CHIEF COMPLAINT: HEADACHE

PRESENT ILLNESS: Mr. [**Known lastname 23657**] is a 54 yo RHM with h/o HCV who presents with
headache, R leg and hand weakness. The patient developed a
headache last Wednesday (6 days PTA). The headache was severe
but
waxed and waned, he cannot recall how it started but does not
recall a sudden thunderclap onset. Pain is located behind face
(eyes, forehead) bilaterally, and is pressure-like. It has kept
him awake at nights, and he has slept in few hour increments.
Headache has no positional component. Patient endorses neck
stiffness, denies photophobia. No vision changes or diplopia.
The patient had an episode of leg weakness last night. He was
walking from kitchen to couch when his legs buckled, he felt his
R leg was weaker. There were no other symptoms last night.
This AM, patient went to work and kept dropping his lunchbag
from
the right hand. His legs buckled again. Coworkers made him go to
ED, and he presented to [**Hospital3 **].
At [**Hospital3 **], patient was mildly confused, c/o slurred speech.
NCHCT showed small SAH. He received Zofran, morphine, potassium.

MEDICAL HISTORY: HCV- treated x 2 with ribavirin

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]:  2      [**Doctor Last Name **]: 3
O: T: 97  BP: 155/75/         HR: 78   R  16     O2Sats 96/RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3 to 2.5mm        EOMs intact
Neck: Supple. No bruits.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Negative for intracranial hemorrhage or aneurysm. Uncle had
stroke in his 50s, father had [**Name2 (NI) **].

SOCIAL HISTORY: Works for the government as a electronic tech. Smokes, drinks
rare EtOH, no illicits.
Subarachnoid hemorrhage,Other specified transient cerebral ischemias,Thrombocytopenia, unspecified,Alcohol withdrawal,Fever, unspecified,Tobacco use disorder,Muscle weakness (generalized),Personal history of other infectious and parasitic diseases
Subarachnoid hemorrhage,Trans cereb ischemia NEC,Thrombocytopenia NOS,Alcohol withdrawal,Fever NOS,Tobacco use disorder,Muscle weakness-general,Prsnl hst oth nfct parst
Admission Date:  [**2124-5-8**]              Discharge Date:   [**2124-5-15**]

Date of Birth:  [**2069-9-7**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
HEADACHE

Major Surgical or Invasive Procedure:
[**2124-5-8**]: Cerebral Angiogram for coiling of the ACOMM aneurysm,
balloon angioplasty of R MCA, and interarterial verapamil


History of Present Illness:
Mr. [**Known lastname 23657**] is a 54 yo RHM with h/o HCV who presents with
headache, R leg and hand weakness. The patient developed a
headache last Wednesday (6 days PTA). The headache was severe
but
waxed and waned, he cannot recall how it started but does not
recall a sudden thunderclap onset. Pain is located behind face
(eyes, forehead) bilaterally, and is pressure-like. It has kept
him awake at nights, and he has slept in few hour increments.
Headache has no positional component. Patient endorses neck
stiffness, denies photophobia. No vision changes or diplopia.
The patient had an episode of leg weakness last night. He was
walking from kitchen to couch when his legs buckled, he felt his
R leg was weaker. There were no other symptoms last night.
This AM, patient went to work and kept dropping his lunchbag
from
the right hand. His legs buckled again. Coworkers made him go to
ED, and he presented to [**Hospital3 **].
At [**Hospital3 **], patient was mildly confused, c/o slurred speech.
NCHCT showed small SAH. He received Zofran, morphine, potassium.



Past Medical History:
HCV- treated x 2 with ribavirin


Social History:
Works for the government as a electronic tech. Smokes, drinks
rare EtOH, no illicits.


Family History:
Negative for intracranial hemorrhage or aneurysm. Uncle had
stroke in his 50s, father had [**Name2 (NI) **].


Physical Exam:
PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]:  2      [**Doctor Last Name **]: 3
O: T: 97  BP: 155/75/         HR: 78   R  16     O2Sats 96/RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3 to 2.5mm        EOMs intact
Neck: Supple. No bruits.
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. Irritable.
Orientation: Oriented to person, place, and date.
Attention: months of year backwards- makes 2 uncorrected errors
Language: Speech fluent with good comprehension and repetition.
Naming intact. Mild dysarthria. No paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2.5
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 [**6-15**] throughout. Trace R upwards
pronator drift.

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

Reflexes: B T Br Pa Ac
Right     2 2 2  2  1
Left      2 2 2  2  1

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements

Gait: normal base and stride

On the day of discharge: [**2124-5-15**]
The patient is alert and oriented to person place and time.  The
patient's strength and sensation are full.  The patient is
independently ambulatory with steady gait and has been cleared
by physical therapy.  There is no facial droop.  There is no
pronator drift.


Pertinent Results:
CTA Head [**2124-5-8**]:
ACOMM aneurysm 5x4mm, vasospasm seen especially at R MCA but
appears to still be patent.

[**5-9**] ECHO: The left atrium is normal in size. No atrial septal
defect is seen by 2D or color Doppler. There is mild symmetric
left ventricular hypertrophy with normal cavity size and
regional/global systolic function (LVEF>55%). There is no
ventricular septal defect. Right ventricular chamber size and
free wall motion are normal. The aortic valve leaflets (3) are
mildly thickened. There is no valvular aortic stenosis. The
increased transaortic velocity is likely related to high cardiac
output. No aortic regurgitation is seen. The mitral valve
appears structurally normal with trivial mitral regurgitation.
Physiologic mitral regurgitation is seen (within normal limits).
The estimated pulmonary artery systolic pressure is normal.
There is no pericardial effusion.

[**5-9**] CT head: IMPRESSION:
1. No CT evidence of an acute major vascular infarct. MRI would
be more
sensitive, if indicated.
2. Extensive subarachnoid hemorrhage is again noted in the
interhemispheric fissure and cerebral sulci, grossly stable
allowing for recent iv contrast administration, with stable
extension into the right inferomedial frontal lobe parenchyma
and moderate surrounding parenchymal edema. Stable mild
parafalcine and paratentorial subdural hemorrhage.

CHEST (PA & LAT) Study Date of [**2124-5-12**] 10:32 AM
Final Report

COMPARISON: Radiographs dating back to [**2124-5-9**].
FINDINGS: Right lower lobe density appears new since [**2124-5-9**].
There is no
pleural effusion. The cardiac size is normal. The left internal
jugular
central venous catheter has been removed.
IMPRESSION:
New right lower lobe density could represent either atelectasis
or pneumonia.

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






[**2124-5-8**] 10:07PM   GLUCOSE-83 UREA N-11 CREAT-0.7 SODIUM-140
POTASSIUM-3.3 CHLORIDE-111* TOTAL CO2-22 ANION GAP-10
[**2124-5-8**] 10:07PM   CALCIUM-7.4* PHOSPHATE-3.5 MAGNESIUM-1.8
[**2124-5-8**] 10:07PM   WBC-7.0 RBC-4.10* HGB-14.6 HCT-41.1 MCV-100*
MCH-35.7* MCHC-35.5* RDW-14.3
[**2124-5-8**] 10:07PM   PLT COUNT-110*
[**2124-5-8**] 10:07PM   PT-18.0* PTT-98.7* INR(PT)-1.6*
[**2124-5-8**] 06:00PM URINE  HOURS-RANDOM
[**2124-5-8**] 06:00PM URINE  GR HOLD-HOLD
[**2124-5-8**] 04:11PM   K+-3.5
[**2124-5-8**] 04:08PM   GLUCOSE-88 UREA N-13 CREAT-0.6 SODIUM-137
POTASSIUM-3.4 CHLORIDE-105 TOTAL CO2-24 ANION GAP-11
[**2124-5-8**] 04:08PM   estGFR-Using this
[**2124-5-8**] 04:08PM   ALT(SGPT)-68* AST(SGOT)-84* LD(LDH)-243 ALK
PHOS-100 TOT BILI-2.0*
[**2124-5-8**] 04:08PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2124-5-8**] 04:08PM   WBC-6.2 RBC-4.45* HGB-15.9 HCT-43.7 MCV-98
MCH-35.6* MCHC-36.3* RDW-14.2
[**2124-5-8**] 04:08PM   PLT COUNT-101*
[**2124-5-8**] 04:08PM   PT-16.6* PTT-29.6 INR(PT)-1.5*
[**2124-5-14**] 09:40AM BLOOD WBC-5.0 RBC-4.00* Hgb-14.9 Hct-40.2
MCV-100* MCH-37.2* MCHC-37.0* RDW-14.1 Plt Ct-122*
[**2124-5-14**] 09:40AM BLOOD Plt Ct-122*
[**2124-5-14**] 09:40AM BLOOD Glucose-138* UreaN-8 Creat-0.7 Na-135
K-3.6 Cl-103 HCO3-24 AnGap-12
[**2124-5-12**] 05:40AM BLOOD ALT-54* AST-85* LD(LDH)-271* AlkPhos-122
TotBili-1.6*
[**2124-5-14**] 09:40AM BLOOD Calcium-8.0* Phos-2.9 Mg-1.7
[**2124-5-12**] 05:40AM BLOOD Phenyto-13.0

Brief Hospital Course:
54M who presented to the ER with headache since [**5-3**], Head CT
showed a SAH and a CTA was performed which showed a ACOMM
aneurysm. He was taken to angiogram and underwent a coiling;
diffused vasospasm was noted and a balloon angioplasty was done
on the R MCA and interarterial verapamil was injected. He was
then admitted to the Neuro ICU. Initially, his SBP was kept at
180-200 with the use of pressors, but after receiving
Nimodipine, his SBP was unable to maintain > 180. Pressors were
increased and multiple ones were added but his SBP remained
labile.

On [**5-8**], Alt/AST68* 84*

On [**5-9**] AM, the pressors were weaned off and he was given a
bolus of dilantin for subtherapeutic level. He was taken to
angio and underwent repeat imaging which revealed no vasospasm.
He was started on aspirin. CXR was consistent with linear
density in the left lower lobe is most likely related to
atelectasis. There was no
evidence of consolidation, effusion or pneumothorax.

On [**5-10**] he remained neurologically stable so he was cleared for
transfer to the stepdown unit.

On [**5-11**], the patient was transferred to the Step Down Unit.  The
patient was febrile.

On [**5-12**], CXR consistent with new right lower lobe density could
represent either atelectasis or pneumonia.  The patients
neurologic exam continued to be intact.platlet count was 85.
Platlets were trended over next two days. ALT/ AST 54* 85*

On [**5-13**], Dilantin was discontinued secondary to elevated liver
function tests.  The subcutaneous Heparin was discontinued.
Platlets 119.

[**5-14**]: Platlet count was 122.  Plan for possible discharge was
made for [**5-15**].

[**5-15**]: The electrolytes were repleated for a K of 3.6, MG 1.7, CA
8.  The patient was neurologicall intact.  He was alert and
oriented to person, place, and time.  His strength was full. The
patient had a temperature of 99 and was encouraged to use his
incentive spirometer.  The patient was discharged with a
incentive spirometer and asked to use this every 2 hours.  The
patient was looking forward to his discharge and asking to leave
the hospital.


Medications on Admission:
None

Discharge Medications:
1. diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) as needed for insomnia, allergies.
2. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
[**Month/Day (4) **]:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
[**Month/Day (4) **]:*30 Tablet(s)* Refills:*0*
4. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
[**Month/Day (4) **]:*30 Capsule(s)* Refills:*0*
6. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours
as needed for pain: do not drive while taking, do not take if
lethargic.
[**Month/Day (4) **]:*40 Tablet(s)* Refills:*0*
7. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
[**Month/Day (4) **]:*30 Tablet(s)* Refills:*2*
8. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): please discuss with your primary care physician to
continue.
[**Month/Day (4) **]:*10 Tablet(s)* Refills:*0*
9. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
please discuss continued use and prscriptions with your primary
care doctor.
[**Last Name (Titles) **]:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Subarachnoid Hemorrhage
ACOMM Aneurysm
Diffused cerebral vasospasm
Fever
Thrombocytopenia
Elevated liver enzymes


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


Discharge Instructions:
Angiogram with Embolization
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.

Please use your INCENTIVE SPIROMETER every two hours taking care
to take 10 deep breaths every two hours.

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


Followup Instructions:
Please follow-up with Dr. [**First Name (STitle) **] in 4 weeks with a MRI/MRA
([**Doctor Last Name **] protocol).
[**2124-6-15**]  02:00p   [**Last Name (LF) **],[**First Name3 (LF) **] J.
  LM [**Hospital Unit Name **], [**Location (un) **]
  NEUROSURGERY WEST

[**2124-6-15**]  12:40p   XMR WEST GE 3T
  CC CLINICAL CENTER, BASEMENT
  RADIOLOGY

 If you are unable to keep this appointment, please call Ms.
[**Name14 (STitle) 89584**] [**Doctor First Name **] [**Telephone/Fax (1) 4296**] to make this appointment.



Completed by:[**2124-5-15**]
{'Subarachnoid hemorrhage,Other specified transient cerebral ischemias,Thrombocytopenia, unspecified,Alcohol withdrawal,Fever, unspecified,Tobacco use disorder,Muscle weakness (generalized),Personal history of other infectious and parasitic diseases'}


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: Mr. [**Known lastname 23657**] is a 54 yo RHM with h/o HCV who presents with
headache, R leg and hand weakness. The patient developed a
headache last Wednesday (6 days PTA). The headache was severe
but
waxed and waned, he cannot recall how it started but does not
recall a sudden thunderclap onset. Pain is located behind face
(eyes, forehead) bilaterally, and is pressure-like. It has kept
him awake at nights, and he has slept in few hour increments.
Headache has no positional component. Patient endorses neck
stiffness, denies photophobia. No vision changes or diplopia.
The patient had an episode of leg weakness last night. He was
walking from kitchen to couch when his legs buckled, he felt his
R leg was weaker. There were no other symptoms last night.
This AM, patient went to work and kept dropping his lunchbag
from
the right hand. His legs buckled again. Coworkers made him go to
ED, and he presented to [**Hospital3 **].
At [**Hospital3 **], patient was mildly confused, c/o slurred speech.
NCHCT showed small SAH. He received Zofran, morphine, potassium.

MEDICAL HISTORY: HCV- treated x 2 with ribavirin

MEDICATION ON ADMISSION: None

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: PHYSICAL EXAM:
Hunt and [**Doctor Last Name 9381**]:  2      [**Doctor Last Name **]: 3
O: T: 97  BP: 155/75/         HR: 78   R  16     O2Sats 96/RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3 to 2.5mm        EOMs intact
Neck: Supple. No bruits.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Negative for intracranial hemorrhage or aneurysm. Uncle had
stroke in his 50s, father had [**Name2 (NI) **].

SOCIAL HISTORY: Works for the government as a electronic tech. Smokes, drinks
rare EtOH, no illicits. 

### Response:
{'Subarachnoid hemorrhage,Other specified transient cerebral ischemias,Thrombocytopenia, unspecified,Alcohol withdrawal,Fever, unspecified,Tobacco use disorder,Muscle weakness (generalized),Personal history of other infectious and parasitic diseases'}
