CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 57 year-old man
who was found face down in his garden at home at
approximately 6:00 p.m. on [**2184-7-4**].  The patient works
as an electrician at the [**Hospital1 69**]
and had worked prior in the day and was last seen
approximately a half an hour before being found prone in his
garden.  On EMT arrival the patient was found awake with his
eyes closed and he was not following commands.  At this time
his pupils were 2 mm reactive bilaterally and he was moving
all extremities.  Electrocardiogram revealed a rhythm of
atrial fibrillation at a rate of 140.  In route to the
Emergency Department at approximately 6:15 p.m. the patient
exhibited 20 seconds of seizure activity.  He began to
demonstrate decerebrate posturing and he was therefore
intubated for airway protection.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subarachnoid hemorrhage,Atrial fibrillation,Obstructive hydrocephalus,Cerebral artery occlusion, unspecified with cerebral infarction,Quadriplegia, C1-C4, complete,Anemia, unspecified
Subarachnoid hemorrhage,Atrial fibrillation,Obstructiv hydrocephalus,Crbl art ocl NOS w infrc,Quadrplg c1-c4, complete,Anemia NOS
Admission Date: [**2184-7-4**]        Discharge Date: [**2184-7-11**]

Date of Birth:  [**2126-8-4**]        Sex:  M

Service:  NSU


ADMISSION DIAGNOSES:  grade V subarachnoid hemorrhage.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 57 year-old man
who was found face down in his garden at home at
approximately 6:00 p.m. on [**2184-7-4**].  The patient works
as an electrician at the [**Hospital1 69**]
and had worked prior in the day and was last seen
approximately a half an hour before being found prone in his
garden.  On EMT arrival the patient was found awake with his
eyes closed and he was not following commands.  At this time
his pupils were 2 mm reactive bilaterally and he was moving
all extremities.  Electrocardiogram revealed a rhythm of
atrial fibrillation at a rate of 140.  In route to the
Emergency Department at approximately 6:15 p.m. the patient
exhibited 20 seconds of seizure activity.  He began to
demonstrate decerebrate posturing and he was therefore
intubated for airway protection.

Per the Emergency Room physician the patient was started on
Propofol on arrival and had 2 mm reactive pupils and was seen
moving all extremities.  He was transported expediently to
the CT scanner, which showed a large left temporal bleed with
blood extending to the cisterns and a left frontal
intraparenchymal contusion without any evidence of skull
fracture. He was also seen to demonstrate decerebrate posturing
on the left upper extremity and had only minimal inward rotation
on the right upper extremity without any movement in his lower
extremities.  Significant admission laboratory values
revealed stable hematocrit and coagulation panel and based on
the CT findings, which were significant for a massive left
temporal lobe intraparenchymal hemorrhage with diffuse
subarachnoid hemorrhage and early demonstration of a shift
from left to right of his septum [**Last Name (LF) 23543**], [**First Name3 (LF) **] emergent
ventricular drain was placed by the neurosurgical resident in
the Emergency Room.  The patient was then transported to the
neuro SICU for close monitoring.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature afebrile,
heart rate 80 with a rate of atrial fibrillation, pressure
189/110, ventilator 99 percent on 100 percent oxygen.  The
patient was intubated and sedated.  He was not following
commands.  Left pupil was 5 mm nonreactive, right pupil was
3.5 mm minimally reactive, with minimal corneal reflexes on
the right and no corneal reflexes of his left eye. The left
upper extremity demonstrated decerebrate posturing, and the
right upper extremity demonstrated minimal inward rotation.
Bilateral lower extremities demonstrated no movement to
painful stimuli.  Babinski was positive bilaterally. There
was no evidence of clonus.  Reflexes were normal in the
bilateral biceps and bilateral patella.

HOSPITAL COURSE:  On [**7-4**] after placement of ventricular
drain the patient was transported to the neuro CICU.  CT of
the C spine was read as negative without any evidence of
fracture dislocation. He was transported for a CTA of the
head four hours after his first CT, which demonstrated
interval increase with mass effect and subthalassin
herniation.  The drainage catheter was in good place.  CTA
was significant for a 5 mm aneurysm at the bifurcation of the
left MCA.  On [**7-5**] in the early morning the patient was
taken to angio by Dr. [**Last Name (STitle) 1132**], which was significant for a
ruptured pedunculated left middle cerebral artery, which was
then coiled.  His postop check revealed stable disconjugate
gaze with his left pupil being down and out.  At this time
both pupils were 2 mm trace reactive and he did have a
bilateral weak corneal reflex.  The patient was localizing to
the bilateral upper extremities and had only slight withdraw
to his lower extremities.  He was continued on Ancef for his
ventricular drain and goal pressures were under systolics of
130s with PCO2s of 35 to 40. His drain was kept at 15 cm and
he was continued on Mannitol, Nimodipine, and Dilantin.

On [**7-6**] the patient was found to have ICPs ranging from 12
to 16 and therefore his drain was decreased to 10 cm while
the Mannitol was continued.  His examination had not changed
from the day before where he continued to localize his
bilateral upper extremities and had slow slight withdraw to
the bilateral lower extremities.  Due to the patient's
continued high intracranial pressures in the high teens and
low 20s on Mannitol the decision was made by the
neurosurgical team to take the patient to the Operating Room
for a decompressive craniectomy.  The procedure involved a
large left craniectomy with intraabdominal placement of bone
flap and it went well without any complications.  For further
details please see the operative note dictated on this day.
He was transferred back to the neuro CICU at this time where
he was continued on Mannitol 25 q four hours and was started
on Lasix 10 mg for ICPs greater then 25 and CVPs greater then
10.  On [**7-7**] the patient was found to have a fever to
101.2.  He was pan cultured with results being negative and
he was maintained on his Mannitol and Lasix with frequent
serum osmol checks.  His drain was dropped to 0 for his
intracranial pressures in the high teens and low 20s.  He was
also transfused 2 units of red blood cells for a low
hematocrit.  On [**7-8**] the patient continued to have fevers
to 101.1 and his examination on Propofol revealed only trace
movement of the bilateral upper extremities with very little
movement of the lower extremities.  A CT of the head was done
and revealed stable ventricles and trans central herniation,
however, it also was significant for new infarct of the
occipital lobe in the left frontal parietal region.  The
large subarachnoid hemorrhage and left temporal lobe
intraparenchymal hemorrhage appeared stable on this scan.
Cultures were resent including cerebral spinal fluid and came
back negative.  The patient's examination did not change
during this time.  He continued to be unresponsive and had
minimal movement to stimulation.

On [**7-9**] the patient went down for another CT scan
revealing no change in the trans central herniation and
stable progression of his new infarct in the occipital lobe
and left frontal parietal region.  His surgical drain was
discontinued at this time.  He was ruled out for an
myocardial infarction with cardiac enzymes times three and he
was transfused a unit of packed red blood cells for a low
hematocrit of 26.6.  In addition, he was bolused to establish
a therapeutic Dilantin level.  The patient continued to have
fevers overnight to 102.2 and on [**7-10**] an x-ray was
performed showing a right lower lobe opacity as well as some
fluid overload, therefore the patient was aggressively
diuresed and started on Levofloxacin in addition to the
Kefzol for his ventricular drain.  Family meetings were held
with discussion with the neuro Intensive Care Unit team and
the neurosurgical team and discussion was held regarding the
patient's likely poor prognosis given his very limited
examination, large bleed with herniation of the brain and new
infarcts.  On [**7-11**] the patient's extended family arrived
and a discussion was held with the SICU staff and the patient
where the decision was made to make the patient CMO on [**2184-7-12**] with subsequent organ donation at this time.  The
organ bank was contact[**Name (NI) **].

DISCHARGE DIAGNOSES:  Left middle cerebral aneurysm and
subarachnoid hemorrhage.

DISCHARGE STATUS:  Expired.



                        [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**]

Dictated By:[**Last Name (NamePattern1) 23544**]
MEDQUIST36
D:  [**2184-7-12**] 10:55:03
T:  [**2184-7-12**] 12:26:52
Job#:  [**Job Number 23545**]
{'Subarachnoid hemorrhage,Atrial fibrillation,Obstructive hydrocephalus,Cerebral artery occlusion, unspecified with cerebral infarction,Quadriplegia, C1-C4, complete,Anemia, unspecified'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 57 year-old man
who was found face down in his garden at home at
approximately 6:00 p.m. on [**2184-7-4**].  The patient works
as an electrician at the [**Hospital1 69**]
and had worked prior in the day and was last seen
approximately a half an hour before being found prone in his
garden.  On EMT arrival the patient was found awake with his
eyes closed and he was not following commands.  At this time
his pupils were 2 mm reactive bilaterally and he was moving
all extremities.  Electrocardiogram revealed a rhythm of
atrial fibrillation at a rate of 140.  In route to the
Emergency Department at approximately 6:15 p.m. the patient
exhibited 20 seconds of seizure activity.  He began to
demonstrate decerebrate posturing and he was therefore
intubated for airway protection.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subarachnoid hemorrhage,Atrial fibrillation,Obstructive hydrocephalus,Cerebral artery occlusion, unspecified with cerebral infarction,Quadriplegia, C1-C4, complete,Anemia, unspecified'}
