CHIEF COMPLAINT: 

PRESENT ILLNESS: Ms. [**Known lastname 74655**] is an 87 year-old
female who was transferred from [**Hospital 4415**]
with recent onset of left CN III palsy and headache.  An MRA
performed at [**Hospital1 336**] had revealed the presence of a left bilobed
PCOM aneurysm. On arrival to [**Hospital1 69**]
she was awake, arousable, followed commands.  She did have a
ventricular drain that was placed at [**Hospital 4415**].
She was brought to the angio suite on [**2177-7-26**] where she had
partial treatment of her wide-necked bilobed aneurysm.
Postoperatively, the patient's vital signs were heart rate 89
blood pressure 167/60, 100%, 17 respirations, 97.6.  She was
arousable, following commands, unable to open her left eye.
Heart rate was regular rate and rhythm.  Lungs were clear.
She had an A line in place.  She was receiving Nipride for
her blood pressure control.

MEDICAL HISTORY: Coronary artery bypass graft done in
[**2172**].  She had a right lobectomy in her right lung.  She has
had back surgery.  Questionable hypertension and
incontinence.

MEDICATION ON ADMISSION: 1.  Imdur.
2.  Vasotec.
3.  Prilosec.
4.  Lasix.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cerebral aneurysm, nonruptured,Iatrogenic cerebrovascular infarction or hemorrhage,Urinary tract infection, site not specified,Encounter for palliative care,Aphasia,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Aortocoronary bypass status
Nonrupt cerebral aneurym,Iatrogen CV infarc/hmrhg,Urin tract infection NOS,Encountr palliative care,Aphasia,Hypertension NOS,Delirium d/t other cond,Aortocoronary bypass
Admission Date:  [**2177-7-26**]     Discharge Date:  [**2177-8-23**]


Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  Ms. [**Known lastname 74655**] is an 87 year-old
female who was transferred from [**Hospital 4415**]
with recent onset of left CN III palsy and headache.  An MRA
performed at [**Hospital1 336**] had revealed the presence of a left bilobed
PCOM aneurysm. On arrival to [**Hospital1 69**]
she was awake, arousable, followed commands.  She did have a
ventricular drain that was placed at [**Hospital 4415**].
She was brought to the angio suite on [**2177-7-26**] where she had
partial treatment of her wide-necked bilobed aneurysm.
Postoperatively, the patient's vital signs were heart rate 89
blood pressure 167/60, 100%, 17 respirations, 97.6.  She was
arousable, following commands, unable to open her left eye.
Heart rate was regular rate and rhythm.  Lungs were clear.
She had an A line in place.  She was receiving Nipride for
her blood pressure control.

PAST MEDICAL HISTORY:  Coronary artery bypass graft done in
[**2172**].  She had a right lobectomy in her right lung.  She has
had back surgery.  Questionable hypertension and
incontinence.

MEDICATIONS ON ADMISSION:
1.  Imdur.
2.  Vasotec.
3.  Prilosec.
4.  Lasix.

PHYSICAL EXAMINATION:  Her arterial blood gas postoperatively
was 7.48, 34, 26.  Neurological examination she obeys
commands, intubated, moving all four extremities, opens eyes
to voice, sleepy, but easily arousable, alert to person and
place not time.  Full fields in right eye.  Left eye ptosis,
irregular pupil on the left eye.  Right pupil was 4 to 2
brisk, full extraocular movements intact on the right,
dysconjugate gaze and III nerve palsy.  Good grasp.

LABORATORY:  Hematocrit 29, white blood cell count 6.7,
platelets 146, sodium 139, potassium 3.8, chloride 107, CO2
24, 10 for BUN, creatinine .7, 155.

HOSPITAL COURSE:  On the [**5-27**] in the morning the
patient did appear to be having some decreased mental status,
however, she was awake, not alert and oriented.  Speech was
somewhat garbled.  Her right pupil was reactive.  CT of the
head showed no hemorrhages or early signs of infarction.  She
was felt maybe to have sundowning.  In the morning
of the 17th she was found to have a complete ptosis of the
left eye.  She did have confused confabled speech.  Her blood
pressures were kept in the 120s to 140s.  She received an MRI
with DWI images that day.  She was continued to be monitored
in the Intensive Care Unit given her decrease in mental
status.  The patient was kept in the Intensive Care Unit.
The MRI that was done earlier in the day showed an acute
parietal left middle cerebral artery territorial infarct
along with chronic lacunar infarcts in the basal ganglion.  The
patient was kept in the Intensive Care Unit through the 21st.
She had dysarthria and aphagia.  She also seemed to be having
some delirium where psychiatry was involved.  Her blood
pressures were kept below the 140 range.  She was given
supportive care during this time.  She was seen by physical
therapy and began a rehab plan.  On the [**6-1**] when she
was on the floor she was afebrile.  Heart rate was 80s. Blood
pressure 170s/90s.  Seemed to follow some commands.  Seemed
to be neurologically improved.  Her blood pressure was
aggressively controlled.  She did have a speech and swallow
test, which she did not pass and she continued to receive
nasogastric tube feedings.  Psychiatry was following her for
her delirium, which was felt to be secondary to her recent
cerebral infarction.  She was also found to have a urinary
tract infection at this time.  On the [**6-4**] the
patient was found to be arousable, but very sleepy, still
aphasic.  CT of the head was done on the 25th and was still a
stable area of infarct.  No further infarct was noted.  The
patient also had a more of a metabolic workup that showed her
electrolytes to be all within normal limits and her white
blood cell count was 7.7, hematocrit 34.9, liver function
tests were normal.  Her TSH was also normal.  Her metabolic
workup was felt to be negative at this time.

The patient did have a MRI on the 27th that showed slight
anterior flow increase.  The comparison on the MRI from [**7-27**]
again noted there is a left temporal posterior insular
subacute infarction.  There is no change in the appearance of
this abnormalities and no new areas of infarction were
identified.  No focal microvascular infarction.  There was
overall stable appearance of the brain.  The patient also had
an electroencephalogram evaluation and was continued on tube
feedings.  She had a gastrointestinal consult, however, the
family was not in agreement about starting PEG tube feedings.
They continued with the nasogastric tube feedings. The
patient continued to wax and wane as far as her mental
status.  She was not following commands, however, was
attentive and opened her eyes.  Her vital signs had been
stable.  On the [**5-12**] the patient had not made up
their mind regarding PEG tube placement.  Social work did get
involved with the family.  On the 3rd there was a family
meeting with Dr. [**Last Name (STitle) 1132**] and the quality of life was discussed
for the patient and the family decided to hold off on any
discharge or rehab planning and PEG tube feedings at that
time.  On the [**5-22**] Dr. [**Last Name (STitle) 1132**] discussed with the
family who decided given the patient's quality of life that
she would not want to continue to live in her current status
and not want to have a feeding tube in.  The family decided
to make her DNR/DNI and comfort measures only.  The patient
passed away on [**2177-8-23**] at 2:25 p.m. on a morphine drip with
her family at her bedside.





                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern4) 32961**]

MEDQUIST36

D:  [**2177-8-23**]  04:54
T:  [**2177-8-25**]  09:31
JOB#:  [**Job Number 95976**]
{'Cerebral aneurysm, nonruptured,Iatrogenic cerebrovascular infarction or hemorrhage,Urinary tract infection, site not specified,Encounter for palliative care,Aphasia,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Aortocoronary bypass status'}


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: Ms. [**Known lastname 74655**] is an 87 year-old
female who was transferred from [**Hospital 4415**]
with recent onset of left CN III palsy and headache.  An MRA
performed at [**Hospital1 336**] had revealed the presence of a left bilobed
PCOM aneurysm. On arrival to [**Hospital1 69**]
she was awake, arousable, followed commands.  She did have a
ventricular drain that was placed at [**Hospital 4415**].
She was brought to the angio suite on [**2177-7-26**] where she had
partial treatment of her wide-necked bilobed aneurysm.
Postoperatively, the patient's vital signs were heart rate 89
blood pressure 167/60, 100%, 17 respirations, 97.6.  She was
arousable, following commands, unable to open her left eye.
Heart rate was regular rate and rhythm.  Lungs were clear.
She had an A line in place.  She was receiving Nipride for
her blood pressure control.

MEDICAL HISTORY: Coronary artery bypass graft done in
[**2172**].  She had a right lobectomy in her right lung.  She has
had back surgery.  Questionable hypertension and
incontinence.

MEDICATION ON ADMISSION: 1.  Imdur.
2.  Vasotec.
3.  Prilosec.
4.  Lasix.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cerebral aneurysm, nonruptured,Iatrogenic cerebrovascular infarction or hemorrhage,Urinary tract infection, site not specified,Encounter for palliative care,Aphasia,Unspecified essential hypertension,Delirium due to conditions classified elsewhere,Aortocoronary bypass status'}
