CHIEF COMPLAINT: Headache/ SAH

PRESENT ILLNESS: Patient is a 62 year old female who has had a week of
headaches focusing on the right side primarily behind the eye
and
ear, as well as in her neck. She presented to an outside
hospital
for evaluation and head CT was done which showed subarachnoid
hemorrhage in the sylvian fissure on the right side. As a result
of these finding she was transferred to [**Hospital1 18**] for further
evaluation. upon arrival neurosurgery was consulted and given
her
imaging we recommended a CTA of the head and neck to better
evaluate her vessels. She c/o headache which has remained
constant in intensity, she denies dizziness, photophobia,
nausea,
vomiting, changes in vision , hearing, or speech, she has no
signs of meningismus.

MEDICAL HISTORY: HLD, migraines, choly, tonsilectomy

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Simvastatin 20 mg PO DAILY
2. Escitalopram Oxalate 20 mg PO DAILY
3. Aspirin 81 mg PO DAILY

ALLERGIES: Penicillins / Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: On the day of admission: [**2112-6-27**] PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]:  1        [**Doctor Last Name **]: 2          GCS  15
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: mother laryngeal cancer and CAD, father lung cancer

SOCIAL HISTORY: director of counseling at [**University/College **], smokes 15
cigarettes a day, social ETOH
Subarachnoid hemorrhage,Candidiasis of mouth,Unspecified transient cerebral ischemia,Tobacco use disorder,Other and unspecified hyperlipidemia,Aneurysm of artery of neck
Subarachnoid hemorrhage,Thrush,Trans cereb ischemia NOS,Tobacco use disorder,Hyperlipidemia NEC/NOS,Aneurysm of neck
Admission Date:  [**2112-6-27**]              Discharge Date:   [**2112-7-9**]

Date of Birth:  [**2049-8-14**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins / Sulfa(Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Headache/ SAH

Major Surgical or Invasive Procedure:
[**2112-6-27**] Diagnostic cerebral angiogram
[**2112-6-29**] Angiogram with coiling of P-Comm artery aneurysm


History of Present Illness:
Patient is a 62 year old female who has had a week of
headaches focusing on the right side primarily behind the eye
and
ear, as well as in her neck. She presented to an outside
hospital
for evaluation and head CT was done which showed subarachnoid
hemorrhage in the sylvian fissure on the right side. As a result
of these finding she was transferred to [**Hospital1 18**] for further
evaluation. upon arrival neurosurgery was consulted and given
her
imaging we recommended a CTA of the head and neck to better
evaluate her vessels. She c/o headache which has remained
constant in intensity, she denies dizziness, photophobia,
nausea,
vomiting, changes in vision , hearing, or speech, she has no
signs of meningismus.

Past Medical History:
HLD, migraines, choly, tonsilectomy


Social History:
director of counseling at [**University/College **], smokes 15
cigarettes a day, social ETOH


Family History:
mother laryngeal cancer and CAD, father lung cancer


Physical Exam:
On the day of admission: [**2112-6-27**] PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]:  1        [**Doctor Last Name **]: 2          GCS  15
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-23**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3mm to
2mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to finger rub bilaterally.
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 [**3-26**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin

On the day of discharge:
AAO3, perrl, face symmetric, tongue mildline, no pronator drift
motor is [**3-26**] bilaterally, sensory intact, Babinski - flexor
gait is steady


Pertinent Results:
CTA head/ neck [**2112-6-27**]
CONCLUSION:
1.  Bilateral subarachnoid hemorrhage.
2.  Right posterior communicating artery aneurysm measuring 5 mm
in diameter needs neurosurgical attention.
Preliminary report was generated that read "diffuse subarachnoid
hemorrhage, not increased since the outside CT of [**2112-6-27**] at
11:31 a.m.  Right posterior communicating artery aneurysm,
approximately 5 mm in greatest dimension.

CHEST (PORTABLE AP) [**2112-6-27**]
IMPRESSION:  AP chest reviewed in the absence of prior chest
radiographs:
ET tube in standard placement.  Nasogastric tube ends in the mid
to low
stomach.  Supine positioning explains distention of mediastinal
and pulmonary veins.  Heart size normal.  Lungs clear.

Diagnostic cerebral angiogram [**2112-6-27**]
IMPRESSION:  [**Known firstname **] [**Known lastname **] underwent diagnostic cerebral
angiography, and due to the presence of two adjacent aneurysms,
one of which was wide necked and not amenable to coiling,
surgery was recommended.

[**2112-6-28**] ECG:
Sinus rhythm. Early R wave progression. ST-T wave changes in the
precordial leads marred by artifact. Since the previous tracing
of [**2112-6-27**] probably no significant change.

[**2112-6-29**] CXR:
Lungs are fully expanded and clear following tracheal
extubation.  Pulmonary vasculature is unremarkable.  Heart size
is normal.  No pleural abnormality.  Nasogastric tube passes
into the stomach and out of view.

Skull xray [**2112-6-30**]:
No movement of coil mass appreciated

[**2112-7-3**] CTA head
IMPRESSION:
1.  Improvement in the subarachnoid hemorrhage and
intraventricular hemorrhage compared to the prior head CT dated
[**2112-6-27**].
2.  Status post coiling of right PCOM aneurysm.
3.  The major intra- intracranial vessels are patent, however,
there is mild hypoattenuation or possible narrowing of the right
posterior communicating artery, possibly representing vasospasm.


[**2112-7-4**] Chest Xray: In comparison with the study of [**6-29**], there
is some mild indistinctness of pulmonary vessels consistent with
some elevated pulmonary venous pressure.  Hazy opacification at
the bases raises the possibility of pleural effusions with
compressive atelectasis.  However, much of this may be due to
overlying soft tissues and scattered radiation related to the
size of the patient.

[**2112-7-5**] CTA head CONCLUSION:
1.  Vessels of anterior and posterior circulation are unchanged
in caliber
compared to prior exams with no evidence of vasospasm.
2. Stable appearance of subarachnoid hemorrhage compared to
prior CT from
[**2112-7-3**].
3.  The patient is status post coiling of right PCOM aneurysm.
4.  Opthalmic artery aneurysm seen on cerebral angiography is
seen partially obscured by coil artifacts.

[**2112-7-6**] SKull X-rays
Vascular coil again present in the region of the right posterior
communicating artery.

[**2112-7-7**] LENS
No evidence of deep vein thrombosis of either right or left
lower
extremity.

[**2112-7-7**] CT head
Minimal residual subarachnoid hemorrhage with no evidence of new

hemorrhage or infarct.


Brief Hospital Course:
This is a 62 year old female who has had a week of headaches
focusing on the right side primarily behind the eye and ear, as
well as in her neck. She presented to an outside hospital for
evaluation and head CT was done which showed subarachnoid
hemorrhage in the sylvian fissure on the right side. The patient
was transferred to this hospital on [**2112-6-27**] and underwent
further evaluation which included a CTA of the Head and Neck
which was consistent with bilateral subarachnoid hemorrhage and
right posterior communicating artery aneurysm measuring 5 mm in
diameter
needs neurosurgical attention. The patient underwent a cerebral
angiogram which was consistent with a Opthalmic and a pcom
aneurysm.

On [**6-28**], The dilantin level was 2.1 corrected and the patient was
loaded with 1 gm dilantin.  Magnesium was  repleted. Urine
output this am - 30-35 cc hr for 3 hours and intravenous fluid
was started at 50 cc/hr.  The open aneurysm clipping was
cancelled due to OR availability.  The patient was electively
extubated. On exam the patient was neurologically intact.  At
1700 the patient complained of new onset double vision eye and
intermittent tremor left leg.  The patient was requiring
vasopressors to keep SBP < 140.  The patient was evaluated by
the team and Dr [**Last Name (STitle) **]. An open clipping was discussed with the
family if coiling was not successful.

On [**6-29**] the patient underwent repeat angiography with successful
coiling of the aneurysm. The patient tolerated the procedure
well. A small part of the coil remained in the parent vessel so
she was kept on a heparin drip overnight.
On [**6-30**] she was neurologically stable. Heparin drip was
discontinued and she was started on a full aspirin. A skull xray
was performed to evaluate the location of the coil mass and
ensure no migration. This remained stable compared to the
angiogram. Family was updated. The patient remained in the ICU
for monitoring. On [**2112-7-1**] TCDs were negative for spasm. On
[**2112-7-3**] a CTA was done which showed improvement in the SAH and
no vasospasm was noted.

On [**7-4**] patient had TCDs in the ICU which did not show any
evidence of vasospasm. She was transferred to the step down unit
for observation.  [**7-5**] she underwent CTA that demonstrated
stable SAH and no evidence of vasospasm.  She remained on IVF,
maintaining even to positive fluid status.  She continued to
have nausea without emesis and Compazine was added to her
medication regimen in addition to Zofran PRN.  She also
continued to report [**2110-5-31**] left retro orbital pain with only
minimal relief from narcotics and Fioricet.  She remained
neurologically intact and was able to work with physical
therapy.

Due to the change in her HA from right retro-orbital to global,
CT head was done on [**7-7**]. There was interval improvement in SAH.
Her medication was changed from oxycodone to Dilaudid and
Toradol. She mentioned that years ago she had hedaches like the
one she had overnight but does not recall her treatment. Her
PCP's office was contact[**Name (NI) **] and they had no records of this. She
continued to have photo and phonophpbia.  Now DOD, she is set
for d/c home and will follow-up accordingly.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Simvastatin 20 mg PO DAILY
2. Escitalopram Oxalate 20 mg PO DAILY
3. Aspirin 81 mg PO DAILY


Discharge Medications:
1. Aspirin 325 mg PO DAILY
RX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
Refills:*3
2. Simvastatin 20 mg PO HS
RX *simvastatin 20 mg 1 tablet(s) by mouth daily Disp #*30
Tablet Refills:*0
3. Acetaminophen-Caff-Butalbital [**11-23**] TAB PO Q4H:PRN headache
RX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg 1 tablet(s)
by mouth every four (4) hours Disp #*100 Tablet Refills:*0
4. Diazepam 5 mg PO Q6H:PRN anxiety
hold rr < 12/lethargy
RX *diazepam 5 mg 1 tab by mouth four times a day Disp #*40
Tablet Refills:*0
5. Docusate Sodium 100 mg PO TID
RX *Col-Rite 100 mg 1 capsule(s) by mouth twice a day Disp #*60
Capsule Refills:*0
6. Famotidine 20 mg PO BID
while on steroids
RX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*60
Tablet Refills:*0
7. Fluocinonide 0.05% Ointment 1 Appl TP 30MINS S/P
BREAKFAST,LUNCH, AND QHS
per [**Hospital1 112**] records; mouth sores
RX *fluocinonide 0.05 % Appl 30MINS S/P BREAKFAST,LUNCH, AND QHS
as indicated Disp #*1 Tube Refills:*0
8. Metoprolol Tartrate 12.5 mg PO BID
RX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth
twice a day Disp #*30 Tablet Refills:*1
9. Nicotine Patch 14 mg TD DAILY
RX *nicotine 14 mg/24 hour 1 patch daily Disp #*30 Each
Refills:*0
10. Nimodipine 60 mg PO Q4H
RX *nimodipine 30 mg 2 capsule(s) by mouth every four (4) hours
Disp #*360 Capsule Refills:*0
11. PredniSONE 10 mg PO TAPER Duration: 24 Hours
2 tabs po daily x 3 days, 1 tab po daily x 3 days, 1 tab po BID
x 2 days then discontinue
Tapered dose - DOWN
RX *prednisone 10 mg 1 tablet(s) by mouth as indicated Disp #*14
Tablet Refills:*0
12. Senna 2 TAB PO BID
RX *senna 8.6 mg 1 tab by mouth twice a day Disp #*60 Tablet
Refills:*0
13. Escitalopram Oxalate 20 mg PO DAILY
14. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN headaches
RX *Dilaudid 2 mg 1 tablet(s) by mouth every four (4) hours Disp
#*60 Tablet Refills:*0


Discharge Disposition:
Home

Discharge Diagnosis:
Right posterior communicating artery aneurysm
Right ophthalmic artery aneurysm
Subarachnoid hemorrhage


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Angiogram with coil placement
Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **]
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:
Please call [**Telephone/Fax (1) 4296**] to make an appointment to see Dr [**First Name (STitle) **]
in 4 weeks with a MRI/MRA brain ([**Doctor Last Name **] protocol).



Completed by:[**2112-7-9**]
{'Subarachnoid hemorrhage,Candidiasis of mouth,Unspecified transient cerebral ischemia,Tobacco use disorder,Other and unspecified hyperlipidemia,Aneurysm of artery of neck'}


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: Headache/ SAH

PRESENT ILLNESS: Patient is a 62 year old female who has had a week of
headaches focusing on the right side primarily behind the eye
and
ear, as well as in her neck. She presented to an outside
hospital
for evaluation and head CT was done which showed subarachnoid
hemorrhage in the sylvian fissure on the right side. As a result
of these finding she was transferred to [**Hospital1 18**] for further
evaluation. upon arrival neurosurgery was consulted and given
her
imaging we recommended a CTA of the head and neck to better
evaluate her vessels. She c/o headache which has remained
constant in intensity, she denies dizziness, photophobia,
nausea,
vomiting, changes in vision , hearing, or speech, she has no
signs of meningismus.

MEDICAL HISTORY: HLD, migraines, choly, tonsilectomy

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from Patient.
1. Simvastatin 20 mg PO DAILY
2. Escitalopram Oxalate 20 mg PO DAILY
3. Aspirin 81 mg PO DAILY

ALLERGIES: Penicillins / Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: On the day of admission: [**2112-6-27**] PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]:  1        [**Doctor Last Name **]: 2          GCS  15
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: mother laryngeal cancer and CAD, father lung cancer

SOCIAL HISTORY: director of counseling at [**University/College **], smokes 15
cigarettes a day, social ETOH 

### Response:
{'Subarachnoid hemorrhage,Candidiasis of mouth,Unspecified transient cerebral ischemia,Tobacco use disorder,Other and unspecified hyperlipidemia,Aneurysm of artery of neck'}
