CHIEF COMPLAINT: balance difficulty and confusion

PRESENT ILLNESS: This is a 70 yr old gentlman who has flown in from [**Male First Name (un) 36290**] this afternoon and was directly transported to [**Hospital1 18**] for
assessment of progressive LE weakness.  The patient was last
seen
by his daughter in [**Month (only) 359**] who has found him bedridden, weak,
and
incontinent of urine.  This is a change from [**2124-1-29**].  It is
not known when the progression of weakness occurred.  The
patient
has a prior EtOH abuse history; his last drink was 5 months ago.

MEDICAL HISTORY: EtOH abuse, ? gastric ulcer

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam upon admission:
T: 97.8 BP: 189/84    HR: 106    R 18      O2Sats ?82 %RA
Gen: WD/WN, NAD. Spanish-speaking.
HEENT: Pupils:  6mm, non-reactive   EOMIs
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.  Initially the patient was somnolent, yet easily
arousable. After his daughter arrived, he was more
conversational, awake, and alert.
Orientation: Oriented to person, place, only.
Language: Spanish-speaking.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives in [**Male First Name (un) 1056**], has 6 children, prior EtOH
abuse, 1ppd tobacco, no drugs
Obstructive hydrocephalus,Intracerebral hemorrhage,Iatrogenic cerebrovascular infarction or hemorrhage,Hemiplegia, unspecified, affecting unspecified side,Urinary tract infection, site not specified,Swelling, mass, or lump in head and neck,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Cirrhosis of liver without mention of alcohol,Tobacco use disorder,Pressure ulcer, lower back
Obstructiv hydrocephalus,Intracerebral hemorrhage,Iatrogen CV infarc/hmrhg,Unsp hemiplga unspf side,Urin tract infection NOS,Swelling in head & neck,Abn react-surg proc NEC,Cirrhosis of liver NOS,Tobacco use disorder,Pressure ulcer, low back
Admission Date:  [**2124-11-3**]              Discharge Date:   [**2124-11-8**]

Date of Birth:  [**2054-4-1**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
balance difficulty and confusion

Major Surgical or Invasive Procedure:
3rd ventriculostomy


History of Present Illness:
This is a 70 yr old gentlman who has flown in from [**Male First Name (un) 36290**] this afternoon and was directly transported to [**Hospital1 18**] for
assessment of progressive LE weakness.  The patient was last
seen
by his daughter in [**Month (only) 359**] who has found him bedridden, weak,
and
incontinent of urine.  This is a change from [**2124-1-29**].  It is
not known when the progression of weakness occurred.  The
patient
has a prior EtOH abuse history; his last drink was 5 months ago.

CT head in the ED was consistent with massive hydrocephalus.


Past Medical History:
EtOH abuse, ? gastric ulcer

Social History:
lives in [**Male First Name (un) 1056**], has 6 children, prior EtOH
abuse, 1ppd tobacco, no drugs


Family History:
non-contributory

Physical Exam:
Exam upon admission:
T: 97.8 BP: 189/84    HR: 106    R 18      O2Sats ?82 %RA
Gen: WD/WN, NAD. Spanish-speaking.
HEENT: Pupils:  6mm, non-reactive   EOMIs
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.  Initially the patient was somnolent, yet easily
arousable. After his daughter arrived, he was more
conversational, awake, and alert.
Orientation: Oriented to person, place, only.
Language: Spanish-speaking.

Cranial Nerves:
I: Not tested
II: Pupils 6mm non-reactive; 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: Cachexic. No abnormal movements, tremors. Strength full
power 4+/5 UE, [**3-4**] LE.


Pertinent Results:
[**2124-11-2**] 07:45PM BLOOD WBC-10.8 RBC-4.16* Hgb-13.9* Hct-40.1
MCV-96 MCH-33.5* MCHC-34.7 RDW-13.8 Plt Ct-141*
[**2124-11-2**] 07:45PM BLOOD Glucose-207* UreaN-20 Creat-1.0 Na-139
K-3.9 Cl-103 HCO3-26 AnGap-14
[**2124-11-3**] 02:36AM BLOOD Albumin-3.2* Calcium-8.7 Phos-2.6* Mg-2.0
Iron-32*
[**2124-11-3**] 02:36AM BLOOD PT-14.5* PTT-26.9 INR(PT)-1.3*

[**2124-11-6**] 02:51AM BLOOD WBC-9.9 RBC-4.18* Hgb-14.0 Hct-38.7*
MCV-93 MCH-33.4* MCHC-36.1* RDW-14.1 Plt Ct-134*
[**2124-11-6**] 02:51AM BLOOD PT-13.9* PTT-27.2 INR(PT)-1.2*
[**2124-11-6**] 02:51AM BLOOD Glucose-138* UreaN-17 Creat-0.7 Na-139
K-3.6 Cl-105 HCO3-24 AnGap-14
[**2124-11-6**] 02:51AM BLOOD Calcium-8.6 Phos-2.5* Mg-2.2

[**11-2**] Head CT: Acute severe noncommunicating hydrocephalus caused
by at least two posterior fossa masses causing edema and mass
effect on the fourth ventricle.

[**11-4**] Head CT: Status post ventriculostomy. Interval development
of hemorrhage along the right basal ganglia extending into the
mid brain. Hyperdense tract through the right frontal lobe,
likely related to prior ventriculostomy catheter placement.
Small amount of intraventricular hemorrhage. Persistent
hydrocephalus and tonsillar herniation. Multiple masses within
the posterior fossa.

[**11-5**] Head CT:
Marked increase in size of large right parenchymal hemorrhage,
which
extends into the thalamus, midbrain and pons. Marked increase in

intraventricular hemorrhage. New subarachnoid hemorrhage,
predominantly in
the basal cisterns. Increased hemorrhage along the right frontal

ventriculostomy track.

2. New compression of the third ventricle with enlargement of
the temporal
horns of the lateral ventricles, indicative of trapping.
Persistent
transependymal CSF flow.

3. Increased intracranial pressure with new right uncal
herniation, increased sulcal effacement, increased effacement of
the frontal [**Doctor Last Name 534**] of the right lateral ventricle, and new
leftward shift of the septum pellucidum.

4. Cerebellar masses with compression of the fourth ventricle
again noted.

[**11-4**] Chest/Abd/Pelvis CT:
Concentric thickening of the colon in the region of the cecum.
Direct
visualization is recommended with colonoscopy to exclude colon
carcinoma.

2. Severe emphysematous changes within the lungs with two
suspicious soft
tissue lesions within the left upper lobe. While these foci may
represent scarring, further evaluation recommended with CT PET
imaging to
evaluate for metabolic activity in these foci which may exclude
possiblity of carcinoma.

3. Moderate secretions within the distal trachea. Please
correlate with
recent intubation/extubation.

4. Minimal ascitic fluid surrounding the liver and gallbladder.

5. Cirrhosis witihout secondary evidence of decompensated liver
disease
aside from small amount of paragastric varices.



Brief Hospital Course:
The patient was admitted to the ICU for Q 1 hour neuro checks.
On [**11-3**] He was taken to the operating room several hours later
for a 3rd ventriculostomy because he had a cerebllar mass that
was compressing the 4th venticle. He went to the PACU post-op
and was oriented x1, MAE. With MRI showing large cerebellar mass
s/p 3rd ventriculostomy.  On [**11-4**] he had a Head CT due to right
mydriasis and
left hemiparesis which showed hemorrhage along the right basal
ganglia extending into the mid brain. He also had CT torso
showing multiple mets throughout and continued to have decline
in MS. A family meeting was conducted on [**11-6**] and the decision
was made to make pt [**Name (NI) 3225**] due to pt condition and prognosis. On
[**11-8**] at 12:45p the pt was pronounced by palliative care.

Medications on Admission:
none

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
cerebellar mass
obstructive hydrocephalus
right basal ganglia hemorrhage extending into the mid brain
R uncal herniation

Discharge Condition:
Deceased


Completed by:[**2124-11-8**]
{'Obstructive hydrocephalus,Intracerebral hemorrhage,Iatrogenic cerebrovascular infarction or hemorrhage,Hemiplegia, unspecified, affecting unspecified side,Urinary tract infection, site not specified,Swelling, mass, or lump in head and neck,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Cirrhosis of liver without mention of alcohol,Tobacco use disorder,Pressure ulcer, lower back'}


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: balance difficulty and confusion

PRESENT ILLNESS: This is a 70 yr old gentlman who has flown in from [**Male First Name (un) 36290**] this afternoon and was directly transported to [**Hospital1 18**] for
assessment of progressive LE weakness.  The patient was last
seen
by his daughter in [**Month (only) 359**] who has found him bedridden, weak,
and
incontinent of urine.  This is a change from [**2124-1-29**].  It is
not known when the progression of weakness occurred.  The
patient
has a prior EtOH abuse history; his last drink was 5 months ago.

MEDICAL HISTORY: EtOH abuse, ? gastric ulcer

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam upon admission:
T: 97.8 BP: 189/84    HR: 106    R 18      O2Sats ?82 %RA
Gen: WD/WN, NAD. Spanish-speaking.
HEENT: Pupils:  6mm, non-reactive   EOMIs
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.  Initially the patient was somnolent, yet easily
arousable. After his daughter arrived, he was more
conversational, awake, and alert.
Orientation: Oriented to person, place, only.
Language: Spanish-speaking.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives in [**Male First Name (un) 1056**], has 6 children, prior EtOH
abuse, 1ppd tobacco, no drugs 

### Response:
{'Obstructive hydrocephalus,Intracerebral hemorrhage,Iatrogenic cerebrovascular infarction or hemorrhage,Hemiplegia, unspecified, affecting unspecified side,Urinary tract infection, site not specified,Swelling, mass, or lump in head and neck,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Cirrhosis of liver without mention of alcohol,Tobacco use disorder,Pressure ulcer, lower back'}
