CHIEF COMPLAINT: Headache

PRESENT ILLNESS: This is a 46 year old woman who was a passenger on a
motorcycle this evening when she developed severe headache at
the
vertex that she describes as the worst headache of her life. She
was taken to OSH and CT showed SAH. She was transferred to [**Hospital1 18**]
for further management

MEDICAL HISTORY: AIDS (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4109**] [**Hospital 1559**] Medical Center),
Hepatitis C, CD4 in 20's, viral load 190,000, thrombocytopenia,
recently seen by Hem/Onc at OSH, depression, hypertension,
ureteral implants, colposcopy, IV drug use, rotator cuff injury,
gallstones

MEDICATION ON ADMISSION: lopressor, fluconazole 200mg QD, Truvada, Trazodone 0.5 QHS,
DApsone 100mg po QD, Kaletra, Acyclovir 400 QD, Azithromycin
600mg 2 tabs weekly, Triamcinolone

ALLERGIES: Penicillins / Egg / Sulfa(Sulfonamide Antibiotics) /
Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: On Admission:
: T:98.7 BP: 145/99  HR: 70 R 24  O2Sats 100% 2L NC
Gen: WD/WN, uncomfortable, photophobic.
HEENT: Pupils: [**2-19**] EOMs intact
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: No aneurysms

SOCIAL HISTORY: She formally used IV drugs, reports no current ETOH.
Reports 3 cigarettes for 1 year. She lives in a sober house. She
is on disability.
Subarachnoid hemorrhage,Human immunodeficiency virus [HIV] disease,Acute respiratory failure following trauma and surgery,Other pancytopenia,Other ascites,Acute kidney failure, unspecified,Mixed acid-base balance disorder,Unspecified viral hepatitis C without hepatic coma,Cirrhosis of liver without mention of alcohol,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Do not resuscitate status,Personal history of tobacco use,Other drugs and medicinal substances causing adverse effects in therapeutic use
Subarachnoid hemorrhage,Human immuno virus dis,Ac resp flr fol trma/srg,Other pancytopenia,Ascites NEC,Acute kidney failure NOS,Mixed acid-base bal dis,Hpt C w/o hepat coma NOS,Cirrhosis of liver NOS,Depressive disorder NEC,Hypertension NOS,Esophageal reflux,Do not resusctate status,History of tobacco use,Adv eff medicinal NEC
Admission Date:  [**2166-4-11**]              Discharge Date:   [**2166-4-18**]

Date of Birth:  [**2119-11-6**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins / Egg / Sulfa(Sulfonamide Antibiotics) /
Sulfa(Sulfonamide Antibiotics)

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

Major Surgical or Invasive Procedure:
cerebral angiogram

History of Present Illness:
This is a 46 year old woman who was a passenger on a
motorcycle this evening when she developed severe headache at
the
vertex that she describes as the worst headache of her life. She
was taken to OSH and CT showed SAH. She was transferred to [**Hospital1 18**]
for further management

Past Medical History:
AIDS (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4109**] [**Hospital 1559**] Medical Center),
Hepatitis C, CD4 in 20's, viral load 190,000, thrombocytopenia,
recently seen by Hem/Onc at OSH, depression, hypertension,
ureteral implants, colposcopy, IV drug use, rotator cuff injury,
gallstones

Social History:
She formally used IV drugs, reports no current ETOH.
Reports 3 cigarettes for 1 year. She lives in a sober house. She
is on disability.


Family History:
No aneurysms


Physical Exam:
On Admission:
: T:98.7 BP: 145/99  HR: 70 R 24  O2Sats 100% 2L NC
Gen: WD/WN, uncomfortable, photophobic.
HEENT: Pupils: [**2-19**] EOMs intact
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake but lethargic, somewhat uncooperative with
exam. Yelling at examiner.
Orientation: Oriented to person, place, and date.
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, 2 to 1
mm bilaterally.
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. Patient not cooperative with exam due to HA, moving
symmetrically. No pronator drift

Sensation: Intact to light touch

Toes downgoing bilaterally
on the day of discharge:
[**2166-5-19**]- deceased


Pertinent Results:
CTA head [**2166-4-11**]
CT angiography of the head demonstrates an
approximately 3.5 mm aneurysm arising from the anterior
communicating artery at the junction of the right A1 and A2
segments and pointing to the left side. No other definite
aneurysms are identified in the arteries of anterior and
posterior circulation.

IMPRESSION:
1. CT head demonstrates subarachnoid and intraventricular blood
and signs of early obstructive hydrocephalus.
2. CT angiography of the head demonstrates a 3.5 mm aneurysm
from the
anterior communicating artery at the junction of the right A1
and A2 segment and pointing to the left side. No other aneurysms
are seen in the head.
3. CT angiography of the neck demonstrates no vascular occlusion
or stenosis.

CT Head [**2166-4-12**]:
IMPRESSION:
1. Status post coiling of ACOM aneurysm. Stable amount of
subarachnoid
hemorrhage with interval redistribution. Minimal interval
increase in the
left lateral ventricle IVH.
2. Diffuse sulcal effacement, as before, likely secondary to
mild global
edema.
3. No new hemorrhage.

ECHO [**2166-4-14**]:
The left atrium is mildly dilated. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic stenosis or aortic
regurgitation. The mitral valve leaflets are mildly thickened.
There is no mitral valve prolapse. Mild (1+) mitral
regurgitation is seen. There is mild pulmonary artery systolic
hypertension. There is no pericardial effusion.

CTA Head [**2166-4-15**]:
IMPRESSION:

1. Status post coiling of anterior communicating artery aneurysm
with
decreased subarachnoid and intraventricular hemorrhage since the
prior exam.  No new hemorrhage or obvious infarction. Cerebral
edema has improved since the prior exam. A small hypodense focus
in the right frontal lobe laterally may relate to volume
averaging or less likely a focus of ischemic change and needs
attention on f/u.
2. No flow limiting stenosis or obvious vasospasm or new large
aneurysm.
3. Right distal cervical ICA is tortuous, of uncertain
significance. Given
young age and lack of atherosclerotic disease, clinical
correlation for
connective tissue/ vascular disorders is suggested.

 ABDOMEN U.S. (COMPLETE STUDY) PORT Study Date of [**2166-4-16**] 7:36
AM

IMPRESSION:
1. Moderate ascites within the abdomen.
2. No focal liver lesion and no biliary dilatation.
3. Splenomegaly.

CHEST (PORTABLE AP) Study Date of [**2166-4-17**] 3:31 AM

FINDINGS: As compared to the previous radiograph, there is
unchanged position
of the right PICC line. Unchanged moderate cardiomegaly.
However, the
increased vascular diameter and slightly increased diameter of
the right
paramediastinal vessels suggest newly appeared moderate
pulmonary edema.

The observation was made at the time of dictation, 8:34 a.m., on
[**2166-4-17**]. At that time, the referring physician was paged for
notification.
Findings were subsequently discussed over the telephone.


[**2166-4-17**] 01:57AM BLOOD WBC-6.4 RBC-2.81* Hgb-9.3* Hct-29.7*
MCV-106* MCH-33.0* MCHC-31.3 RDW-17.0* Plt Ct-102*
[**2166-4-11**] 10:30PM BLOOD Neuts-74.8* Bands-0 Lymphs-16.1*
Monos-5.6 Eos-3.1 Baso-0.4
[**2166-4-17**] 01:57AM BLOOD Plt Ct-102*
[**2166-4-15**] 09:43AM BLOOD Fibrino-164*
[**2166-4-17**] 06:20PM BLOOD Glucose-114* UreaN-42* Creat-2.5* Na-138
K-6.0* Cl-110* HCO3-17* AnGap-17
[**2166-4-17**] 01:57AM BLOOD ALT-55* AST-102* LD(LDH)-375*
AlkPhos-147* TotBili-1.9*
[**2166-4-17**] 06:20PM BLOOD Calcium-8.9 Phos-4.1 Mg-2.6
[**2166-4-17**] 06:25PM BLOOD Type-ART pO2-92 pCO2-25* pH-7.44
calTCO2-18* Base XS--4
[**2166-4-17**] 06:25PM BLOOD K-6.1*
[**2166-4-13**] 06:26AM BLOOD freeCa-0.98*

Brief Hospital Course:
Ms. [**Known lastname 4110**] was admitted to the NICU. CTA was done that
redemonstrated SAH and suggested R ACOMM aneurysm. She was
started on nimodipine and Keppra with Q1 hr neuro checks while
in the ICU. She underwent an angio with coiling. She remained
intubated post-op secondary to delayed reversal. She was
angiosealed to the R side. She was extubated Saturday evening
but then required reintubation for hypoxia on [**4-12**].

On [**4-13**] she was hypotensive and Nimodipine was held. TCDs on
[**4-14**] were normal and her SBP normalized and she restarted
Nimodipine. Patient expressed her wishes and declared herself
DNI.

On [**4-15**], she appeared more confused in the AM. A CTA head was
done which showed no vasospasm. No changes were made to her
management. A UA/UC was sent, UA was negative. We also checked
her liver enzymes which appeared improved since admission.

On [**4-16**], Transcranial dopplers revealed no vasospasm.  She
continued to be observed. Hepatology saw her for moderate acites
on US. They recommended lactulose, aldactone and lasix. The
patient continues to exerience to have tachypnea.

[**4-17**]: Hepatology performed diagnostic paracentesis (40cc) which
the patient refused half way through the procedure that was
negative for infection, given 100g albumin. Pt made Care and
comfort measures only per her and family wishes
TCD showed no overt spasm.   Hepatology reccommende starting
lactulose, lasix and aldactone; increasing abdominal distention
overnight, pancultured  complained of SOB and was given lasix
for a urine output of 50-60ml/hr.  The patients hyperkalemia
worsened and so insulin/D50 was given along with kayexylate.
nephrology consulted and recommended giving 80mg lasix and
patient did not respond, so an additional 160mg of lasix was
given. Dialysis not an option as informed by mother (health care
proxy) that patient would never want to be dialyzed. Ultimately,
family decided for CMO for patient.  The patient experienced
respiratory ditress overnight, tachypnea and was on a morphine
gtt for comfort.  Due to respiratory distress the patient
wxpired at 0941 on [**4-18**].


Medications on Admission:
lopressor, fluconazole 200mg QD, Truvada, Trazodone 0.5 QHS,
DApsone 100mg po QD, Kaletra, Acyclovir 400 QD, Azithromycin
600mg 2 tabs weekly, Triamcinolone


Discharge Medications:
none- deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
deceased

Discharge Condition:
none- patient deceased

Discharge Instructions:
none - pt deceased

Followup Instructions:
pt deceased


Completed by:[**2166-4-18**]
{'Subarachnoid hemorrhage,Human immunodeficiency virus [HIV] disease,Acute respiratory failure following trauma and surgery,Other pancytopenia,Other ascites,Acute kidney failure, unspecified,Mixed acid-base balance disorder,Unspecified viral hepatitis C without hepatic coma,Cirrhosis of liver without mention of alcohol,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Do not resuscitate status,Personal history of tobacco use,Other drugs and medicinal substances causing adverse effects in therapeutic use'}


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: This is a 46 year old woman who was a passenger on a
motorcycle this evening when she developed severe headache at
the
vertex that she describes as the worst headache of her life. She
was taken to OSH and CT showed SAH. She was transferred to [**Hospital1 18**]
for further management

MEDICAL HISTORY: AIDS (Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 4109**] [**Hospital 1559**] Medical Center),
Hepatitis C, CD4 in 20's, viral load 190,000, thrombocytopenia,
recently seen by Hem/Onc at OSH, depression, hypertension,
ureteral implants, colposcopy, IV drug use, rotator cuff injury,
gallstones

MEDICATION ON ADMISSION: lopressor, fluconazole 200mg QD, Truvada, Trazodone 0.5 QHS,
DApsone 100mg po QD, Kaletra, Acyclovir 400 QD, Azithromycin
600mg 2 tabs weekly, Triamcinolone

ALLERGIES: Penicillins / Egg / Sulfa(Sulfonamide Antibiotics) /
Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: On Admission:
: T:98.7 BP: 145/99  HR: 70 R 24  O2Sats 100% 2L NC
Gen: WD/WN, uncomfortable, photophobic.
HEENT: Pupils: [**2-19**] EOMs intact
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: No aneurysms

SOCIAL HISTORY: She formally used IV drugs, reports no current ETOH.
Reports 3 cigarettes for 1 year. She lives in a sober house. She
is on disability. 

### Response:
{'Subarachnoid hemorrhage,Human immunodeficiency virus [HIV] disease,Acute respiratory failure following trauma and surgery,Other pancytopenia,Other ascites,Acute kidney failure, unspecified,Mixed acid-base balance disorder,Unspecified viral hepatitis C without hepatic coma,Cirrhosis of liver without mention of alcohol,Depressive disorder, not elsewhere classified,Unspecified essential hypertension,Esophageal reflux,Do not resuscitate status,Personal history of tobacco use,Other drugs and medicinal substances causing adverse effects in therapeutic use'}
