CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 73 yo F with DM, neuropathy, HTN presented to an OSH on [**7-7**]
with 5 days of headache, denied any trauma to head. OSH CT noted
to have bilateral chronic subdural hematomas with mild midline
shift so patient was transferred to [**Hospital1 **]. In the ER given
dilaudid and labetelol for high BP, and she was initially
admitted to neurosurgery. On the floor, she had an episode of
bradycardia to 30 and a brief low BP. She was seen by neurosurg
and was thought to have this from high vagal tone in setting of
vomiting. Repeat head CT did not show acute change.
.
Patient was transferred to medicine for further work up. At time
of transfer she did not have any complaints. Denies
ha/nausea/f/chills. No change in bowel habbits. States "feels
like how she was at home". Per her family, she is considerably
more confused and disoriented than three months ago.  Of note
recently, she had a PICC placed for cellulitis treatment and
during the Heparin flushes her daughter reported that her head
felt funny. Around this time, it was noticed that her thinking
became less clear.
.

MEDICAL HISTORY: 1.DMII-insulin dependent
2.Osteoporosis
3.chronic low back pain
4.R sciatica pain

MEDICATION ON ADMISSION: unknown

ALLERGIES: Penicillins / Aleve / Ibuprofen / Valium / Codeine / Morphine /
Oxycodone Hcl/Acetaminophen / Darvocet-N 100 / Vicodin /
Levaquin / Rocephin / Cipro

PHYSICAL EXAM: VSS T 98.5 HR 91 BP 130/48 RR 16 O2 100% 3L
General Lying in bed, oriented to person and time, place
"hospital....[**Hospital1 1872**]?" Slightly confused, when answering
questions will often start talking about her blood sugars, but
easily redirectable
HEENT PERRL, EOMI, CNII-XII intact grossly, MMM, no lesions in
her oropharynx, anicteric sclera
Neck: Supple, no lymphadenopathy, no carotid bruits, JVP 8-10 cm

FAMILY HISTORY: Mother and sister both had intracranial aneurysms

SOCIAL HISTORY: Lives with daughter and husband in [**Name (NI) 1475**]
Subdural hemorrhage,Drug-induced delirium,Dehydration,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Osteoporosis, unspecified,Other specified cardiac dysrhythmias,Other opiates and related narcotics causing adverse effects in therapeutic use,Sciatica
Subdural hemorrhage,Drug-induced delirium,Dehydration,DMII neuro nt st uncntrl,Neuropathy in diabetes,Hypertension NOS,Osteoporosis NOS,Cardiac dysrhythmias NEC,Adv eff opiates,Sciatica
Admission Date:  [**2134-7-7**]              Discharge Date:   [**2134-7-13**]

Date of Birth:  [**2061-4-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins / Aleve / Ibuprofen / Valium / Codeine / Morphine /
Oxycodone Hcl/Acetaminophen / Darvocet-N 100 / Vicodin /
Levaquin / Rocephin / Cipro

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
R frontal and parietal burr hole drainage of SDH

History of Present Illness:
73 yo F with DM, neuropathy, HTN presented to an OSH on [**7-7**]
with 5 days of headache, denied any trauma to head. OSH CT noted
to have bilateral chronic subdural hematomas with mild midline
shift so patient was transferred to [**Hospital1 **]. In the ER given
dilaudid and labetelol for high BP, and she was initially
admitted to neurosurgery. On the floor, she had an episode of
bradycardia to 30 and a brief low BP. She was seen by neurosurg
and was thought to have this from high vagal tone in setting of
vomiting. Repeat head CT did not show acute change.
.
Patient was transferred to medicine for further work up. At time
of transfer she did not have any complaints. Denies
ha/nausea/f/chills. No change in bowel habbits. States "feels
like how she was at home". Per her family, she is considerably
more confused and disoriented than three months ago.  Of note
recently, she had a PICC placed for cellulitis treatment and
during the Heparin flushes her daughter reported that her head
felt funny. Around this time, it was noticed that her thinking
became less clear.
.



Past Medical History:
1.DMII-insulin dependent
2.Osteoporosis
3.chronic low back pain
4.R sciatica pain


Social History:
Lives with daughter and husband in [**Name (NI) 1475**]

Family History:
Mother and sister both had intracranial aneurysms

Physical Exam:
VSS T 98.5 HR 91 BP 130/48 RR 16 O2 100% 3L
General Lying in bed, oriented to person and time, place
"hospital....[**Hospital1 1872**]?" Slightly confused, when answering
questions will often start talking about her blood sugars, but
easily redirectable
HEENT PERRL, EOMI, CNII-XII intact grossly, MMM, no lesions in
her oropharynx, anicteric sclera
Neck: Supple, no lymphadenopathy, no carotid bruits, JVP 8-10 cm

Card: RRR S1 and S2 no m/r/g
Pulm: CTAB
Abd: obese, +BS, soft, non-tender, non-distended
Ext: 1+ bilateral ankle edema going 1/2 up her shins, 2+ DP
pulses bilaterally
Skin: no rashes or lesions noted. pressure ulcer
Neurologic:
-motor: normal bulk, strength and tone throughout. -sensory: No
deficits to light touch throughout.
-cerebellar: No nystagmus, dysarthria, intention or action
tremor, dysdiadochokinesia noted. FNF and HKS WNL bilaterally.
-DTRs: 2+ biceps, triceps, brachioradialis, patellar and 1+
ankle jerks bilaterally. Plantar response was flexor
bilaterally.


Pertinent Results:
[**2134-7-7**] 08:13PM   WBC-8.4 RBC-4.31 HGB-13.5 HCT-38.7 MCV-90
MCH-31.3 MCHC-35.0 RDW-13.6
[**2134-7-7**] 08:13PM   ASA-NEG ETHANOL-NEG ACETMNPHN-10.0
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2134-7-7**] 08:13PM   PHENYTOIN-<0.6*
[**2134-7-7**] 08:13PM   CK-MB-4 cTropnT-<0.01
[**2134-7-7**] 08:13PM   CK(CPK)-164*
[**2134-7-7**] 08:13PM   GLUCOSE-131* UREA N-19 CREAT-1.0 SODIUM-137
POTASSIUM-5.6* CHLORIDE-104 TOTAL CO2-24 ANION GAP-15
[**2134-7-7**] 08:13PM   PT-10.7 PTT-23.6 INR(PT)-0.9
.
Head CT
[**2134-7-7**] Bilateral chronic subdural hematomas, right greater than
left. Associated leftward midline shift of 6 mm max. A tiny
focus of high-density material on the right indicates a small
acute component. No evidence of transtentorial herniation
.
[**2134-7-10**] Bilateral subdural hematomas, right greater than left
side, with subfalcine herniation to the left and signs of early
central herniation. Small area of slow diffusion in the
distribution of left anterior cerebral artery, which could
indicate acute infarct related to subfalcine herniation.
.
EKG
Sinus rhythm. Left atrial enlargement. Right bundle-branch
block. No
previous tracing available for comparison.

Brief Hospital Course:
Mrs. [**Known lastname 1458**] is a 73 year old female who presented to an OSH on [**7-7**]
with a 5 day history of atraumatic headache.  At the OSH, her
head CT showed bilateral chronic subdural hematomas with mild
midline shift so she was transferred to [**Hospital1 18**] on [**7-7**] for
further evaluation and care.  In the [**Hospital1 18**] ER she was given
dilaudid and labetelol for high BP, and she was initially
admitted to neurosurgery.  On the neurosurgery floor, she had an
episode of bradycardia and hypotension that coincided with bouts
of vomiting.  These findings were thought to have resulted from
high vagal tone, and a repeat head CT did not show any acute
changes.

The patient was then transferred to geriatric medicine for
further work up of her hypotension and bradycardia.  At the time
of transfer she did not have any complaints.  She denies
ha/nausea/f/chills, reports no change in bowel habbits, and
states she "feels like how she was at home".  Per her family,
she is considerably more confused and disoriented than three
months ago.  Of note recently, she had a PICC placed for
cellulitis treatment and during the Heparin flushes her daughter
reported that her head felt funny.  Around this time, it was
noticed that her thinking became less clear.  The neurosurgery
team continued to follow her and monitor her clinical course
daily.

On [**7-10**] she was admitted to the medical ICU for further
monitoring of her SDH.  Upon further evaluation, her course was
suggestive of a worsening SDH with symptoms from herniation.  As
a result, she underwent emergent R frontal and parietal burr
hole SDH evacuation on [**7-10**].  She tolerated this procedure well
and was monitored overnight in the surgical ICU.  On POD#1 she
was transferred to the floor.  Her diet and activity were
advanced, and her surgical incision remained clean and dry.  She
was seen by PT and OT and recommended for discharge home with
physical therapy.  She is being discharged today in stable
condition, tolerating a regular diet, with prescriptions
written.

Medications on Admission:
unknown

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO DAILY (Daily).
4. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
Disp:*120 Capsule(s)* Refills:*2*
6. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection four times a day: please take your insulin sliding
scale as previously prescribed.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Subdural hematoma
Diabetes Mellitus Type II
Osteoporosis


Discharge Condition:
Stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY
??????	Have a family member check your incision daily for signs of
infection
??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	You may wash your hair today
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
Please return to the office in 7 days to have your staples
removed.  Call [**Telephone/Fax (1) **] to schedule an appointment.

You will then need to be seen in 4 weeks by Dr. [**Last Name (STitle) 548**] at
[**Telephone/Fax (1) **] with a CT scan of the brain.
{'Subdural hemorrhage,Drug-induced delirium,Dehydration,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Osteoporosis, unspecified,Other specified cardiac dysrhythmias,Other opiates and related narcotics causing adverse effects in therapeutic use,Sciatica'}


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: Headache

PRESENT ILLNESS: 73 yo F with DM, neuropathy, HTN presented to an OSH on [**7-7**]
with 5 days of headache, denied any trauma to head. OSH CT noted
to have bilateral chronic subdural hematomas with mild midline
shift so patient was transferred to [**Hospital1 **]. In the ER given
dilaudid and labetelol for high BP, and she was initially
admitted to neurosurgery. On the floor, she had an episode of
bradycardia to 30 and a brief low BP. She was seen by neurosurg
and was thought to have this from high vagal tone in setting of
vomiting. Repeat head CT did not show acute change.
.
Patient was transferred to medicine for further work up. At time
of transfer she did not have any complaints. Denies
ha/nausea/f/chills. No change in bowel habbits. States "feels
like how she was at home". Per her family, she is considerably
more confused and disoriented than three months ago.  Of note
recently, she had a PICC placed for cellulitis treatment and
during the Heparin flushes her daughter reported that her head
felt funny. Around this time, it was noticed that her thinking
became less clear.
.

MEDICAL HISTORY: 1.DMII-insulin dependent
2.Osteoporosis
3.chronic low back pain
4.R sciatica pain

MEDICATION ON ADMISSION: unknown

ALLERGIES: Penicillins / Aleve / Ibuprofen / Valium / Codeine / Morphine /
Oxycodone Hcl/Acetaminophen / Darvocet-N 100 / Vicodin /
Levaquin / Rocephin / Cipro

PHYSICAL EXAM: VSS T 98.5 HR 91 BP 130/48 RR 16 O2 100% 3L
General Lying in bed, oriented to person and time, place
"hospital....[**Hospital1 1872**]?" Slightly confused, when answering
questions will often start talking about her blood sugars, but
easily redirectable
HEENT PERRL, EOMI, CNII-XII intact grossly, MMM, no lesions in
her oropharynx, anicteric sclera
Neck: Supple, no lymphadenopathy, no carotid bruits, JVP 8-10 cm

FAMILY HISTORY: Mother and sister both had intracranial aneurysms

SOCIAL HISTORY: Lives with daughter and husband in [**Name (NI) 1475**] 

### Response:
{'Subdural hemorrhage,Drug-induced delirium,Dehydration,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Unspecified essential hypertension,Osteoporosis, unspecified,Other specified cardiac dysrhythmias,Other opiates and related narcotics causing adverse effects in therapeutic use,Sciatica'}
