CHIEF COMPLAINT: Progressive weakness after a fall.

PRESENT ILLNESS: 89 year-old male progressive weaness on the left side got
worse over the weekend. S/P fall 3-4 weeks ago. Recently started

MEDICAL HISTORY: 1.  HTN
2.  Neuropathy
3.  Colon cancer, s/p right hemicolectomy in [**2185**]

MEDICATION ON ADMISSION: HCTZ, Norvasc, Coumadin and Flomax

ALLERGIES: Lasix

PHYSICAL EXAM: Vitals: 98 84 180/47 16 97 RA
Gen:elderly gentelmen lying in strecther NAD.
Neck:No Carotid bruits, neck supple.
CV: irregular, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: Retired, lives alone, performs all ADL's independantly; daughter
lives nearby. Former 4 ppd smoker but quit 20 yrs ago, no EtOH
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified fall,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine
Traumatic subdural hem,Atrial fibrillation,CHF NOS,Fall NOS,Long-term use anticoagul,Hypertension NOS,Hx of colonic malignancy
Admission Date:  [**2188-9-2**]              Discharge Date:   [**2188-9-8**]


Service: NEUROSURGERY

Allergies:
Lasix

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Progressive weakness after a fall.

Major Surgical or Invasive Procedure:
Craniotomy


History of Present Illness:
89 year-old male progressive weaness on the left side got
worse over the weekend. S/P fall 3-4 weeks ago. Recently started

on Coumadin for atrial fibrillation. Last Coumadin dose was
thursday evening 1.25mg. LAst INR prior to ED visit was 2.5 his
PCP told him to stop his coumadin.

Past Medical History:
1.  HTN
2.  Neuropathy
3.  Colon cancer, s/p right hemicolectomy in [**2185**]


Social History:
Retired, lives alone, performs all ADL's independantly; daughter
lives nearby. Former 4 ppd smoker but quit 20 yrs ago, no EtOH

Family History:
NC

Physical Exam:
Vitals: 98 84 180/47 16 97 RA
Gen:elderly gentelmen lying in strecther NAD.
Neck:No Carotid bruits, neck supple.
CV: irregular, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally

Neurologic examination:
Mental status: Awake and alert, cooperative with exam, normal
affect
Orientation: oriented to person, place, and date
Recall: [**2-28**] at 5 minutes, naming intaact.
Language: 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, 4 to 3
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 finger rub bilaterally.
IX, X: Palatal elevation symmetrical
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations, intact movements
Motor:
Normal bulk and tone bilaterally
No tremor
D T B WF WE FiF [**Last Name (un) **] IP Gl Q H AF AE TF TE
Right 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
Left 2 2 2 2 2 1 1 4- 3 3 3 3 3 1 1

left pronator drift
Sensation: Intact to light touch.
Reflexes: B T Br Pa Pl
Right 2 2 2 2 2
Left 2 2 2 2 2

Toes were downgoing right, upgoing left.
Coordination: normal but slow on finger-nose-finger, heel to
shin also normal
Gait was not assessed.


Pertinent Results:
[**2188-9-2**] 10:35PM   CK(CPK)-92
[**2188-9-2**] 10:35PM   CK-MB-NotDone cTropnT-0.02*
[**2188-9-2**] 01:14PM   GLUCOSE-119* UREA N-40* CREAT-1.8* SODIUM-139
POTASSIUM-4.5 CHLORIDE-99 TOTAL CO2-23 ANION GAP-22*
[**2188-9-2**] 01:14PM   CK(CPK)-144
[**2188-9-2**] 01:14PM   cTropnT-0.01
[**2188-9-2**] 01:14PM   WBC-14.1*# RBC-4.71 HGB-11.5* HCT-36.8*
MCV-78* MCH-24.4* MCHC-31.3 RDW-16.0*

Brief Hospital Course:
A head CT showed a large right subdural hemorrhage with
significant mass affect, midline shift, subfalcine herniation.
He was taken to the operating room and underwent a right sided
craniotomy without complication.  Post-operatively he was awake,
alert and orientated X3 and moving all extremeties.  A repeat
head CT showed decrease subdural hematoma size with reduction in
mass effect. He was placed on 100% O2 to decrease a collection
of frontal air.

On Post-op day 2 he remained neurologically intact and was
transferred to the neurostep down unit.  He had a CXR on post-op
day 2 and 3 which showed worsening CHF he was given doses of IV
ethacrynic acid (due to allergy of Lasix) with good results, his
renal function remained stable but with a slightly high
creatinine, which according to his daughter is being followed by
his primary care physcian.

He was seen by physcial therapy and felt to be a candidate for
acute rehab.

On day of discharge he was awake alert and orientated following
commands, incision was clean dry and intact.


Medications on Admission:
HCTZ, Norvasc, Coumadin and Flomax

Discharge Medications:
1. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
2. Amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
5. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO BID
(2 times a day).
6. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
7. Famotidine 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection [**Hospital1 **] (2 times a day).
9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
10. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for wheezing .
11. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed for wheezing.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Subdural Hematoma


Discharge Condition:
Neurologically stable


Discharge Instructions:
Watch incision for redness, drainage, bleeding, swelling, fever
greater than 101.5 or any neurologic problems call Dr [**Name (NI) 17511**]
problems.  [**Name (NI) **] not get incision wet until sutures out.
No heavy lifting

Followup Instructions:
Follow up in 2 weeks with CT scan at Dr[**Name (NI) 9034**] office.  Call
for an appointment [**Telephone/Fax (1) 2731**]


Completed by:[**2188-10-8**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified fall,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine'}


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: Progressive weakness after a fall.

PRESENT ILLNESS: 89 year-old male progressive weaness on the left side got
worse over the weekend. S/P fall 3-4 weeks ago. Recently started

MEDICAL HISTORY: 1.  HTN
2.  Neuropathy
3.  Colon cancer, s/p right hemicolectomy in [**2185**]

MEDICATION ON ADMISSION: HCTZ, Norvasc, Coumadin and Flomax

ALLERGIES: Lasix

PHYSICAL EXAM: Vitals: 98 84 180/47 16 97 RA
Gen:elderly gentelmen lying in strecther NAD.
Neck:No Carotid bruits, neck supple.
CV: irregular, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally

FAMILY HISTORY: NC

SOCIAL HISTORY: Retired, lives alone, performs all ADL's independantly; daughter
lives nearby. Former 4 ppd smoker but quit 20 yrs ago, no EtOH 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Atrial fibrillation,Congestive heart failure, unspecified,Unspecified fall,Long-term (current) use of anticoagulants,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine'}
