CHIEF COMPLAINT: Worst headache of his life

PRESENT ILLNESS: 54 y/o male who was transferred from an [**Hospital1 **] [**Location (un) 620**] after a CT
revealed subarachnoid hemorrhage.

MEDICAL HISTORY: PMHx:Afib

MEDICATION ON ADMISSION: Atenolol 100mg daily, ASA 81mg

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]: 1         [**Doctor Last Name **]:2     GCS 15  E: 4   V: Motor6
O: T:  BP:124 /80         HR:60    R12       O2Sats 100RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT
Neck: Nuchal rigidity, pain with lateral movements
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: NC

SOCIAL HISTORY: Social Hx:Married, has two children. Works in computer sales.
Smokes cigars socially. Drinks one glass of wine daily.
Subarachnoid hemorrhage,Atrial fibrillation
Subarachnoid hemorrhage,Atrial fibrillation
Admission Date:  [**2130-4-25**]              Discharge Date:   [**2130-4-29**]

Date of Birth:  [**2075-8-8**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
[**2130-4-25**] DIAGNOSTIC CEREBRAL ANGIOGRAM


History of Present Illness:
54 y/o male who was transferred from an [**Hospital1 **] [**Location (un) 620**] after a CT
revealed subarachnoid hemorrhage.

Patient presents a history of having a mild headache this
evening, going to bed around 10 pm and upon laying down
developing a bad headache that gradually worsened over 4 to 5
min.  He says he wouldn't describe the headache as the worst
headache of his life, or thunderclap in nature. He denies visual
changes, nausea, vomiting or loss of consciousness.


Past Medical History:
PMHx:Afib


Social History:
Social Hx:Married, has two children. Works in computer sales.
Smokes cigars socially. Drinks one glass of wine daily.


Family History:
NC

Physical Exam:
PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]: 1         [**Doctor Last Name **]:2     GCS 15  E: 4   V: Motor6
O: T:  BP:124 /80         HR:60    R12       O2Sats 100RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT
Neck: Nuchal rigidity, pain with lateral movements
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: [**2-23**] 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,3 to 2
mm 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 [**4-27**] throughout. No pronator drift

Sensation: Intact to light touch

Coordination: normal on finger-nose-finger

CT: perimesencephalic SAH
CTA: negative for aneurysm/AVM

On Discharge: nonfocal

Pertinent Results:
[**2130-4-25**] CTA BRAIN
FINDINGS:

CT HEAD:

Scattered areas of bilateral subarachnoid hemorrhage in the
cerebral sulci,
small amount of blood in the interpeduncular, prepontine
cisterns and little
blood in the posterior [**Doctor Last Name 534**] of the lateral ventricles are
redemonstrated.
There is no evidence of a new hemorrhage. The ventricular
dimensions are
stable. The [**Doctor Last Name 352**]-white matter differentiation is preserved. The
visualized
paranasal sinuses are clear. No cranial fractures shown.

CTA HEAD:

Volume-rendered images are noisy limiting the resolution for
small aneurysm detection. Within the limitation, there is no
evidence of a large
intracranial aneurysm, flow-limiting stenosis, or vascular
malformation.

IMPRESSION:

1. Scattered areas of subarachnoid hemorrhage in the cerebral
sulci,
hemorrhage in the interpeduncular and prepontine cisterns and
tiny blood
layering the posterior horns of lateral ventricles are stable.
No evidence of new intracranial hemorrhage.

2. Within the limitation of noisy CTA volume rendered images,
there is no
evidence of enlarged intracranial aneurysm or vascular
malformation.

The study and the report were reviewed by the staff radiologist.



MRI C-Spine
PFI: Mild degenerative changes. No other significant
abnormalities on MRI of the cervical spine with and without
gadolinium.

MRI Brain:
IMPRESSION: No significant abnormalities on MRI of the brain
with and without gadolinium including focused images of the
pineal gland.


Brief Hospital Course:
Pt was admitted to the ICU for close neurological observation
after transfer to [**Hospital1 18**] for SAH.  He was started on Nimodpine.
He underwent a diagnostic cerebral angiogram on HD#1 which was
negative for anueurysm.  On 5.4 he was transferred to the SDU
and remained stable. On 5.5 he was transferred to the floor and
complained of minor headaches and neck pain. On [**4-28**] as he
prepared for discharge MRi of the brain to eval for pineal
lesion and MRi of the cervical spine to assess for any possible
spinal AVM's were obtained which showed no intracranial or
spinal abnormalities. On [**4-29**] he was deemed fit for discharge and
was discharged to home without services with instructions for
follow-up

Medications on Admission:
Atenolol 100mg daily, ASA 81mg


Discharge Medications:
1. atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
4. acetaminophen-codeine 300-30 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for headache.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
SUBARACHNOID HEMORRHAGE


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


Discharge Instructions:
General Instructions

??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, or
Ibuprofen etc.
??????	If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion, lethargy or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	New onset of the loss of function, or decrease of function on
one whole side of your body.


Followup Instructions:
Follow-Up Appointment Instructions

??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast prior to
your appointment. This can be scheduled when you call to make
your office visit appointment.



Completed by:[**2130-4-29**]
{'Subarachnoid hemorrhage,Atrial fibrillation'}


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 his life

PRESENT ILLNESS: 54 y/o male who was transferred from an [**Hospital1 **] [**Location (un) 620**] after a CT
revealed subarachnoid hemorrhage.

MEDICAL HISTORY: PMHx:Afib

MEDICATION ON ADMISSION: Atenolol 100mg daily, ASA 81mg

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]: 1         [**Doctor Last Name **]:2     GCS 15  E: 4   V: Motor6
O: T:  BP:124 /80         HR:60    R12       O2Sats 100RA
Gen: WD/WN, comfortable, NAD.
HEENT: NCNT
Neck: Nuchal rigidity, pain with lateral movements
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: NC

SOCIAL HISTORY: Social Hx:Married, has two children. Works in computer sales.
Smokes cigars socially. Drinks one glass of wine daily. 

### Response:
{'Subarachnoid hemorrhage,Atrial fibrillation'}
