CHIEF COMPLAINT: 

PRESENT ILLNESS: This is an 84-year-old man with
a history of hypertension who woke up at 2:30 in the morning
on [**4-10**] confused per his wife, not giving appropriate
answers to questions. The patient went back to bed and woke
up still confused. EMS was called to bring the patient to the
emergency room.

MEDICAL HISTORY: Asthma and hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Intracerebral hemorrhage,Unspecified essential hypertension,Asthma, unspecified type, unspecified
Intracerebral hemorrhage,Hypertension NOS,Asthma NOS
Admission Date: [**2125-4-10**]        Discharge Date: [**2125-4-18**]


Service:  NSU


HISTORY OF PRESENT ILLNESS:  This is an 84-year-old man with
a history of hypertension who woke up at 2:30 in the morning
on [**4-10**] confused per his wife, not giving appropriate
answers to questions. The patient went back to bed and woke
up still confused. EMS was called to bring the patient to the
emergency room.

His wife denied any trauma. The patient's baseline is fully
functional. He recently drove back to [**State 350**] from
[**State 108**].

Head CT in the emergency room showed a large left frontal 7
cm bleed, likely to be amyloid related to history and age.

PAST MEDICAL HISTORY:  Asthma and hypertension.

LABORATORY DATA:  On admission sodium was 139, potassium 4.5,
chloride 100, CO2 29, BUN 20, creatinine 1.2, sugar 138;
hematocrit 41.5, white count 9.4, platelet count 167; INR
1.0.

PHYSICAL EXAMINATION:  Vital signs: Temperature 97.3, blood
pressure 170/69, respirations 18, oxygen saturation 92% on
room air. General: He was alert to voice stimulation.
Cardiovascular: Regular, rate, and rhythm. Lungs: Clear
bilaterally. Abdomen: Soft and nondistended. Neurologic: EOMs
full. Visual fields full to confrontation. Pupils 2.5-1.5
bilaterally. No weakness. Symmetric motor strength. Speech
was fluent. He was only alert and oriented times one. Motor
exam was 2+ in his uppers and patellas and 1+ in his
Achilles. Again strength was 5 out of 5 in both upper and
lower extremities.

HOSPITAL COURSE:  The patient was brought emergently to the
operating room where he underwent a left frontal craniotomy
for evacuation of this hematoma. Postoperatively he was awake
however intubated over night. He was moving his left upper
extremity was good strength with full movement. He was able
to raise his right upper extremity with a strong grip. His
blood pressure was in the 116-130 range. Heart rate was 58.
He was loaded with Dilantin in the emergency room and was
continued on Dilantin 100 mg t.i.d.

He was monitored in the intensive care unit. On his first
postoperative day, his blood pressure was 116-140s. He was
alert and following commands times three. He had some less
movement in his right upper extremity. He was extubated on
his first day.

His head CT showed good evacuation of the hemorrhage. He did
have some gas collection within the subdural and subgaleal
compartments.

On his postoperative day, he was extubated as previously
mentioned, and he was found to be aphasic, and alert and
oriented times two. His blood pressure was kept strictly less
than 140. He was weaned from his Nipride drip and started on
Lopressor and Norvasc, and he was evaluated by speech and
swallow and physical therapy.

On his second postoperative day, he was found to be aphasic
with problems with naming objects but alert and attentive
following commands. Pupils were equal and reactive. EOMs were
full.

He had a bed side swallow evaluation which at that time felt
for him to be too lethargic to complete the exam appropriate,
and he appeared to be aspirating thin liquids. He was started
on a diet of nectar-thick liquids and soft solids.

On his third postoperative day, he appeared much improved;
however, he was having some periods of agitation for which
neurology was consulted. They were consulted to rule out the
possibility of having seizures, which they felt he did not
have seizures but that his change in mental status was
probably secondary to the intracerebral bleed and increased
edema. They recommended possibly starting him on Decadron to
minimize the inflammation.

During his hospitalization, he was found to have some periods
of respiratory difficulties. He had had a chest x-ray which
noted to have a hazy opacity in the left mid and lower lung
zones which resolved over the following three days serially
and treating with albuterol inhalers. Most likely it was
found to be pleural fluid and atelectasis.

On [**2125-4-16**], he was transferred to the neurology step-down
unit. He appeared much more awake and following simple
commands. Speech was nonfluent; however, he was able to name
[**12-17**] objects. He had no drift. His wound was clean, dry, and
intact. He appeared much more appropriate. He was transferred
to the step-down unit for blood pressure monitoring to keep
strictly in the 140 range.

He had a repeat head CT which showed a stable appearance of
the left frontal intraparenchymal hemorrhage and left frontal
infarct. There were no new areas of hemorrhage identified
within the brain.

On [**4-17**] fiberoptic endoscopic evaluation of his swallowing
was done that showed a functional oral pharyngeal swallowing
ability of pureed food and nectar-thick liquids. They
recommended continuing a diet of pureed foods and nectar-
thick, that he should take two swallows per bit or sip and
alternate between one bite and one sip to clear residue from
his throat. He should only eat when fully seated upright. A
video swallow could be performed at rehabilitation to see is
his diet can be advanced.

He remained neurologically improved on [**4-18**], which is his
discharge date. He is awake, alert, and oriented times three.
He had a slight droop and left-sided weakness. His lungs were
clear on discharge. He had no further respiratory
difficulties; however, we do recommend to have a chest x-ray
in the next week at rehabilitation to follow-up for clearance
of his pleural fluid and atelectasis. Also they had found an
oval-shaped opacity adjacent to the left hemidiaphragm which
they felt was due to nipple shadow but also recommended
following up to rule out a pulmonary nodule.

He should continue on his Dilantin until he follows up with
Dr. [**First Name (STitle) **] and have a weekly Dilantin level checked, and he needs
aggressive and physical and occupational therapy. His Foley
remains in and may be discontinued at the rehabilitation
facility's guidance.

DISCHARGE INSTRUCTIONS:  Keep incision clean and dry until
staples are removed. They may be removed at the
rehabilitation facility on [**2125-4-20**]. He is to watch
incision for redness, drainage, bleeding, swelling, or any
fever greater than 101. He is to call Dr.[**Name (NI) 14510**] office. He
should continue with aggressive physical therapy and
occupational therapy.

FOLLOW UP:  With Dr. [**First Name (STitle) **] on [**5-11**] at 10:15 at the [**Hospital Ward Name **]
radiology for head CT and follow-up with Dr. [**First Name (STitle) **] at 11
o'clock. Again he should have a chest x-ray at the
rehabilitation facility to follow-up on the resolution of his
atelectasis and questionable opacity that was seen on
previous chest x-ray.

DISCHARGE MEDICATIONS:  Tylenol as needed, heparin 5000 units
t.i.d., Norvasc 5 mg half tablet daily, artificial tear
p.r.n., Protonix 40 mg daily, Dilantin 50 mg 2 tab p.o.
t.i.d., hydralazine 25 mg 1 tab p.o. t.i.d.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**]

Dictated By:[**Last Name (NamePattern1) 12790**]
MEDQUIST36
D:  [**2125-4-18**] 11:03:49
T:  [**2125-4-18**] 12:14:26
Job#:  [**Job Number 99645**]
{'Intracerebral hemorrhage,Unspecified essential hypertension,Asthma, unspecified type, 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: 

PRESENT ILLNESS: This is an 84-year-old man with
a history of hypertension who woke up at 2:30 in the morning
on [**4-10**] confused per his wife, not giving appropriate
answers to questions. The patient went back to bed and woke
up still confused. EMS was called to bring the patient to the
emergency room.

MEDICAL HISTORY: Asthma and hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Intracerebral hemorrhage,Unspecified essential hypertension,Asthma, unspecified type, unspecified'}
