CHIEF COMPLAINT: Unresponsive.

PRESENT ILLNESS: The pt is a 78 year-old woman who was reportedly well until this
AM when she was found down and unresponsive.  Pt taken to OSH
where CT head revealed large
intracranial bleed with intraventricular extension and midline
shift.  Pt apparently able to follow some commends with RUE at
OSH prior to intubation and transfer. Repeat CT on arrival to
[**Hospital1 18**] shows no progression of bleed compared to OSH, but approx
40-50cc hemorrhage in R BG with extension throughout the
ventricular system and mild ventricular dilatation. There is no
history of antecedant illness or symptoms, including headache.

MEDICAL HISTORY: -hx of recent cataract surgery which had to be aborted due to
hemorrhage

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:    afeb  116-148/64-97
General: intubated
HEENT: Anicteric, MMM without lesions
Neck: Supple, no LAD, no carotid bruits, no thyromegaly
CV: RRR  s1s2     no m/r/g
Resp: CTAB   no r/w/r
Abd: +BS    Soft/NT/ND    no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

FAMILY HISTORY: No history of stroke.

SOCIAL HISTORY: The pt lives alone at home.  There is no history of tobacco,
alcohol, illicit drug use.
Unspecified intracranial hemorrhage,Obstructive hydrocephalus,Unspecified essential hypertension
Intracranial hemorr NOS,Obstructiv hydrocephalus,Hypertension NOS
Admission Date:  [**2162-2-25**]              Discharge Date:   [**2162-2-26**]

Date of Birth:  [**2084-2-6**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
Unresponsive.

Major Surgical or Invasive Procedure:
Intubation.

History of Present Illness:
The pt is a 78 year-old woman who was reportedly well until this
AM when she was found down and unresponsive.  Pt taken to OSH
where CT head revealed large
intracranial bleed with intraventricular extension and midline
shift.  Pt apparently able to follow some commends with RUE at
OSH prior to intubation and transfer. Repeat CT on arrival to
[**Hospital1 18**] shows no progression of bleed compared to OSH, but approx
40-50cc hemorrhage in R BG with extension throughout the
ventricular system and mild ventricular dilatation. There is no
history of antecedant illness or symptoms, including headache.


Past Medical History:
-hx of recent cataract surgery which had to be aborted due to
hemorrhage

Social History:
The pt lives alone at home.  There is no history of tobacco,
alcohol, illicit drug use.

Family History:
No history of stroke.

Physical Exam:
VS:    afeb  116-148/64-97
General: intubated
HEENT: Anicteric, MMM without lesions
Neck: Supple, no LAD, no carotid bruits, no thyromegaly
CV: RRR  s1s2     no m/r/g
Resp: CTAB   no r/w/r
Abd: +BS    Soft/NT/ND    no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

MS: intubated, does not alert to verbal cues, minimal response
to
noxious tactile cues. Cannot follow midline commands
CN: I - not tested, II,III - pupils OD 4mm fixed, OS 3mm
sluggishly reactive; III,IV,VI -minimal OCR;  V- corneal intact,
responds to nasal tickle; VII - no obvious facial asymmetry
though difficult to asses due to intubation; IX,X -gag intact
Motor: nl bulk and flaccid tone in L, no tremor, rigidity or
bradykinesia.

DTRs: [**Name2 (NI) **] (C56) BR (C6) Tri (C7) Pa (L34) Ac (S12)  Plantar
        L 2 2 2 2 2   up
        R 2 2 2 2 2   up
Sensory: some w/d to ungula pressure and pinch in RUE, posturing
with deep noxious stim in RLE and left side

Pertinent Results:
[**2162-2-25**] 07:19PM BLOOD WBC-9.8 RBC-4.29 Hgb-10.0* Hct-28.7*
MCV-67* MCH-23.4* MCHC-35.0 RDW-15.9* Plt Ct-155
[**2162-2-25**] 07:19PM BLOOD PT-12.5 PTT-21.1* INR(PT)-1.0
[**2162-2-25**] 07:19PM BLOOD Glucose-111* UreaN-11 Creat-0.7 Na-140
K-3.6 Cl-100 HCO3-23 AnGap-21*
[**2162-2-25**] 07:19PM BLOOD Calcium-8.7 Phos-2.6* Mg-1.7
[**2162-2-25**] 07:57PM BLOOD Type-ART Temp-38.2 Rates-20/0 Tidal V-600
PEEP-5 FiO2-50 pO2-204* pCO2-25* pH-7.59* calHCO3-25 Base XS-4
-ASSIST/CON Intubat-INTUBATED

Head CT:
FINDINGS: There is a large hemorrhage originating from the right
thalamic region, with associated mass effect and contralateral
shift of normally midline structures. This hemorrhage extends
into the lateral and third ventricles, with moderate
supratentorial hydrocephalus. The fourth ventricle is of normal
size and configuration. No extra- axial hemorrhage is
identified. The [**Doctor Last Name 352**]- white matter junction appears intact.
There is a small osteoma within the left ethmoid sinus. There is
minimal mucosal thickening within the sphenoid sinus, and a
small mucous retention cyst in the right maxillary sinus.
Mastoid air cells are clear.

IMPRESSION: Large, likely hypertensive right thalamic
hemorrhage, with extension into the ventricles and associated
mass effect, shift of normally midline structures, and
hydrocephalus

Brief Hospital Course:
The pt was found to have a large right thalamic bleed on repeat
head CT upon arrival to the [**Hospital1 18**] ED.  She was admitted to the
Neuro ICU.  The etiology behind her intracranial hemorrhage was
felt to be most likely due to occult hypertension. She remained
intubated and ventilated over the course of the first hospital
night.  She briefly required pressors for hypotension.
Clinically, her condition worsened over the course of the
hospital stay.  She did not respond to stimuli and was posturing
to noxious stimuli.  A family meeting was held on the second
hospital day with the patient's next of [**Doctor First Name **] (including her
sister and two brothers).  It was decided that given her grave
prognosis, to shift the goals of care to comfort measures only.
She was extubated on the evening of the second hospital day.
She passed away shortly thereafter with her family by her side.

Medications on Admission:
None.

Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Right thalamic hemorrhage

Discharge Condition:
Deceased

Discharge Instructions:
N/A


Followup Instructions:
N/A

                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]
{'Unspecified intracranial hemorrhage,Obstructive hydrocephalus,Unspecified essential hypertension'}


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: Unresponsive.

PRESENT ILLNESS: The pt is a 78 year-old woman who was reportedly well until this
AM when she was found down and unresponsive.  Pt taken to OSH
where CT head revealed large
intracranial bleed with intraventricular extension and midline
shift.  Pt apparently able to follow some commends with RUE at
OSH prior to intubation and transfer. Repeat CT on arrival to
[**Hospital1 18**] shows no progression of bleed compared to OSH, but approx
40-50cc hemorrhage in R BG with extension throughout the
ventricular system and mild ventricular dilatation. There is no
history of antecedant illness or symptoms, including headache.

MEDICAL HISTORY: -hx of recent cataract surgery which had to be aborted due to
hemorrhage

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:    afeb  116-148/64-97
General: intubated
HEENT: Anicteric, MMM without lesions
Neck: Supple, no LAD, no carotid bruits, no thyromegaly
CV: RRR  s1s2     no m/r/g
Resp: CTAB   no r/w/r
Abd: +BS    Soft/NT/ND    no HSM/masses
Ext: No c/c/e, distal pulses intact
Skin: No rashes, petechiae

FAMILY HISTORY: No history of stroke.

SOCIAL HISTORY: The pt lives alone at home.  There is no history of tobacco,
alcohol, illicit drug use. 

### Response:
{'Unspecified intracranial hemorrhage,Obstructive hydrocephalus,Unspecified essential hypertension'}
