CHIEF COMPLAINT: Worst headache of Life

PRESENT ILLNESS: 48 year old Portugese speaking female without
significant past medical history who presents to the ED today
with her husband from an outside hospital after experiencing the
worst headache of her life at 1pm this afternoon.  The head CT
from the outside hospital was consistent with subarachnoid
hemorrhage and the patient was transferred here for further
evaluation. The patient denies any weakness, numbness, visual
disturbance or hearing deficit.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
O: T:  BP: 134/69  HR: 94   R: 16  O2Sats: 98%RA
Gen: lethargic comfortable, NAD.
HEENT: Pupils:  4-3mm bilat       EOMs:intact
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: patient is lethargic, but responds readily to
questions and follows commands consistently. Oriented to person,
place, and date.
Language: Speech fluent with good comprehension and repetition
per husband who acts as an interpreter at the bedside.

FAMILY HISTORY: Mother passed from Cerebral Aneurysm

SOCIAL HISTORY: denies EOTH and tobacco
Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Acute edema of lung, unspecified,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Hyposmolality and/or hyponatremia,Aphasia,Urinary tract infection, site not specified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, unspecified,Vascular complications of other vessels,Anemia, unspecified
Subarachnoid hemorrhage,Crbl art ocl NOS w infrc,Acute lung edema NOS,Ac DVT/emb prox low ext,Hyposmolality,Aphasia,Urin tract infection NOS,Staphylococcus unspcfied,Vascular comp vessel NEC,Anemia NOS
Admission Date:  [**2147-1-15**]              Discharge Date:   [**2147-2-3**]

Date of Birth:  [**2098-5-15**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Worst headache of Life

Major Surgical or Invasive Procedure:
[**2147-1-16**]: Cerebral angiogram with coiling
[**2147-1-22**]: Cerebral angiogram
[**2147-1-23**]: Cerebral angiogram
[**2147-1-31**]: IVCF PLACEMENT


History of Present Illness:
48 year old Portugese speaking female without
significant past medical history who presents to the ED today
with her husband from an outside hospital after experiencing the
worst headache of her life at 1pm this afternoon.  The head CT
from the outside hospital was consistent with subarachnoid
hemorrhage and the patient was transferred here for further
evaluation. The patient denies any weakness, numbness, visual
disturbance or hearing deficit.


Past Medical History:
None

Social History:
denies EOTH and tobacco

Family History:
Mother passed from Cerebral Aneurysm

Physical Exam:
On admission:
O: T:  BP: 134/69  HR: 94   R: 16  O2Sats: 98%RA
Gen: lethargic comfortable, NAD.
HEENT: Pupils:  4-3mm bilat       EOMs:intact
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: patient is lethargic, but responds readily to
questions and follows commands consistently. Oriented to person,
place, and date.
Language: Speech fluent with good comprehension and repetition
per husband who acts as an interpreter at the bedside.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 4 to 3
mm bilaterally.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**5-17**] throughout. No pronator drift

Sensation: Intact to light touch bilaterally.
Toes downgoing bilaterally

On discharge
awake alert and with expressive aphasi - able to make needs
known reliably through yes no nodding. Otherwise neurologically
nonfocal


Pertinent Results:
[**2147-1-15**] Head CT:
subarachnoid blood in the left sylvian fissure and throughout
the basilar cisterns. no hydrocephalus. CTA shows a 7 x 5 mm
aneurysm projecting posteriorly in the region of the left ica
bifurcation, likely of left pComm origin. a smaller 3 mm
component projects medially. irregularity may reflect rupture.
no other aneurysms are identified.

[**2147-1-16**] Head CT:
Stable appearance to subarachnoid hemorrhage in the region of
bilateral sylvian fissures, and the basilar cistern. There is no
new hemorrhage.

[**2147-1-17**] Right Femoral Vascular Ultrasound:
No pseudoaneurysm, AV fistula or hematoma in the right groin.

[**2147-1-22**] CT/CTA:
Marked vasospasm related to the SAH, with thrombotic or embolic
etiologies, much less likely.


Brief Hospital Course:
Patient initially presented to [**Hospital3 3583**] on [**2146-1-15**] at
approximately 1pm for complaint of worst headache of her life.
Head CT from [**Hospital1 46**] was consistent with SAH and she was
transferred to [**Hospital1 18**] for further management.  Upon arriving at
[**Hospital1 **] she denied any weakness, numbness, visual disturbance or
hearing loss.  She received a Head CT in the ER here which
showed a 7mm by 5mm left posterior communicating artery aneurysm
with subarachnoid blood in the left sylvian fissure and the
basilar cistern.  She was admitted to neurosurgery and was
planned for cerebral angiography.  On [**2147-1-16**] her exam, which was
accomplished through a Portugese interpreter, was positive for
slight lethargy and nuchal rigidity but was otherwise nonfocal.
Her head CT on that day showed stable subarachnoid hemorrhage
and she subsequently underwent angiography with Dr. [**First Name (STitle) **].
During this procedure he coiled the aneurysm with good results
and she was prophylactically place on a heparin gtt overnight.
Her exam was nonfocal after the procedure. On [**2147-1-17**] she was
neurologically intact and had no deficits.  On exam of her angio
site on the right groin, a bruit was auscultated. As a result
Dr. [**Last Name (STitle) **] was consulted who recommended ultrasound to assess the
area. Her right femoral, popliteal, dorsalis pedis, and
posterior tibial pulses were all 2+. The ultrasound was
negative.

She continued to do well. She remained nonfocal on exams. On [**1-19**]
she had a fever spike and a urine analysis showed a UTI and
Levaquin was started. On [**1-21**] there was some mental status
(aphasia) changes and her blood pressure dropped required
boluses of normal saline. A CT/CTA was performed which was
suspicious for vasospasm, and she was transferred to the ICU.
Blood pressure was maintained with pressors and IV fluids. On
[**1-23**] she remained expressively aphasic but other wise well. A
repeat angiogram showed the artery to be more open and was given
a one time dosing of Verapamil. She remained aphasic on HHH
therapy. Repeat angio gram was done on [**1-27**] showing improved
vasospasm and verapimil was also administered. Patient's
expressive aphasia fluctates, on [**1-31**], CTA/P was ordered to
access status of vasospam. CTA/P was stable and patient's SBP
parameters were decreased to 120-140.

Patient was transferred to the floor, seen and evaluate by
PT/OT/ST and recommendations were made for acute rehab
placement.

Medications on Admission:
None

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for headache.
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**1-14**]
Tablets PO Q4H (every 4 hours) as needed for headache.
4. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
6. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
decreased stooling.
8. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed for thrush.
9. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
10. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
11. Ascorbic Acid 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
12. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
14. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
for 6 months.
15. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] [**Hospital 1108**] Rehab Unit at
[**Hospital6 1109**] - [**Location (un) 1110**]

Discharge Diagnosis:
left posterior communicating artery aneurysm


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent
EXPRESSIVE APHASIC / NEAR COMPLETE


Discharge Instructions:
Medications:
?????? Take Aspirin 325mg (enteric coated) once daily.
?????? Continue all other medications you were taking before surgery,
unless otherwise directed
?????? You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
?????? When you go home, you may walk and go up and down stairs.
?????? You may shower (let the soapy water run over groin incision,
rinse and pat dry)
?????? Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
?????? After 1 week, you may resume sexual activity.
?????? After 1 week, gradually increase your activities and distance
walked as you can tolerate.
?????? No driving until you are no longer taking pain medications

What to report to office:
?????? Changes in vision (loss of vision, blurring, double vision,
half vision)
?????? Slurring of speech or difficulty finding correct words to use
?????? Severe headache or worsening headache not controlled by pain
medication
?????? A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
?????? Trouble swallowing, breathing, or talking
?????? Numbness, coldness or pain in lower extremities
?????? Temperature greater than 101.5F for 24 hours
?????? New or increased drainage from incision or white, yellow or
green drainage from incisions
?????? Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room!


Followup Instructions:
You will need to follow-up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]  IN ONE MONTH
WIHT AN MRA OF THE BRAIN  AT [**Telephone/Fax (1) **]



Completed by:[**2147-2-3**]
{'Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Acute edema of lung, unspecified,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Hyposmolality and/or hyponatremia,Aphasia,Urinary tract infection, site not specified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, unspecified,Vascular complications of other vessels,Anemia, unspecified'}


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: Worst headache of Life

PRESENT ILLNESS: 48 year old Portugese speaking female without
significant past medical history who presents to the ED today
with her husband from an outside hospital after experiencing the
worst headache of her life at 1pm this afternoon.  The head CT
from the outside hospital was consistent with subarachnoid
hemorrhage and the patient was transferred here for further
evaluation. The patient denies any weakness, numbness, visual
disturbance or hearing deficit.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission:
O: T:  BP: 134/69  HR: 94   R: 16  O2Sats: 98%RA
Gen: lethargic comfortable, NAD.
HEENT: Pupils:  4-3mm bilat       EOMs:intact
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: patient is lethargic, but responds readily to
questions and follows commands consistently. Oriented to person,
place, and date.
Language: Speech fluent with good comprehension and repetition
per husband who acts as an interpreter at the bedside.

FAMILY HISTORY: Mother passed from Cerebral Aneurysm

SOCIAL HISTORY: denies EOTH and tobacco 

### Response:
{'Subarachnoid hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Acute edema of lung, unspecified,Acute venous embolism and thrombosis of deep vessels of proximal lower extremity,Hyposmolality and/or hyponatremia,Aphasia,Urinary tract infection, site not specified,Staphylococcus infection in conditions classified elsewhere and of unspecified site, staphylococcus, unspecified,Vascular complications of other vessels,Anemia, unspecified'}
