CHIEF COMPLAINT: Transfer from [**Hospital3 3583**] with large left
frontal hemorrhage.

PRESENT ILLNESS: The pt is a [**Age over 90 **] year-old woman with a past medical history
that included PNA in [**2116**], hypercholesterolemia, and HTN (other
history is not known and the data we have here is very sparse)
who presented to [**Hospital3 3583**] after being found down in her
bathroom covered in emesis.  She was last seen well on Monday.
She was intubated at [**Hospital3 3583**] for declining mental
status.
Intubation was done with etomidate, succinyl choline,
vecuronium,
and lidocaine.  Ativan 2mg was also given to maintain intubation
and a gram of phosphenytoin was given prophylactically.  Head CT
at outside shows a high left frontal hypodensity with associated
hemorrhage.  Bicarbonate was 16 and WBC was 16.5.  Coags were
normal.  A troponin I was 0.6 (cut off for acute MI was 0.5).

MEDICAL HISTORY: HTN
Hypercholesterolemia.

MEDICATION ON ADMISSION: Phenytoin 100mg IV TID
Ceftriaxone 1gm IV daily
Vanco 1gm IV
Labetalol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Breathing effortlessly, keeps eyes closed.
HEENT: NC/AT, no scleral icterus noted, MM-very dry, no lesions
noted in oropharynx
Neck: in collar.
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: Blowing early peaking systolic murmur heard best a
LUSB.
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: dry, variable edema of the extremities, right knuckle
abrasion with an open wound
Neurologic:
-Mental Status: Keeps eyes closed. Doesn't follow any commands.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Unknown
Intracerebral hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Pure hypercholesterolemia
Intracerebral hemorrhage,Crbl art ocl NOS w infrc,Subendo infarct, initial,Hypertension NOS,Pure hypercholesterolem
Admission Date:  [**2124-8-17**]              Discharge Date:   [**2124-8-22**]


Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Transfer from [**Hospital3 3583**] with large left
frontal hemorrhage.


Major Surgical or Invasive Procedure:
NONE


History of Present Illness:
The pt is a [**Age over 90 **] year-old woman with a past medical history
that included PNA in [**2116**], hypercholesterolemia, and HTN (other
history is not known and the data we have here is very sparse)
who presented to [**Hospital3 3583**] after being found down in her
bathroom covered in emesis.  She was last seen well on Monday.
She was intubated at [**Hospital3 3583**] for declining mental
status.
Intubation was done with etomidate, succinyl choline,
vecuronium,
and lidocaine.  Ativan 2mg was also given to maintain intubation
and a gram of phosphenytoin was given prophylactically.  Head CT
at outside shows a high left frontal hypodensity with associated
hemorrhage.  Bicarbonate was 16 and WBC was 16.5.  Coags were
normal.  A troponin I was 0.6 (cut off for acute MI was 0.5).

Here the initial blood pressure was 78/52 on initial check and
111/32
on the next check.

ROS
Impossible to obtain.

Past Medical History:
HTN
Hypercholesterolemia.


Social History:
Unknown

Family History:
Noncontributory

Physical Exam:
General: Breathing effortlessly, keeps eyes closed.
HEENT: NC/AT, no scleral icterus noted, MM-very dry, no lesions
noted in oropharynx
Neck: in collar.
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: Blowing early peaking systolic murmur heard best a
LUSB.
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: dry, variable edema of the extremities, right knuckle
abrasion with an open wound
Neurologic:
-Mental Status: Keeps eyes closed. Doesn't follow any commands.


-Cranial Nerves: PERRL 1.5 to 1mm and brisk.  Unable to
determine
VFF given keeps her eyes closed.  Corneal intact.  Gag intact.

-Motor:
LUE - initially to noxious in the finger she extensor postured,
but to noxious on the sternum she localized with this hand.
RUE - extensor posturing to noxious.
LLE - withdrawal vs. triple flexion to noxious.
RLE - withdrawal vs. triple flexion to noxious.
Pt currently is able to sponataneuously move her left arm.

-Sensory: As above to noxious.

-Coordination: not tested.

- Reflex: No clonus
 [**Hospital1 **]  	Tri 	Bra 	Pat  	An   	Toes
 C5  	C7  	C6  	L4   	S1 	CST
L2   	1  	1    	0    	1   	down
R2   	1   	1    	0    	1       down

-Gait: Not tested.


Brief Hospital Course:
The patient was admitted to the neuro ICU after she was found to
have a large left MCA infarction. This caused global aphasia and
right hemiparesis. After extensive discussion with the family,
the patient was made CMO and discharged home with hospice care.

Medications on Admission:
Phenytoin 100mg IV TID
Ceftriaxone 1gm IV daily
Vanco 1gm IV
Labetalol PRN

Discharge Medications:
1. Morphine Concentrate 20 mg/mL Solution Sig: 5-20 mg PO q1 as
needed for pain.
Disp:*30 ml* Refills:*0*
2. Ativan 1 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for pain: [**1-5**] to 2 tabs sublingual.
Disp:*20 Tablet(s)* Refills:*0*
3. Levsin/SL 0.125 mg Tablet, Sublingual Sig: One (1)
Sublingual every four (4) hours as needed for shortness of
breath or wheezing: 1-2 tabs.
Disp:*30 tabs* Refills:*0*
4. Acetaminophen 650 mg Suppository Sig: One (1) Suppository
Rectal Q4H (every 4 hours) as needed.
Disp:*6 Suppository(s)* Refills:*0*
5. Diphenhydramine HCl 12.5 mg/5 mL Elixir Sig: One (1)  PO Q6H
(every 6 hours) as needed for nausea .
Disp:*30 ml* Refills:*0*
6. Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for nausea.
Disp:*6 Tablet(s)* Refills:*0*
7. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours) as needed for nausea and vomiting.
Disp:*6 Tablet(s)* Refills:*0*
8. Prochlorperazine 25 mg Suppository Sig: One (1) Suppository
Rectal Q12H (every 12 hours) as needed for nausea  and vomiting.
Disp:*6 Suppository(s)* Refills:*0*
9. Hyoscyamine Sulfate 0.125 mg Tablet, Sublingual Sig: One (1)
Tablet, Sublingual Sublingual Q4H (every 4 hours) as needed for
increased secretions.
Disp:*6 Tablet, Sublingual(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
cranberry hospice

Discharge Diagnosis:
Left Ischemic MCA Infarction with hemorrhagic frontoparietal
hemorrhage with midline shift & NSTEMI


Discharge Condition:
Stable. Pt is currently breathing on her own moving the left
upper extremity. Her left arm has a variable amount of edema. Pt
does not seem to be in any distress.


Discharge Instructions:
Patient will be discharged home with pallative care management
of her comfort measures. Her PCP is aware of the hospital course
and will follow as an outpatient

Followup Instructions:
F/u with PCP [**Doctor Last Name 72900**],[**Name9 (PRE) **] [**Name9 (PRE) **] [**Telephone/Fax (1) 63184**] for an appt
F/U with Pallative Care at [**Hospital 34412**] Hospice


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2124-8-22**]
{'Intracerebral hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Pure hypercholesterolemia'}


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: Transfer from [**Hospital3 3583**] with large left
frontal hemorrhage.

PRESENT ILLNESS: The pt is a [**Age over 90 **] year-old woman with a past medical history
that included PNA in [**2116**], hypercholesterolemia, and HTN (other
history is not known and the data we have here is very sparse)
who presented to [**Hospital3 3583**] after being found down in her
bathroom covered in emesis.  She was last seen well on Monday.
She was intubated at [**Hospital3 3583**] for declining mental
status.
Intubation was done with etomidate, succinyl choline,
vecuronium,
and lidocaine.  Ativan 2mg was also given to maintain intubation
and a gram of phosphenytoin was given prophylactically.  Head CT
at outside shows a high left frontal hypodensity with associated
hemorrhage.  Bicarbonate was 16 and WBC was 16.5.  Coags were
normal.  A troponin I was 0.6 (cut off for acute MI was 0.5).

MEDICAL HISTORY: HTN
Hypercholesterolemia.

MEDICATION ON ADMISSION: Phenytoin 100mg IV TID
Ceftriaxone 1gm IV daily
Vanco 1gm IV
Labetalol PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Breathing effortlessly, keeps eyes closed.
HEENT: NC/AT, no scleral icterus noted, MM-very dry, no lesions
noted in oropharynx
Neck: in collar.
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: Blowing early peaking systolic murmur heard best a
LUSB.
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: dry, variable edema of the extremities, right knuckle
abrasion with an open wound
Neurologic:
-Mental Status: Keeps eyes closed. Doesn't follow any commands.

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Unknown 

### Response:
{'Intracerebral hemorrhage,Cerebral artery occlusion, unspecified with cerebral infarction,Subendocardial infarction, initial episode of care,Unspecified essential hypertension,Pure hypercholesterolemia'}
