CHIEF COMPLAINT: depressed level of consciousness

PRESENT ILLNESS: The patient is an 81 year old woman with HTN, HL, and DM2 who
reportedly felt dizzy while driving on [**2177-8-7**], pulled over her
car, and then subsequently lost consciousness. She presented
initially to [**Hospital **] Hospital where she was found to be very
hypertensive (BP 225/123, HR 67), diaphoretic, and unresponsive.
Her initial NC Head CT showed a large left frontoparietal
hemorrhage with intraventricular extension, an associated left
frontal subdural hemorrhage, effacement of the basal cisterns,
brainstem hypodensity, and a 5 millimeter midline shift. She was
intubated, placed on Propofol, and transferred to [**Hospital1 18**] for
further care. Her initial exam revealed pupil asymmetry,
impaired brainstem reflexes, and minimal movement of the LUE.
The patient was started on hyperosmolar therapy with Mannitol.

MEDICAL HISTORY: [] Cardiovascular - HTN, HL
[] Endocrine - DM2

MEDICATION ON ADMISSION: 

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: Exam at admission:
Gen; intubated, NAD
HEENT; NC/AT
CV; RRR, no murmurs
Pulm; CTA anteriorly
Abd; soft, nt, nd
Extr; no edema
Neuro; (off propofol for 5 minutes) unarousable to voice or
noxious stimuli.  Eyes closed.  1mm downward deviation of left
eye.  L pupil 3mm, R pupil 2.5mm, sluggish.  No blink to threat.

FAMILY HISTORY: Not known

SOCIAL HISTORY: Not known
Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Hemiplegia, unspecified, affecting unspecified side,Other amyloidosis,Subdural hemorrhage,Encounter for palliative care,Do not resuscitate status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified cerebrovascular disease,Facial weakness,Other and unspecified hyperlipidemia
Intracerebral hemorrhage,Compression of brain,Acute respiratry failure,Unsp hemiplga unspf side,Amyloidosis NEC,Subdural hemorrhage,Encountr palliative care,Do not resusctate status,DMII wo cmp nt st uncntr,Hypertension NOS,Cerebrovasc disease NOS,Facial weakness,Hyperlipidemia NEC/NOS
Admission Date:  [**2177-8-7**]              Discharge Date:   [**2177-8-9**]

Date of Birth:  [**2096-4-27**]             Sex:   F

Service: NEUROLOGY

Allergies:
No Allergies/ADRs on File

Attending:[**First Name3 (LF) 2569**]
Chief Complaint:
depressed level of consciousness

Major Surgical or Invasive Procedure:
None

History of Present Illness:
The patient is an 81 year old woman with HTN, HL, and DM2 who
reportedly felt dizzy while driving on [**2177-8-7**], pulled over her
car, and then subsequently lost consciousness. She presented
initially to [**Hospital **] Hospital where she was found to be very
hypertensive (BP 225/123, HR 67), diaphoretic, and unresponsive.
Her initial NC Head CT showed a large left frontoparietal
hemorrhage with intraventricular extension, an associated left
frontal subdural hemorrhage, effacement of the basal cisterns,
brainstem hypodensity, and a 5 millimeter midline shift. She was
intubated, placed on Propofol, and transferred to [**Hospital1 18**] for
further care. Her initial exam revealed pupil asymmetry,
impaired brainstem reflexes, and minimal movement of the LUE.
The patient was started on hyperosmolar therapy with Mannitol.

Past Medical History:
[] Cardiovascular - HTN, HL
[] Endocrine - DM2

Social History:
Not known

Family History:
Not known

Physical Exam:
Exam at admission:
Gen; intubated, NAD
HEENT; NC/AT
CV; RRR, no murmurs
Pulm; CTA anteriorly
Abd; soft, nt, nd
Extr; no edema
Neuro; (off propofol for 5 minutes) unarousable to voice or
noxious stimuli.  Eyes closed.  1mm downward deviation of left
eye.  L pupil 3mm, R pupil 2.5mm, sluggish.  No blink to threat.

No corneals.  No gag.  Increased tone in legs.  Minimal
spontaneous movement distal LUE and withdraws minimally to
noxious in LLE.  No movement or withdrawl to noxious in RUE or
RLE.  Brisk reflexes througout, upgoing toes

Pertinent Results:
NCHCT [**2177-8-7**] - Large left frontoparietal 6 x 4.5 x 6 cm
intraparenchymal hemorrhage with associated subdural hemorrhage
and intraventricular extension, midline shift of 5 mm and mass
effect of on the left lateral ventricle, midbrain slightly
hypodense, effacement of the basal cisterns

Brief Hospital Course:
81yoW h/o HTN, HL, DM2 who became dizzy and drowsy while driving
on [**2177-8-7**] and subsequently lost consciousness who was later
found to a large left intraparenchymal, subdural, and
intraventricular hemorrhage with mass effect on the lateral
ventricles and brainstem and midline shift.

[] Intraparenchymal Hemorrhage, Subdural Hemorrhage,
Intraventricular Hemorrhage - The patient's spontaneous,
atraumatic hemorrhage has caused midline shift and mass effect
on the areas of the brain that maintain consciousness. Off
sedation, the patient has remained nonresponsive with some
brainstem reflexes present (corneal) and several absent
(oculocephalics, gag) and some degree of motor response to pain.
Neurosurgery was consulted initially but felt that there was no
indication for neurosurgical intervention given the patient's
exam and poor prognosis. The patient was treated with
hyperosmolar therapy (Mannitol). The family was available at the
bedside and reported that the patient's advanced directive
indicates that she was DNR/DNI prior to her hospitalization
(which was not known at the time she was intubated at the
outside hospital). Since she was intubated, they were okay with
maintaining intubation/ventilation and reintubating if
necessary. Our team met with the daughters and the patient's
husband and explained the patient's impaired neurologic status
and her poor prognosis. The family decided to make her CMO
overnight on [**2177-8-8**]. She was extubated, her nicardipine and
mannitol were stopped, and she placed on a morphine infusion for
air hunger. She passed on [**2177-8-9**] in the morning.

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Intraparenchymal Hemorrhage (atraumatic)
Subdural Hemorrhage
Intraventricular Hemorrhage
Hypoxic Respiratory Failure
Hypertension

Discharge Condition:
Deceased

Discharge Instructions:
N/A

Followup Instructions:
N/A

                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2575**]
{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Hemiplegia, unspecified, affecting unspecified side,Other amyloidosis,Subdural hemorrhage,Encounter for palliative care,Do not resuscitate status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified cerebrovascular disease,Facial weakness,Other and unspecified hyperlipidemia'}


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: depressed level of consciousness

PRESENT ILLNESS: The patient is an 81 year old woman with HTN, HL, and DM2 who
reportedly felt dizzy while driving on [**2177-8-7**], pulled over her
car, and then subsequently lost consciousness. She presented
initially to [**Hospital **] Hospital where she was found to be very
hypertensive (BP 225/123, HR 67), diaphoretic, and unresponsive.
Her initial NC Head CT showed a large left frontoparietal
hemorrhage with intraventricular extension, an associated left
frontal subdural hemorrhage, effacement of the basal cisterns,
brainstem hypodensity, and a 5 millimeter midline shift. She was
intubated, placed on Propofol, and transferred to [**Hospital1 18**] for
further care. Her initial exam revealed pupil asymmetry,
impaired brainstem reflexes, and minimal movement of the LUE.
The patient was started on hyperosmolar therapy with Mannitol.

MEDICAL HISTORY: [] Cardiovascular - HTN, HL
[] Endocrine - DM2

MEDICATION ON ADMISSION: 

ALLERGIES: No Allergies/ADRs on File

PHYSICAL EXAM: Exam at admission:
Gen; intubated, NAD
HEENT; NC/AT
CV; RRR, no murmurs
Pulm; CTA anteriorly
Abd; soft, nt, nd
Extr; no edema
Neuro; (off propofol for 5 minutes) unarousable to voice or
noxious stimuli.  Eyes closed.  1mm downward deviation of left
eye.  L pupil 3mm, R pupil 2.5mm, sluggish.  No blink to threat.

FAMILY HISTORY: Not known

SOCIAL HISTORY: Not known 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Acute respiratory failure,Hemiplegia, unspecified, affecting unspecified side,Other amyloidosis,Subdural hemorrhage,Encounter for palliative care,Do not resuscitate status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Unspecified cerebrovascular disease,Facial weakness,Other and unspecified hyperlipidemia'}
