CHIEF COMPLAINT: Headache

PRESENT ILLNESS: Patient (supposed real name [**Known lastname 33754**], [**Known firstname 429**]) is a 58 year old
male with history of hypertension (reportedly noncompliant),
CABG, who reportedly presented to an OSH for chest pain.  This
history was taken from the outside hospital as no family could
be
contact[**Name (NI) **].  [**Name2 (NI) **] preortedly called an ambulance, after he had been
drinking beer and complained of chest pain.  He looked to
bystanders like he was going to pass out. Presenting BP was
209/130. EKG at OSH sinus rhythm with LVH, diffuse ST and T wave
changes. Labs were significant for a WBC of 10.7, Hct of 50.9,
negative cardiac enzymes, and an EtOH of 66.  INR was 1.0.  A
nitroglycerine drip was initiated to control the blood pressure
which reportedly regularly runs greater than 100 diastolic, 200
systolic. Following this he reportedly became less responsive,
responding to pain only.  No further speech.  At this point
patient was intubaged for airway protection.  He was given
fentanyl initially and then succinyl coline and etomidate.  He
was given an additional 20 mg of labetalol and a nitroprusside
gtt was started.  Head CT demonstrated a left thalamic
hemorrhage
with intraventricular extension.  His BP was in the 150s prior
to
transfer to [**Hospital1 18**].  At some point at the OSH BP reportedly
"dropped" and he was given dopamine and IV fluids and fentanyl
to
help with aggitation.  Upon transfer to [**Hospital1 18**] Neurology was
called for further management.  With his poorly declining status
we contact[**Name (NI) **] Neurosurgery to emergently place an EVD.  The
opening pressure was 18.

MEDICAL HISTORY: CABG performed 2 to 3 years ago.  .
HTN - reportedly does not take his medication.

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: 73   96/66  11  97% on CMV@100% 480x17 PEEP@5

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Smokes tobacco, Reportedly a "heavy" drinker
Intracerebral hemorrhage,Cerebral edema,Obstructive hydrocephalus,Unspecified hypertensive heart disease without heart failure,Memory loss,Dysphagia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Acute alcoholic intoxication in alcoholism, continuous,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Intracerebral hemorrhage,Cerebral edema,Obstructiv hydrocephalus,Hyp hrt dis NOS w/o hf,Memory loss,Dysphagia NOS,Hx of past noncompliance,Ac alcohol intox-contin,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date:  [**2109-5-25**]              Discharge Date:   [**2109-6-7**]

Date of Birth:  [**2051-3-23**]             Sex:   M

Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 5018**]
Chief Complaint:
Headache

Major Surgical or Invasive Procedure:
External Ventricular Drain
Endotracheal Intubation


History of Present Illness:
Patient (supposed real name [**Known lastname 33754**], [**Known firstname 429**]) is a 58 year old
male with history of hypertension (reportedly noncompliant),
CABG, who reportedly presented to an OSH for chest pain.  This
history was taken from the outside hospital as no family could
be
contact[**Name (NI) **].  [**Name2 (NI) **] preortedly called an ambulance, after he had been
drinking beer and complained of chest pain.  He looked to
bystanders like he was going to pass out. Presenting BP was
209/130. EKG at OSH sinus rhythm with LVH, diffuse ST and T wave
changes. Labs were significant for a WBC of 10.7, Hct of 50.9,
negative cardiac enzymes, and an EtOH of 66.  INR was 1.0.  A
nitroglycerine drip was initiated to control the blood pressure
which reportedly regularly runs greater than 100 diastolic, 200
systolic. Following this he reportedly became less responsive,
responding to pain only.  No further speech.  At this point
patient was intubaged for airway protection.  He was given
fentanyl initially and then succinyl coline and etomidate.  He
was given an additional 20 mg of labetalol and a nitroprusside
gtt was started.  Head CT demonstrated a left thalamic
hemorrhage
with intraventricular extension.  His BP was in the 150s prior
to
transfer to [**Hospital1 18**].  At some point at the OSH BP reportedly
"dropped" and he was given dopamine and IV fluids and fentanyl
to
help with aggitation.  Upon transfer to [**Hospital1 18**] Neurology was
called for further management.  With his poorly declining status
we contact[**Name (NI) **] Neurosurgery to emergently place an EVD.  The
opening pressure was 18.

ROS - unable to preform secondary to mental status


Past Medical History:
CABG performed 2 to 3 years ago.  .
HTN - reportedly does not take his medication.


Social History:
Smokes tobacco, Reportedly a "heavy" drinker


Family History:
Unknown


Physical Exam:
Vitals: 73   96/66  11  97% on CMV@100% 480x17 PEEP@5

Gen: Intubated, sedated, weaning off paralyctics
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: warm and well perfused.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: will open eyes briefly to deep sternal rub
-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 2 nonreactive BL.  Does not blink to threat in any
field.  No gaze deviation.
III, IV, VI: +vestibuloccular reflex.
V/VII: + Corneals Bilaterally.  Mild left sided facial droop.
IX, X: + gag

-Motor/Sensory: briskly withdraws in bilateral lower
extremities.
Localizes with left upper extremity.  extensor postures in the
right upper extremity to noxious.

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    2   1
R  2  2    2    2   1
Plantar response was flexor extensor.

-Gait: not tested

ON DISCHARGE
MS: alert, not oriented to location or date. Unable to retain
any words or have memory of prior days events. Language is
intact - fluent, w/ normal comprehension, and repetition.
CN: pupils symmetric and reactive; EOMI no nystagmus, skew
resolved
Motor: full strength in upper and lower extremities
Gait: able to walk with assistance of a walker
Reflexes: symmtric/normal, toes down

Pertinent Results:
CT: [**2109-5-25**]
Large left thalamic hemorrhage extending into the ventricles
with
associated mild obstructive hydrocephalus.

CT: [**2109-6-1**]
1. Evolving left thalamic hemorrhage with intraventricular
extension and
surrounding edema and mass effect, stable since the prior study.


2. Interval removal of a right frontal ventriculostomy catheter,
with minimal pneumocephalus. No significant change in the
ventricular size.

3. Extensive small vessel ischemic disease.

TTE: [**2109-5-27**]
Mild symmetric left ventricular hypertrophy with preserved
global and regional biventricular systolic function. Dilated
ascendting aorta. Left atrial enlargement. No valvular pathology
or pathologic flow identified.
These findings are c/w hypertensive heart.

Renal U/S
Bilateral renal blood flow with morphologically normal
waveforms.
There is no difference in peak systolic velocities given the
limitations in technique. There is no definitive evidence of
renal artery stenosis. Mildly elevated resistive indices may be
related to medical renal disease.

CTA
1. Mild atheromatous disease. Hypoplastic left vertebral artery
is not
visualized at its origin, but reconstitutes distally. No
evidence of
vasculitis.
2. Evolving left thalamic hemorrhage, with intraventricular
extension.
3. Right frontal ventriculostomy catheter in position, with
stable
ventricular size and decreased intraventricular blood products.
4. Severe small vessel ischemic disease.

HgA1c 6.3
FLP LDL 71 HDL 64 Chol 151 Tg 82


Brief Hospital Course:
Left Thalamic Hemorrhage

[**Known firstname 429**] [**Known lastname 33754**] was admitted to the neuro-ICU after he had onset
of chest pain and headache and a deterioration in his level of
consciousness. He was intubated in the ED and transferred to the
ICU. On examination he had significant eye movement
abnormalities in the right eye in which it was deviated out, but
improved during his hospital course. He had an EVD placed and
received intraventricular tPA for concern of obstructive
hydrocephalus. On extubation he was found to have a profound
anterograde amnesia. It was unknown whether some of this was
preexisting due to excessive alcohol use or a result of the
thalmaic hemorrhage and connections with the hippocampus. His
exam improved significantly in areas of motor and gait, but he
continued to require a walker to get around. His blood pressure
was controlled with an increased regimen of antihypertensive and
he was normotensive on discharge. He should continue to remain
normotensive and will follow-up with Dr. [**Last Name (STitle) 1693**], but he needs to
call registration prior to his appointment.

Medications on Admission:
None

Discharge Medications:
1. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day.
2. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
3. carvedilol 25 mg Tablet Sig: One (1) Tablet PO twice a day.
4. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
5. multivitamin,tx-minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
DAILY (Daily).
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).


Discharge Disposition:
Extended Care

Facility:
Crotchette Mountain

Discharge Diagnosis:
Left thalamic hemorrhage with intraventricular extension


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


Discharge Instructions:
You were admitted to the neurology service in the ICU after you
had a depressed level of consciousness. You were intubated and
taken to the ICU. Your exam was notable for depressed
consciousness and extensor posturing, however on discharge your
motor exam had improved and your deficits were mostly in
concentration, orientation and memory. You had a CT that showed
a left thalamic hemorrhage with intraventricular extension. You
had an EVD placed by neurosurgery and received intraventricular
tPA. You were transferred out of the ICU and maintained on an
antihypertensive regimen. You will be discharged to an acute
rehab in [**Location (un) 3844**]. A follow-up appointment was made with
Dr. [**Last Name (STitle) 1693**]. Call registration prior to your appointment
[**Telephone/Fax (1) 10676**] as you may need to be self-pay.
1. F/U with Dr. [**Last Name (STitle) 1693**] in 3 months
2. Continue on current antihypertensive

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) 177**] [**Last Name (NamePattern1) **], M.D. Phone:[**Telephone/Fax (1) 1694**]
Date/Time:[**2109-9-17**] 11:30


                             [**Name6 (MD) 4267**] [**Last Name (NamePattern4) 4268**] MD, [**MD Number(3) 5023**]

Completed by:[**2109-6-7**]
{'Intracerebral hemorrhage,Cerebral edema,Obstructive hydrocephalus,Unspecified hypertensive heart disease without heart failure,Memory loss,Dysphagia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Acute alcoholic intoxication in alcoholism, continuous,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}


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 (supposed real name [**Known lastname 33754**], [**Known firstname 429**]) is a 58 year old
male with history of hypertension (reportedly noncompliant),
CABG, who reportedly presented to an OSH for chest pain.  This
history was taken from the outside hospital as no family could
be
contact[**Name (NI) **].  [**Name2 (NI) **] preortedly called an ambulance, after he had been
drinking beer and complained of chest pain.  He looked to
bystanders like he was going to pass out. Presenting BP was
209/130. EKG at OSH sinus rhythm with LVH, diffuse ST and T wave
changes. Labs were significant for a WBC of 10.7, Hct of 50.9,
negative cardiac enzymes, and an EtOH of 66.  INR was 1.0.  A
nitroglycerine drip was initiated to control the blood pressure
which reportedly regularly runs greater than 100 diastolic, 200
systolic. Following this he reportedly became less responsive,
responding to pain only.  No further speech.  At this point
patient was intubaged for airway protection.  He was given
fentanyl initially and then succinyl coline and etomidate.  He
was given an additional 20 mg of labetalol and a nitroprusside
gtt was started.  Head CT demonstrated a left thalamic
hemorrhage
with intraventricular extension.  His BP was in the 150s prior
to
transfer to [**Hospital1 18**].  At some point at the OSH BP reportedly
"dropped" and he was given dopamine and IV fluids and fentanyl
to
help with aggitation.  Upon transfer to [**Hospital1 18**] Neurology was
called for further management.  With his poorly declining status
we contact[**Name (NI) **] Neurosurgery to emergently place an EVD.  The
opening pressure was 18.

MEDICAL HISTORY: CABG performed 2 to 3 years ago.  .
HTN - reportedly does not take his medication.

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: 73   96/66  11  97% on CMV@100% 480x17 PEEP@5

FAMILY HISTORY: Unknown

SOCIAL HISTORY: Smokes tobacco, Reportedly a "heavy" drinker 

### Response:
{'Intracerebral hemorrhage,Cerebral edema,Obstructive hydrocephalus,Unspecified hypertensive heart disease without heart failure,Memory loss,Dysphagia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Acute alcoholic intoxication in alcoholism, continuous,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
