CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 77-year-old man
with a history of hypertension and type 2 diabetes with a
four-day history of progressive gait instability, nausea,
vomiting and headache which became progressively worse over
the 24 hours prior to admission with lethargy and
obtundation.  The patient was taken to [**Hospital3 **] where
head CT showed a large midline cerebellar hemorrhage with
edema and moderate compression of the fourth ventricle and a
small amount of fresh blood in the posterior horns of the
bilateral ventricles.  The patient was then transferred to
[**Hospital6 256**] for further management.

MEDICAL HISTORY: Hypertension.  History of polio with
left arm and leg weakness.  He uses a cane to ambulate but
has moderate antigravity strength of the left arm.
Hypertension.  Diabetes.  Glaucoma.

MEDICATION ON ADMISSION: Metoprolol 100 mg p.o. b.i.d.,
Cozaar 50 mg p.o. b.i.d., enteric coated Glyburide 5 mg p.o.
q.d., Lipitor 10 mg q.d., Aspirin 81 mg q.d.

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Intracerebral hemorrhage,Obstructive hydrocephalus,Compression of brain,Late effects of acute poliomyelitis,Pneumonitis due to inhalation of food or vomitus,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Unspecified pleural effusion,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled
Intracerebral hemorrhage,Obstructiv hydrocephalus,Compression of brain,Late effect acute polio,Food/vomit pneumonitis,Pneumococcal pneumonia,Pleural effusion NOS,DMII oth nt st uncntrld
Admission Date:  [**2188-2-16**]       Discharge Date:  [**2188-3-11**]

Date of Birth:   [**2110-4-5**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 77-year-old man
with a history of hypertension and type 2 diabetes with a
four-day history of progressive gait instability, nausea,
vomiting and headache which became progressively worse over
the 24 hours prior to admission with lethargy and
obtundation.  The patient was taken to [**Hospital3 **] where
head CT showed a large midline cerebellar hemorrhage with
edema and moderate compression of the fourth ventricle and a
small amount of fresh blood in the posterior horns of the
bilateral ventricles.  The patient was then transferred to
[**Hospital6 256**] for further management.

PAST MEDICAL HISTORY:  Hypertension.  History of polio with
left arm and leg weakness.  He uses a cane to ambulate but
has moderate antigravity strength of the left arm.
Hypertension.  Diabetes.  Glaucoma.

MEDICATIONS ON ADMISSION:  Metoprolol 100 mg p.o. b.i.d.,
Cozaar 50 mg p.o. b.i.d., enteric coated Glyburide 5 mg p.o.
q.d., Lipitor 10 mg q.d., Aspirin 81 mg q.d.

ALLERGIES:  NO KNOWN DRUG ALLERGIES.

IMAGING:  CT scan from the outside hospital showed a 4.5 cm
midline cerebellar hemorrhage with moderate surrounding
edema, fourth ventricle patent, blood in the posterior horns
of the bilateral ventricle.

HOSPITAL COURSE:  The patient was admitted to the Surgical
Intensive Care Unit for close monitoring and was taken
emergently to the Operating Room for decompression of the
cerebellar hemorrhage and placement of a ventricular drain.

He underwent posterior fossa craniotomy for evacuation of the
hematoma and placement of an occipital ventriculostomy drain
without intraoperative complication.  Postoperatively the
patient was monitored in the Intensive Care Unit.  He was
difficult to examine due to sedation, but he was moving both
lower extremities.

He had a repeat head CT which showed some reaccumulation of
blood in the hematoma bed in the cerebella but no need for
reevacuation, and ventricular drain was in good position.
The patient had his blood pressure controlled with Nipride,
and his ICP was within normal limits, and he was sedated.

On postoperative day #2, his pupils were 4 down to 3 mm and
brisk.  He opened his eyes to voice.  He moved his legs to
command.  Left upper extremity was antigravity.  Right upper
extremity had less movement.

The patient was extubated on [**2188-2-19**].  On [**2-20**], he
was opening his eyes spontaneously.  He was oriented times
three.  His pupils were 4 down to 3 mm and brisk.  He was
following commands and moving the right arm and leg better
then the left, which is his prehospital condition.  He was
improving neurologically.

The patient was seen by Speech and Swallow Services and found
the patient to be aspirating, requiring an NG tube for
feeding.

The patient had his vent tube weaned on [**2188-2-24**].  The
patient was less interactive, not opening his eyes.  He did
follow some commands with some pushing.  The patient had a
repeat head CT after the drain was pulled, which did show
hydrocephalus.  Therefore, a right frontal ventriculostomy
drain was placed.

On [**2188-2-27**], the patient underwent left VP shunt
placement and removal of right ventricular catheter without
intraoperative complications.  The patient postoperatively
showed pupils to be 5 down to 4 mm and brisk.  He was awake,
attentive, moving upper extremities with antigravity strength
and moving the lower extremities bilaterally.  He was not
following commands.  His dressing was clean, dry, and intact.
The patient was weaned to extubate on [**2188-2-28**].

On [**2188-2-29**], the patient was following commands,
localizing with the upper extremities bilaterally.  His
pupils were symmetric and reactive.  He had Doppler studies
which were negative for DVT.  He was seen by Physical Therapy
and Occupational Therapy and will require a rehabilitation
stay prior to discharge to home.

On [**2188-3-2**], the patient had an episode of spontaneous
hypotension.  He was seen by the Cardiology Service and rule
out for myocardial infarction.  He had an echocardiogram but
did not require any further intervention from the Cardiology
Team.  His cardiac medications were reconfigured, and he had
no further problems with cardiac issues.

He had several attempts for repeat swallow exam but was too
sleepy to tolerate the test.  Therefore, it was decided that
a PEG would be placed, and he would be transferred to
rehabilitation.

The patient also had an episode of hypoglycemia requiring
return to the Intensive Care Unit and intubation.  He was
extubated the following day and transferred back to the
regular floor on [**2188-3-9**], in stable condition.  [**Last Name (un) **]
was consulted, the patient's Insulin regimen was adjusted.

The patient's condition has improved since that episode.  He
is awake, alert, following commands, moving all extremities,
but still requiring maximum assistance out of bed.

DISCHARGE MEDICATIONS:  ................ 90 mg p.o. q.i.d.,
hold for heart rate less than 60, systolic blood pressure
less than 110, Lasix 20 mg p.o. q.d., Digoxin 0.125 mg p.o.
q.d., Clonidine 0.3 mg p.o. t.i.d., hold for systolic blood
pressure less than 110, Labetalol 300 mg p.o. t.i.d., hold
for systolic blood pressure less than 120 and heart rate less
than 60, Zantac 150 mg p.o. b.i.d., Losartan 50 mg p.o.
b.i.d., Timolol 0.5% 1 drop O.U. b.i.d., Albuterol nebs 1 neb
q.6 hours p.r.n., Insulin per sliding scale, NPH.

CONDITION ON DISCHARGE:  Stable at the time of discharge.

FOLLOW-UP:  He will require follow-up head CT and follow-up
with Dr. [**First Name (STitle) **] in one month.




                     DR.[**Last Name (STitle) **],[**First Name3 (LF) 900**] 14-119

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2188-3-10**]  10:34
T:  [**2188-3-10**]  10:33
JOB#:  [**Job Number 49440**]


Admission Date:  [**2161-2-2**]       Discharge Date:  [**2188-3-14**]

Date of Birth:                    Sex:  M

Service:

ADDENDUM:  The patient's discharge was delayed until
[**2188-3-14**] due to lack of rehab beds.  His vital signs were
stable.  He was afebrile.  His neurological status is
improving.  He was awake, alert and following commands,
verbalizing, but at times confused.  His laboratories on
[**2188-3-13**] were sodium 140, K 4.2, chloride 105, CO2 27, BUN
23, creatinine .6, glucose 114.  He was stable with stable
vital signs at the time of discharge following up with Dr. [**First Name (STitle) **]
in one month with repeat head CT.






                            [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D.  [**MD Number(1) 343**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2188-3-14**]  09:41
T:  [**2188-3-14**]  10:28
JOB#:  [**Job Number 49441**]
{'Intracerebral hemorrhage,Obstructive hydrocephalus,Compression of brain,Late effects of acute poliomyelitis,Pneumonitis due to inhalation of food or vomitus,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Unspecified pleural effusion,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled'}


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: 

PRESENT ILLNESS: The patient is a 77-year-old man
with a history of hypertension and type 2 diabetes with a
four-day history of progressive gait instability, nausea,
vomiting and headache which became progressively worse over
the 24 hours prior to admission with lethargy and
obtundation.  The patient was taken to [**Hospital3 **] where
head CT showed a large midline cerebellar hemorrhage with
edema and moderate compression of the fourth ventricle and a
small amount of fresh blood in the posterior horns of the
bilateral ventricles.  The patient was then transferred to
[**Hospital6 256**] for further management.

MEDICAL HISTORY: Hypertension.  History of polio with
left arm and leg weakness.  He uses a cane to ambulate but
has moderate antigravity strength of the left arm.
Hypertension.  Diabetes.  Glaucoma.

MEDICATION ON ADMISSION: Metoprolol 100 mg p.o. b.i.d.,
Cozaar 50 mg p.o. b.i.d., enteric coated Glyburide 5 mg p.o.
q.d., Lipitor 10 mg q.d., Aspirin 81 mg q.d.

ALLERGIES: NO KNOWN DRUG ALLERGIES.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Intracerebral hemorrhage,Obstructive hydrocephalus,Compression of brain,Late effects of acute poliomyelitis,Pneumonitis due to inhalation of food or vomitus,Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia],Unspecified pleural effusion,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled'}
