CHIEF COMPLAINT: Headache

PRESENT ILLNESS: Patient is a 61M visiting from [**State 2690**], w/PMH of HTN who
reportedly was walking along beach this early evening and
experienced sudden onset headache, and subsequent nausea &
vomiting and difficulty verbalizing. He quickly became
unresponsive(approx 10min) and his son called 911. [**Name2 (NI) **] was
scanned at the OSH which revealed a large SDH with approx 2cm
MLS.  He was sedated with versed and intubated for transfer to
[**Hospital1 18**] for definitive neurosurgical care.

MEDICAL HISTORY: 1. HTN

MEDICATION ON ADMISSION: 1. Hyzaar

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
O: T:afebrile  BP:160/80  HR:56   RR:20   O2Sats:100% CMV
Gen: WD/WN intubated white male.
HEENT:normocephalic, atraumatic
Pupils:Asymmetric, non-reactive Rt>Lt
EOMs: unable to assess
Extrem: Warm and well-perfused.
Neuro:
Mental status: non-responsive to verbal stimulus. Right pupil is
8mm and non-reactive, left pupil 6mm non-reactive.  Absent
corneal reflex, weak gag reflex to deep endotracheal
stimulation.
Upper extremities extensor posturing with noxious stimulation,
lower extremity triple flexion to noxious stimulation.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married,
Subdural hemorrhage,Pneumonitis due to inhalation of food or vomitus,Compression of brain,Unspecified essential hypertension
Subdural hemorrhage,Food/vomit pneumonitis,Compression of brain,Hypertension NOS
Admission Date:  [**2185-6-26**]              Discharge Date:   [**2185-7-2**]

Date of Birth:  [**2123-9-30**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
[**6-26**]: Emergent Right Craniotomy for Evacuation


History of Present Illness:
Patient is a 61M visiting from [**State 2690**], w/PMH of HTN who
reportedly was walking along beach this early evening and
experienced sudden onset headache, and subsequent nausea &
vomiting and difficulty verbalizing. He quickly became
unresponsive(approx 10min) and his son called 911. [**Name2 (NI) **] was
scanned at the OSH which revealed a large SDH with approx 2cm
MLS.  He was sedated with versed and intubated for transfer to
[**Hospital1 18**] for definitive neurosurgical care.


Past Medical History:
1. HTN

Social History:
Married,

Family History:
Non-contributory

Physical Exam:
On Admission:
O: T:afebrile  BP:160/80  HR:56   RR:20   O2Sats:100% CMV
Gen: WD/WN intubated white male.
HEENT:normocephalic, atraumatic
Pupils:Asymmetric, non-reactive Rt>Lt
EOMs: unable to assess
Extrem: Warm and well-perfused.
Neuro:
Mental status: non-responsive to verbal stimulus. Right pupil is
8mm and non-reactive, left pupil 6mm non-reactive.  Absent
corneal reflex, weak gag reflex to deep endotracheal
stimulation.
Upper extremities extensor posturing with noxious stimulation,
lower extremity triple flexion to noxious stimulation.

Cranial Nerves:
I: Not tested
II: Pupils are asymmetric and non-reactive 8mm(Rt), 6mm(Lt)
III, IV, VI-XII: unable to assess


Pertinent Results:
Admission CT/A([**6-26**]): Acute Right SDH, measuring 1.3cm at
maximal width, with associated midline shift measuring 1.8cm.
There is notable effacement of the basal cisterns.

CT [**6-27**]:

FINDINGS: Interval evacuation of the right subdural hematoma
with
postoperative pneumocephalus and without significant
postoperative hemorrhage is noted.

There is persistent gyral effacement and leftward subfalcine
herniation
measuring 12 mm compared to prior 19 mm. There is also
persistent effacement of perimesencephalic, quadrigeminal plate
cisterns indicating uncal and downward transtentorial
herniation, minimally improved from the prior study.
There is 2.6 x 1.5 cm focus of intraparenchymal hemorrhage in
the right
occipital lobe, relatively unchanged compared to prior study.
No new foci of intra- or extra-axial hemorrhage are noted.

The right frontal, parietal and temporal calvarial defect from
recent craniotomy is noted. Small amount of subcutaneous air and
surgical
skin staples are also evident. There is moderate lobulated
mucosal thickening in the left maxillary sinus along with
bilateral ethmoid air cells. Mild mucosal thickening is noted in
the right maxillary and sphenoid sinuses.

IMPRESSION:
1. Interval evacuation of the right subdural hematoma with
post-surgical
changes as described above. No new foci of intra- or extra-axial
hemorrhage.
2. Unchanged right occipital intraparenchymal hemorrhage.
3. 12 mm leftward subfalcine and uncal and early downward
transtentorial
herniation, slightly improved than prior study

MRI [**6-27**]:
FINDINGS: The patient is status post right-sided craniotomy for
evacuation of right subdural hematoma. Over the interval, a
layering subdural extra-axial collection has reaccumulated in
the postoperative cavity measuring 10 mm in greatest transverse
dimension. The degree of leftward subfalcine herniation is
unchanged. Uncal herniation as well as subtentorial herniation
has mildly improved.

There are multiple areas of abnormal restricted diffusion
corresponding to
acute infarcts within the paramedian right and left frontal
lobes, right
occipital lobe, right temporal lobe, right basal ganglia, left
insula, left cerebral peduncle, mid brain periaqueductal [**Doctor Last Name 352**]
matter, and medulla. A 22-mm region of susceptibility artifact
in the right occipital lobe corresponds to the known right
occipital hematoma.

There is mild mucosal thickening of the paranasal sinuses.

IMPRESSION:
1. Multifocal acute infarcts as detailed above.
2. Reaccumulation of right subdural extra-axial collection at
the previous
site of evacuation.
3. No change in appearance of leftward subfalcine herniation.
4. Mild improvement in transtentorial and uncal herniation.


MRA OF THE CIRCLE OF [**Location (un) **]

TECHNIQUE: Three-dimensional time-of-flight MR arteriography was
performed
with rotational reconstructions.

FINDINGS: The intracranial vertebral and internal carotid
arteries and their major branches appear normal without evidence
of stenosis, occlusion, or aneurysm formation.

IMPRESSION: Normal study.

MRI [**6-29**]:
FINDINGS: The right extra-axial subdural fluid collection has
decreased in
size measuring 7 mm in greatest transverse dimension. The
superficial fluid collection at the craniotomy site has mildly
increased. Mild leftward subfalcine herniation has decreased,
now measuring 7 mm. Uncal and subtentorial herniation continues
to improve.

Again seen are multiple evolving infarcts. These involve the
right and left paramedian frontal lobes, right and left
paramedian occipital lobes, right and left medial temporal
lobes, right basal ganglia, left insula, left cerebral peduncle,
midbrain aqueductal [**Doctor Last Name 352**] matter, and medulla. The right
occipital intraparenchymal hematoma continues to evolve. There
is moderate mucosal thickening of the paranasal sinuses and
minimal opacification of the mastoid air cells.

IMPRESSION:
1. Evolving multifocal bihemispheric supra- and infratentorial
infarcts, as detailed above.
2. Slight interval decrease in size of right subdural
extra-axial collection at the previous site of evacuation with
decrease in leftward subfalcine herniation.

MRA OF THE CIRCLE OF [**Location (un) **].

Three-dimensional time-of-flight MR arteriography was performed
with
rotational MIP reconstructions.

FINDINGS: The intracranial vertebral and internal carotid
arteries and their major branches appear normal without evidence
of stenosis, occlusion, or aneurysm formation.

IMPRESSION: Normal study.



Brief Hospital Course:
Patient was seen and evaluated in ED, and determined to be
candidate for emergent neurosurgical evacuation of acute SDH.
He was taken to the OR to undergo right craniotomy for
evacuation, which proceded uneventfully.  He was then
transferred to the SICU for post-surgical care.  On [**6-27**], he
underwent cerebral angiogram to further evaluate the etiology of
his SDH, given the atypical presentation and collection
characteristics.  The Angio was negative for AVM or aneurysms.
The MRI showed a midbrain  stroke, temporal stroke, and
occipital stroke. The patient's neuro exam remained poor. He had
frequent neuro checks and remained in the ICU. He was unable to
be extubated. On [**7-1**] there was a family meeting with Dr.
[**Last Name (STitle) **]. Given the patient's poor prognosis, the family decided
to make him comfort measures only. He was extubated in the
evening and expired early in the morning on [**7-2**].

Medications on Admission:
1. Hyzaar

Discharge Medications:
NA

Discharge Disposition:
Expired

Discharge Diagnosis:
Acute Subdural Hematoma


Discharge Condition:
expired

Discharge Instructions:
None

Followup Instructions:
None


Completed by:[**2185-7-2**]
{'Subdural hemorrhage,Pneumonitis due to inhalation of food or vomitus,Compression of brain,Unspecified essential hypertension'}


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

PRESENT ILLNESS: Patient is a 61M visiting from [**State 2690**], w/PMH of HTN who
reportedly was walking along beach this early evening and
experienced sudden onset headache, and subsequent nausea &
vomiting and difficulty verbalizing. He quickly became
unresponsive(approx 10min) and his son called 911. [**Name2 (NI) **] was
scanned at the OSH which revealed a large SDH with approx 2cm
MLS.  He was sedated with versed and intubated for transfer to
[**Hospital1 18**] for definitive neurosurgical care.

MEDICAL HISTORY: 1. HTN

MEDICATION ON ADMISSION: 1. Hyzaar

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
O: T:afebrile  BP:160/80  HR:56   RR:20   O2Sats:100% CMV
Gen: WD/WN intubated white male.
HEENT:normocephalic, atraumatic
Pupils:Asymmetric, non-reactive Rt>Lt
EOMs: unable to assess
Extrem: Warm and well-perfused.
Neuro:
Mental status: non-responsive to verbal stimulus. Right pupil is
8mm and non-reactive, left pupil 6mm non-reactive.  Absent
corneal reflex, weak gag reflex to deep endotracheal
stimulation.
Upper extremities extensor posturing with noxious stimulation,
lower extremity triple flexion to noxious stimulation.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married, 

### Response:
{'Subdural hemorrhage,Pneumonitis due to inhalation of food or vomitus,Compression of brain,Unspecified essential hypertension'}
