CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 64 year old
woman, well known to the neurosurgery service.  She was
admitted originally on [**2195-11-22**] with a subarachnoid hemorrhage
and underwent a left MCA aneurysm clipping.  She then
required a left sided craniectomy for mass effect on
[**2195-12-9**].  She had percutaneous endoscopic gastrostomy and
tracheostomy placed on [**2195-12-16**].  She did not tolerate
ventricular drain wean and had a ventriculoperitoneal shunt
placed on [**1-5**] and bone flap replacement on [**2195-12-29**].

MEDICAL HISTORY: 1.  Hypertension.
2.  Type II diabetes.
3.  Congestive heart failure.
4.  Anemia.
5.  Respiratory failure.
6.  Status post percutaneous endoscopic gastrostomy.
7.  Status post tracheostomy.
8.  Left MCA aneurysm clipping.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Infection and inflammatory reaction due to nervous system device, implant, and graft,Obstructive hydrocephalus,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Candidiasis of other urogenital sites,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side
React-nerv sys dev/graft,Obstructiv hydrocephalus,CHF NOS,Urin tract infection NOS,Candidias urogenital NEC,Anemia NOS,DMII wo cmp nt st uncntr,Hypertension NOS,Late ef-hemplga side NOS
Admission Date:  [**2196-2-11**]       Discharge Date:  [**2196-3-1**]

Date of Birth:                    Sex:

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  The patient is a 64 year old
woman, well known to the neurosurgery service.  She was
admitted originally on [**2195-11-22**] with a subarachnoid hemorrhage
and underwent a left MCA aneurysm clipping.  She then
required a left sided craniectomy for mass effect on
[**2195-12-9**].  She had percutaneous endoscopic gastrostomy and
tracheostomy placed on [**2195-12-16**].  She did not tolerate
ventricular drain wean and had a ventriculoperitoneal shunt
placed on [**1-5**] and bone flap replacement on [**2195-12-29**].

On discharge, she was awake and alert, moving the left side
to command and wiggling her toes to command. The right side
was plegic.  She was unable to speak or attempt to mouth
words and she was discharged on [**2196-1-15**].  She returns on the
29th with fever of 104.5 and foaming at the mouth.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Type II diabetes.
3.  Congestive heart failure.
4.  Anemia.
5.  Respiratory failure.
6.  Status post percutaneous endoscopic gastrostomy.
7.  Status post tracheostomy.
8.  Left MCA aneurysm clipping.

ALLERGIES: No known drug allergies.

PHYSICAL EXAMINATION:  On physical examination, temperature
was 102.5; pulse 100; blood pressure 128/72; respiratory rate
of 23; saturating 100%.  HEAD, EYES, EARS, NOSE AND THROAT:
Pupils are equal, round, and reactive to light and
accommodation.  Neck was supple.  Lungs clear to
auscultation.  Cardiac regular rate and rhythm.  Abdomen
soft, nontender, positive bowel sounds.  Extremities:  No
edema.  Neurologic:  Awake, eyes open. Does not follow
commands.  Pupils 3 mm and trace reactive.  Withdraw slightly
on the left arm to pain. Does not withdraw feet and right
arm. Toes are downgoing.

HOSPITAL COURSE:  The patient was admitted for the floor and
Infectious disease was consulted.  Cerebrospinal fluid was
obtained from the ventriculoperitoneal shunt and sent for
culture.  The patient had her ventriculoperitoneal shunt
externalized at the bedside.  Infectious disease was
consulted and the patient was started on Vancomycin and
Ceftriaxone and Ceftazidime to cover pseudomonas.  She grew
out gram positive cocci from her cerebrospinal fluid.  The
patient also had a urinary tract infection with yeast and
gram negative rods.  She was treated with Fluconazole and
Ceftazidime, in addition to positive cerebrospinal fluid
cultures on [**2196-2-15**], the patient continued to have positive
cerebrospinal fluid cultures with gram positive cocci.  She
continued to be treated with Vancomycin.

On [**2195-12-18**], the patient had her ventriculoperitoneal shunt
removed in the operating room and a ventricular drain was
placed.  The patient had a repeat head CT on [**2196-12-21**] which
just showed decrease in her hydrocephalus.  On [**2196-2-20**], the
cerebrospinal fluid had no PMN's and no organisms.  The last
positive culture was from [**2-18**] which was coagulase negative
staph.  The patient remained neurologically 8unchanged with
negative cerebrospinal fluid cultures started on [**2196-2-20**] and
the patient was taken to the operating room on [**2196-12-26**] for
new ventriculoperitoneal shunt placement.  There were no
intraoperative complications and postoperatively, the patient
was at her neurologic baseline, opening her eyes, moving the
left side spontaneously and the left upper extremity,
occasionally wiggling her toes to commands on the left.
Right side hemiparesis.

She continued on Vancomycin for a total of two weeks from
when the drain was removed, when the ventriculoperitoneal
shunt was removed.  [**Last Name (un) **] as seen by physical therapy and
occupational therapy and found to be stable for return to
acute rehabilitation.  Her vital signs have been stable and
she was been afebrile since new ventriculoperitoneal shunt
placement.

MEDICATIONS ON DISCHARGE:
1.  Vancomycin 1500 mg intravenous q. eight hours.
2.  Insulin sliding scale, 6 doses as well as sliding scale.
3.  Dilantin 100 mg per percutaneous endoscopic gastrostomy
q. a.m., 200 mg q. 2 p.m. and 10 p.m.
4.  Captopril 50 mg per percutaneous endoscopic gastrostomy
three times a day.
5.  Nystatin oral solution.
6.  Metoprolol 150 mg per nasogastric or percutaneous
endoscopic gastrostomy three times a day.
7.  Lansoprazole 30 mg per nasogastric q. day.
8.  Glyburide 10 mg p.o. twice a day.
9.  Heparin 5000 units subcutaneous q. 12 hours.
10.  Colace 100 mg per percutaneous endoscopic gastrostomy
twice a day.
11.  Senna two tablets per nasogastric twice a day.
12.  Hydralazine 50 mg per percutaneous endoscopic
gastrostomy q. six hours.
The patient's condition was stable at the time of discahrge.
She will follow-up with Dr. [**Last Name (STitle) 1132**] in one month with a repeat
head CT.  Staples should be removed on postoperative day
number 14.  The patient's condition was stable.




                 DR [**Last Name (STitle) **] [**Name (STitle) **] 14.133


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

D:  [**2196-2-29**]  01:23
T:  [**2196-2-29**]  13:46
JOB#:  [**Job Number 100028**]


Name:  [**Known lastname 11160**], [**Known firstname 16051**] A                   Unit No:  [**Numeric Identifier 16052**]

Admission Date: [**2196-3-1**]      Discharge Date: [**2196-3-4**]


Date of Birth:   [**2131-6-28**]     Sex:  F

Service: Neurosurgery

Patient's discharge summary was dictated for discharge on
[**2196-3-1**].  Discharge was delayed until [**2196-3-4**] due to
lack of rehab bed.  Patient also had question of a right
upper extremity DVT.  Had an ultrasound, which showed no
evidence of thrombus.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  She was discharged to rehab on [**2196-3-4**]
in stable condition with followup with Dr. [**Last Name (STitle) 365**] in one
month.



                       DR.[**Last Name (STitle) **],[**First Name3 (LF) **] 14-133

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2196-5-23**]  12:22
T:  [**2196-5-23**]  12:27
JOB#:  [**Job Number 16055**]
{'Infection and inflammatory reaction due to nervous system device, implant, and graft,Obstructive hydrocephalus,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Candidiasis of other urogenital sites,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}


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 64 year old
woman, well known to the neurosurgery service.  She was
admitted originally on [**2195-11-22**] with a subarachnoid hemorrhage
and underwent a left MCA aneurysm clipping.  She then
required a left sided craniectomy for mass effect on
[**2195-12-9**].  She had percutaneous endoscopic gastrostomy and
tracheostomy placed on [**2195-12-16**].  She did not tolerate
ventricular drain wean and had a ventriculoperitoneal shunt
placed on [**1-5**] and bone flap replacement on [**2195-12-29**].

MEDICAL HISTORY: 1.  Hypertension.
2.  Type II diabetes.
3.  Congestive heart failure.
4.  Anemia.
5.  Respiratory failure.
6.  Status post percutaneous endoscopic gastrostomy.
7.  Status post tracheostomy.
8.  Left MCA aneurysm clipping.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Infection and inflammatory reaction due to nervous system device, implant, and graft,Obstructive hydrocephalus,Congestive heart failure, unspecified,Urinary tract infection, site not specified,Candidiasis of other urogenital sites,Anemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}
