CHIEF COMPLAINT: Cerebellar hemorrhage.

PRESENT ILLNESS: The patient is a 64-year-old
male with a past medical history significant for melanoma
with metastases to the brain, pelvis, and lungs.  He had a
recent DVT, and he has been on Coumadin and presented to the
emergency department with nausea and vomiting for 1 day.  He
had been seen in Hematology/[**Hospital **] Clinic the day prior to
presentation and was found to have an INR of 8.  He received
vitamin K subcutaneous and was sent home.  Apparently at
home, he fell asleep and awoke next morning with nausea and
multiple episodes of bilious emesis, which was nonbloody.  He
also complained of a frontal headache.  Per his wife, the
patient was agitated the day prior and very unsteady on his
feet, moving from side to side with his walker.  She also
reported that he has been more lethargic than usual, but
denied any history of fevers, chills, speech changes, visual
changes, numbness, or weakness.  The patient had been started
on Lovenox approximately 1 week prior to presentation and
Coumadin on Sunday and the Monday previous to admission,
which would have been 2 and 3 days prior to presentation.

MEDICAL HISTORY: Significant for melanoma in [**9-3**].

MEDICATION ON ADMISSION: 1. Phenytoin.
2. Sertraline.
3. Atorvastatin.
4. Hydrochlorothiazide.
5. Dilantin.
6. Percocet.
7. Senna.
8. Colace.
9. OxyContin.
10.      Decadron.
11.      Coumadin.
12.      Terfenadine.
13.      Ativan.
14.      Ramipril.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Intracerebral hemorrhage,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Personal history of malignant melanoma of skin
Intracerebral hemorrhage,Secondary malig neo bone,Secondary malig neo lung,Hx-malig skin melanoma
Admission Date: [**2181-9-12**]        Discharge Date: [**2181-9-14**]

Date of Birth:  [**2117-5-27**]        Sex:  M

Service:  NSU


CHIEF COMPLAINT:  Cerebellar hemorrhage.

HISTORY OF PRESENT ILLNESS:  The patient is a 64-year-old
male with a past medical history significant for melanoma
with metastases to the brain, pelvis, and lungs.  He had a
recent DVT, and he has been on Coumadin and presented to the
emergency department with nausea and vomiting for 1 day.  He
had been seen in Hematology/[**Hospital **] Clinic the day prior to
presentation and was found to have an INR of 8.  He received
vitamin K subcutaneous and was sent home.  Apparently at
home, he fell asleep and awoke next morning with nausea and
multiple episodes of bilious emesis, which was nonbloody.  He
also complained of a frontal headache.  Per his wife, the
patient was agitated the day prior and very unsteady on his
feet, moving from side to side with his walker.  She also
reported that he has been more lethargic than usual, but
denied any history of fevers, chills, speech changes, visual
changes, numbness, or weakness.  The patient had been started
on Lovenox approximately 1 week prior to presentation and
Coumadin on Sunday and the Monday previous to admission,
which would have been 2 and 3 days prior to presentation.

PAST MEDICAL HISTORY:  Significant for melanoma in [**9-3**].

Status post dissection of a lesion on the left chin.

He also had lymph node dissection in [**10-4**].

He is status post metastases to the brain, pelvis, and lungs.

Status post stereotactic radiosurgery to the left medial
frontal lobe and 2 metastases in the vermis in [**6-5**].

He is also status post DVT in [**9-5**].

He also has history of hypertension.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:
1. Phenytoin.
2. Sertraline.
3. Atorvastatin.
4. Hydrochlorothiazide.
5. Dilantin.
6. Percocet.
7. Senna.
8. Colace.
9. OxyContin.
10.      Decadron.
11.      Coumadin.
12.      Terfenadine.
13.      Ativan.
14.      Ramipril.


PHYSICAL EXAMINATION:  On admission, the patient's vital
signs were temperature 97.6, blood pressure 167/63, pulse of
72, respirations of 18, and saturating 96 percent on room
air.  He was an ill-appearing gentleman, sleeping but
arousable to voice.  His mucous membranes were moist.  Neck
was supple.  Good range of motion.  His lungs were clear to
auscultation bilaterally.  His heart rate was regular.  His
belly was soft, nontender, and nondistended with positive
bowel sounds.  His extremities were warm and well perfused.
No clubbing, cyanosis, or edema.  Neurologically, he was
sleepy but arousable.  He was oriented to person and year.
He was cooperative.  His language was fluent with no
dysarthria, no apraxia.  No gap was noted.  Fund of knowledge
was normal.  His visual fields were full.  Extraocular
movements intact.  Cranial nerves II through XII were intact
grossly.  Tongue was midline.  He had normal bulk and tone.
No noted tremors or drift.  His strength was [**6-6**] throughout
outside of the right [**Last Name (un) 938**], which was noted to be [**5-7**].
Sensation was intact throughout, as was proprioception.
Reflexes were 2 in the upper extremities.  His toes were
upgoing, and his lower extremity reflexes were 2 at the
patellar and 1 at the Achilles.  Coordination revealed some
moderate dysmetria on fine finger movements, left greater
than right.

LABORATORY DATA:  On admission included a white count of 8.9,
hematocrit of 31.2, and platelets of 230,000.  His INR was
4.4.  His panels revealed a sodium of 132, potassium of 3.2,
chloride of 91, bicarb 28, BUN 12, and creatinine 0.6.
Glucose was 260.  His UA revealed elevated glucose and 15
ketones.

HOSPITAL COURSE:  Head CT was consistent with an MRI, which
had been completed on [**2181-8-31**], and revealed a superior
vermian mass, which was enlarged from 1 cm to 2.3 cm,
hemorrhagic.  The fourth ventricle was noted to be narrowed
but without any hydrocephalus present.  He was ordered to
have every 1-hour neurochecks, and dexamethasone was started
for cerebral edema as well as seizure prophylaxis in the form
of Dilantin.  He was also at admission ordered to have
mannitol started to reduce his cerebral swelling.  He was
given some vitamin K to correct his coagulopathy.  Due to his
history of hypertension, he required blood pressure control,
and this was accomplished with a combination of home
medications and p.r.n. hydralazine.  He did require several
transfusions during his hospital course, FFP to correct his
coagulopathy, 1 unit of packed red blood cells to correct his
hematocrit, and his diet was advanced through his hospital
course.  He was initially n.p.o., but by the time of
discharge, he was tolerating a regular diet.  The family
informed that the teams that were involved that the patient
was DNR/DNI.  The patient remained stable through his
hospital course.  He did not require any aggressive
neurosurgical intervention.  Neuro-oncology was involved in
his care due to his history of cancer, and they agreed that
at the time of discharge he would require some visiting nurse
involvement.  This was set up for him.  The setup was for
hospice care following the visiting nurse visits.  The
patient was discharged to home on hospital day number 3.  He
was stable at the time of discharge, tolerating p.o. diet,
working with physical therapy and occupational therapy.

DISCHARGE MEDICATIONS:
1. Pepcid 20 mg p.o. b.i.d.
2. Ativan 1 mg p.o. q.h.s.
3. Sertraline 100 mg p.o. q.d.
4. Lipitor 10 mg p.o. q.d.
5. Hydrochlorothiazide 12.5 mg p.o. q.d.
6. Ramipril 10 mg p.o. q.d.
7. Dilantin 300 mg p.o. t.i.d.
8. Senna 8.6 mg p.o. b.i.d.
9. Colace 100 mg p.o. b.i.d.
10.      Percocet 5/325 mg 1 to 2 tablets p.o. q.4-6h. p.r.n.
   pain.
11.      Insulin sliding scale.
12.      Dexamethasone 6 mg p.o. q.6h.


DISCHARGE INSTRUCTIONS:  The patient was to follow up with
Dr. [**Last Name (STitle) 724**] in [**Hospital 878**] Clinic on [**2181-9-24**] at 3 o'clock and
with Dr. [**Last Name (STitle) **] in Hematology/[**Hospital **] Clinic on [**2181-9-25**]
at 2 o'clock, and he was to have an MRI on [**2181-9-24**] at 01:45
p.m.  A  was completed for the patient for his visiting nurse
visits as well as for hospice care.  Discharge instructions
also included that the patient was to call Dr. [**Last Name (STitle) 724**] or Dr. [**First Name (STitle) **]
or the hospice nurse if he developed any questions or
concerns or if the symptoms were not controlled at home.

DISCHARGE DIAGNOSES:  Metastatic vermal lesion with
hemorrhage.

Metastatic melanoma.

Deep venous thrombosis.

Hypertension.

OTHER INSTRUCTIONS:  Please call with questions, pager number
[**Serial Number 15008**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**]

Dictated By:[**Last Name (NamePattern1) 15009**]
MEDQUIST36
D:  [**2181-9-14**] 09:55:46
T:  [**2181-9-14**] 14:55:43
Job#:  [**Job Number 15010**]
{'Intracerebral hemorrhage,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Personal history of malignant melanoma of skin'}


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: Cerebellar hemorrhage.

PRESENT ILLNESS: The patient is a 64-year-old
male with a past medical history significant for melanoma
with metastases to the brain, pelvis, and lungs.  He had a
recent DVT, and he has been on Coumadin and presented to the
emergency department with nausea and vomiting for 1 day.  He
had been seen in Hematology/[**Hospital **] Clinic the day prior to
presentation and was found to have an INR of 8.  He received
vitamin K subcutaneous and was sent home.  Apparently at
home, he fell asleep and awoke next morning with nausea and
multiple episodes of bilious emesis, which was nonbloody.  He
also complained of a frontal headache.  Per his wife, the
patient was agitated the day prior and very unsteady on his
feet, moving from side to side with his walker.  She also
reported that he has been more lethargic than usual, but
denied any history of fevers, chills, speech changes, visual
changes, numbness, or weakness.  The patient had been started
on Lovenox approximately 1 week prior to presentation and
Coumadin on Sunday and the Monday previous to admission,
which would have been 2 and 3 days prior to presentation.

MEDICAL HISTORY: Significant for melanoma in [**9-3**].

MEDICATION ON ADMISSION: 1. Phenytoin.
2. Sertraline.
3. Atorvastatin.
4. Hydrochlorothiazide.
5. Dilantin.
6. Percocet.
7. Senna.
8. Colace.
9. OxyContin.
10.      Decadron.
11.      Coumadin.
12.      Terfenadine.
13.      Ativan.
14.      Ramipril.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Intracerebral hemorrhage,Secondary malignant neoplasm of bone and bone marrow,Secondary malignant neoplasm of lung,Personal history of malignant melanoma of skin'}
