic hypertrophy.

MEDICATIONS:
1.  Cozaar 50 mg q. day.
2.  Hydrochlorothiazide 25 mg q. day.
3.  [**First Name5 (NamePattern1) 233**] [**Last Name (NamePattern1) 1002**] 20 mg q. day.
4.  Baby aspirin.

PHYSICAL EXAMINATION:  Vital signs on admission, 97.3 F.; 82;
175/96; 20 and 97% on room air.  In general, an elderly
gentleman lying in bed in no acute distress.  HEENT:  No
evidence of trauma.  Oropharynx clear.  Pulmonary:  Clear to
auscultation bilaterally.  Cardiovascular:  Regular rate and
rhythm.  Abdomen benign.  Extremities with two plus pulses.
Neurologically, awake and alert, oriented times three.  Knew
the months of the year backwards and forwards.  He had a
right optic disc blurred; left optic disc could not be
assessed.  Extraocular muscles were full.  Right pupil 4 down
to 3; left was 2 down to 1.5.  No nystagmus.  Facial
sensation is intact with a right facial droop.  Motor
strength on the right, deltoids were two on the right; biceps
were two; triceps was three; wrist flexion was two; wrist
extension was two; finger flexion was two; finger extension
was three.  On the left, deltoid was four plus; biceps five;
triceps was five; wrist flexion five; wrist extension five;
finger flexion four plus; finger extension four plus.  In the
lower extremities, hamstring was four on the right, five on
the left; knee flexion four minus on the right; five on the
left; dorsiflexion was five out of five bilaterally; plantar
flexion was five out of five bilaterally and [**Last Name (un) 938**] was four
plus on the right and five on the left.  The right toe was
equivocal.  Left toe was downgoing.

LABORATORY:  On admission, white blood cell count was 7.0,
hematocrit 36.5, platelets 266.  INR was 1.0, PT 12.2, PTT
26.5.  Sodium 146, potasium 4.3, 106/31; 18/1.0 and 94 was
the glucose.

Head CT scan shows a right sided subdural hematoma with falcine
herniation.

HOSPITAL COURSE:  The patient was admitted to the
Neurosurgery Service.  He had a twist drill drainage of a
subdural hematoma at the bedside.  He was monitored in the
Intensive Care Unit.  His vital signs were stable; he was
afebrile.

The patient had the subdural drain removed on [**2137-7-12**],
after repeat head CT scan showed good evacuation of the
subdural hematoma.  Neurologically, the patient was awake and
alert, conversant, slightly spastic and ataxic movement of
the extremities with strength unchanged on the right side.
The scalp dressing was clean, dry and intact.  Lungs had
scattered rhonchi.  Abdomen was soft.  Neurologically he was
stable.

The patient had a chest x-ray to rule out pneumonia which
showed evidence of aspiration pneumonia secondary to his
Zenker diverticula.  The patient was seen by the Speech and
Swallow Service who performed a video swallow study which
showed evidence of reflux from the Zenker diverticula into
his lungs.  The patient was made NPO and PEG placement was
discussed with the family.

At the time, the family did not want to have PEG placed, but
then after repeated aspiration, the family did consent and
the patient did consent to placement of a PEG tube.  The
patient had a PEG placed on [**2137-7-23**], without complication.
Vital signs have remained stable; he has been afebrile.  He
will be ready for discharge on [**2137-7-24**].

MEDICATIONS AT THE TIME OF DISCHARGE:
1.  Zantac 50 mg intravenously q. eight hours to be changed
to p.o. when PEG placed.
2.  Percocet, one to two tablets p.o. q. four hours p.r.n.
3.  Losartan.
4.  Potassium 50 mg p.o. q. day.
5.  Dulcolax sodium 100 mg p.o. twice a day.
6.  Hydromorphone with 2 mg subcutaneously q. three hours
p.r.n. for pain.
7.  Unasyn 4.5 grams intravenously q. eight hours for
aspiration pneumonia which was started on [**2137-7-16**].
8.  Cosopt, one drop o.p. twice a day.
9.  Pilocarpine 4%, one drop o.s. q. eight hours.

The patient's potassium has been low and he has been replaced
with potassium; his potassium level today was 3.2 and will be
rechecked the day of discharge.

CONDITION AT DISCHARGE:   Stable condition at the time of
discharge.

DISCHARGE INSTRUCTIONS:
1.  He will follow-up with Dr. [**First Name (STitle) **] in two weeks' time with a
repeat head CT scan.


                            [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D.  [**MD Number(1) 343**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2137-7-23**]  12:21
T:  [**2137-7-23**]  13:25
JOB#:  [**Job Number 42757**]





Name:  [**Known lastname 7753**], [**Known firstname 33**]                  Unit No:  [**Numeric Identifier 7754**]

Admission Date:  [**2137-7-10**]     Discharge Date:  [**2137-7-26**]

Date of Birth:   [**2050-8-24**]     Sex:  M

Service:

Addendum to cover hospital course from [**7-17**] to present -
The patient remained a continued aspiration risk.  He
received a ten day course of Unasyn for aspiration pneumonia.
The patient had a percutaneous endoscopic gastrostomy tube
placed on [**2135-7-26**] by the interventional radiology
service.  He was started on ProMod with fiber at 10 cc/hr to
advance by 10 cc/hr to a goal of 70 cc.  The patient will be
discharged to rehabilitation on [**7-26**], with the
percutaneous endoscopic gastrostomy tube in place.  He has no
medication changes from the last discharge summary.




                          [**First Name11 (Name Pattern1) 919**] [**Last Name (NamePattern4) 920**], M.D.  [**MD Number(1) 921**]

Dictated By:[**Last Name (NamePattern1) 6341**]

MEDQUIST36

D:  [**2137-7-26**]  10:49
T:  [**2137-7-26**]  10:58
JOB#:  [**Job Number 7755**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Pneumonitis due to inhalation of food or vomitus,Unspecified fall,Unspecified essential hypertension,Unspecified glaucoma,Diverticulum of esophagus, acquired'}


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: 

PRESENT ILLNESS: The patient is an 86 year-old
male transferred from [**Hospital3 1280**] Emergency Department for
management of subdural hematoma.  The patient was previously
well until [**6-26**] when he sustained a fall at home resulting
in a subdural hematoma for which he was treated
well for two weeks until the morning of admission when he
noted difficulty getting out of bed.  At baseline he has a
right upper limb paresis secondary to a distal infarct from
[**2133**] and he uses his left arm to aid in his mobilization.  He
was unable to do so on the morning of admission.  The
patient's daughter also reports that he was falling to his
left.  The patient denies headache, diplopia, dysarthria or
well.

MEDICAL HISTORY: 1.  Cerebrovascular accident in [**2133**]
resulting in right upper extremity weakness.  2.  Zenker's
diverticulum.  3.  Glaucoma.  4.  Hypertension.  5.  Benign
prostatic hypertrophy.

MEDICATION ON ADMISSION: Cozaar 50 mg po q day,
Hydrochlorothiazide 75 mg po q day, potassium chloride 20
milliequivalents po q day, baby aspirin, Pilocarpine eye
drops, Cosopt eye drops.

ALLERGIES: Bactrim and sulfa drugs.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Occasional alcohol.  No smoking. 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Pneumonitis due to inhalation of food or vomitus,Unspecified fall,Unspecified essential hypertension,Unspecified glaucoma,Diverticulum of esophagus, acquired'}
