CHIEF COMPLAINT: Falls - found to have R cerebellar hemorrhage at OSH

PRESENT ILLNESS: Mr [**Known lastname 61509**] is a LHM, and is a retired printer (former veteran),
who normally does cross-word puzzles, Sodoku and plays Game Boy.
He was in his usual state of health until 3 am on [**10-24**]. His
step-son, [**Name (NI) **] [**Name (NI) 36913**], whom he lives with, found him sitting
by the front door, drenched in blood, and trying to get out. Mr
[**Name13 (STitle) 36913**] cleaned his step-father up, and noticed that he had hit
the right side of his forehead and right forearm. Mr [**Name13 (STitle) 36913**]
took his father back to bed, at around 4 am. Mr [**Known lastname 61509**] [**Last Name (Titles) **] up
around 6:30 am, and had breakfast around 7 am which consisted of
his usual bowl of cereal and two cups of coffee. Mr [**Known lastname 79898**]
daughter-in-law [**Doctor First Name **] noticed that he had made a mess in the
kitchen earlier that morning, taken the kitchen rug and tried to
wrap the table in it. However, both Mr and Mrs [**Last Name (STitle) 36913**] left for
work, requesting their daughter ([**Name (NI) **]) to look in on Mr
[**Name (NI) 61509**]. [**Doctor First Name **] came by to give Mr [**Known lastname 61509**] lunch, and
found that there was more blood in the house, in addition, he
had vomited his breakfast up on the living room sofa. She
noticed that while he was eating his bowl of soup, his soup
spoon kept missing his mouth. In addition, she noticed that her
grand-father's speech was slurred. [**Doctor First Name **] took her Grand-father
to the [**Hospital3 **] [**Name (NI) **]. He had a CT of his brain which
showed a right cerebellar hemorrhagic lesion with vasogenic
edema and some compression of the fourth ventricle, so he was
transferred to [**Hospital1 18**] ED. At the ED he was reviewed by
Neurosurgery.

MEDICAL HISTORY: 1. Asthma
2. Osteoporosis
3. Osteoarthritis
4. s/p bilateral catarect surgery

MEDICATION ON ADMISSION: Fosamax
Advair
Serevent
Albuterol as needed

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T99, HR 40, BP 157/60, RR 16, SpO2 96% on room air
General: right forehead and right arm bruises noted.
HEENT: complained that it tickled when trying to examine the
cervical lymph nodes.
Resp: Poor air entry in the right middle zone
CVS: difficult to hear the heart sounds clearly, as he would not
stop talking
GI: Soft, non-tender with normal bowel sounds.

FAMILY HISTORY: Not known

SOCIAL HISTORY: Lives with his step-son who is his only child and his HCP, his
name is [**Name (NI) **] [**Name (NI) 36913**] and his cell phone number is: [**Telephone/Fax (1) 79899**]. According to Mr [**Last Name (Titles) 36913**], his step-father is DNR/DNI. His
PCP is Dr [**Last Name (STitle) 27542**] at [**Location (un) **]. He is an
ex-smoker, smoking up to two packs per day (not known over the
number of years). Mr [**Known lastname 61509**] does not drink alcohol. His bedroom
is on the [**Location (un) 1773**], and he normally manages his ADLs.
Intracerebral hemorrhage,Compression of brain,Hallucinations,Neoplasm of uncertain behavior of brain and spinal cord,Lack of coordination,Dysphagia, pharyngeal phase,Asthma, unspecified type, unspecified,Other second degree atrioventricular block,Other specified cardiac dysrhythmias,Osteoporosis, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Accidental fall from bed,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use
Intracerebral hemorrhage,Compression of brain,Hallucinations,Unc beh neo brain/spinal,Lack of coordination,Dysphagia, pharyngeal,Asthma NOS,Av block-2nd degree NEC,Cardiac dysrhythmias NEC,Osteoporosis NOS,Osteoarthros NOS-unspec,Leukocytosis NOS,Adv eff corticosteroids,Fall from bed,Hx TIA/stroke w/o resid,History of tobacco use
Admission Date:  [**2107-10-24**]              Discharge Date:   [**2107-11-9**]

Date of Birth:  [**2025-11-13**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 13565**]
Chief Complaint:
Falls - found to have R cerebellar hemorrhage at OSH

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr [**Known lastname 61509**] is a LHM, and is a retired printer (former veteran),
who normally does cross-word puzzles, Sodoku and plays Game Boy.
He was in his usual state of health until 3 am on [**10-24**]. His
step-son, [**Name (NI) **] [**Name (NI) 36913**], whom he lives with, found him sitting
by the front door, drenched in blood, and trying to get out. Mr
[**Name13 (STitle) 36913**] cleaned his step-father up, and noticed that he had hit
the right side of his forehead and right forearm. Mr [**Name13 (STitle) 36913**]
took his father back to bed, at around 4 am. Mr [**Known lastname 61509**] [**Last Name (Titles) **] up
around 6:30 am, and had breakfast around 7 am which consisted of
his usual bowl of cereal and two cups of coffee. Mr [**Known lastname 79898**]
daughter-in-law [**Doctor First Name **] noticed that he had made a mess in the
kitchen earlier that morning, taken the kitchen rug and tried to
wrap the table in it. However, both Mr and Mrs [**Last Name (STitle) 36913**] left for
work, requesting their daughter ([**Name (NI) **]) to look in on Mr
[**Name (NI) 61509**]. [**Doctor First Name **] came by to give Mr [**Known lastname 61509**] lunch, and
found that there was more blood in the house, in addition, he
had vomited his breakfast up on the living room sofa. She
noticed that while he was eating his bowl of soup, his soup
spoon kept missing his mouth. In addition, she noticed that her
grand-father's speech was slurred. [**Doctor First Name **] took her Grand-father
to the [**Hospital3 **] [**Name (NI) **]. He had a CT of his brain which
showed a right cerebellar hemorrhagic lesion with vasogenic
edema and some compression of the fourth ventricle, so he was
transferred to [**Hospital1 18**] ED. At the ED he was reviewed by
Neurosurgery.

Review of systems: Apart from headache, the rest of his systems
review was apparently negative.

Past Medical History:
1. Asthma
2. Osteoporosis
3. Osteoarthritis
4. s/p bilateral catarect surgery

Social History:
Lives with his step-son who is his only child and his HCP, his
name is [**Name (NI) **] [**Name (NI) 36913**] and his cell phone number is: [**Telephone/Fax (1) 79899**]. According to Mr [**Last Name (Titles) 36913**], his step-father is DNR/DNI. His
PCP is Dr [**Last Name (STitle) 27542**] at [**Location (un) **]. He is an
ex-smoker, smoking up to two packs per day (not known over the
number of years). Mr [**Known lastname 61509**] does not drink alcohol. His bedroom
is on the [**Location (un) 1773**], and he normally manages his ADLs.


Family History:
Not known

Physical Exam:
Vitals: T99, HR 40, BP 157/60, RR 16, SpO2 96% on room air
General: right forehead and right arm bruises noted.
HEENT: complained that it tickled when trying to examine the
cervical lymph nodes.
Resp: Poor air entry in the right middle zone
CVS: difficult to hear the heart sounds clearly, as he would not
stop talking
GI: Soft, non-tender with normal bowel sounds.

Neurological Examination
Mental status: Awake and alert, multiple promptings for the
exam. Oriented to person, [**Location (un) 86**] and [**2107**]. Normal repetition; no
anomia. Moderate dysarthria. Registers 0/3,recalls 0/3 in 5
minutes. Right-left confusion.

Cranial Nerves: Fundoscopic examination kept closing his eyes
tightly. Pupils equally round and reactive to light, 3 to 2
mmbilaterally. Visual fields appear to be full to confrontation,
but he is easily distractible. Extraocular movements intact
bilaterally with nystagmus to the right. Sensation appears to
beintact V1-V3. Facial movements are symmetric. Palate
elevationsymmetric. Sternocleidomastoid and trapezius full
strength bilaterally. Tongue midline.

Motor: Decreased bulk diffusely but normal tone bilaterally. No
observed myoclonus, asterixis, or tremor. No pronator drift.
Full strength in all muscles tested.

Sensory testing was totally unreliable.

Reflexes: 2+ and symmetric throughout. Positive Babinski on the
right.

Coordination: Normal finger-nose-finger, heel to shin, and fine
finger movements.

Gait: Unsafe on his feet very unsteady


Pertinent Results:
[**2107-10-24**] 03:55PM BLOOD WBC-8.6 RBC-3.82* Hgb-11.9* Hct-34.0*
MCV-89 MCH-31.2 MCHC-35.1* RDW-13.7 Plt Ct-278
[**2107-10-24**] 03:55PM BLOOD Glucose-92 UreaN-20 Creat-0.9 Na-143
K-4.1 Cl-109* HCO3-23 AnGap-15
[**2107-10-25**] 02:43AM BLOOD ALT-11 AST-18 AlkPhos-92 TotBili-1.0
[**2107-10-24**] 03:55PM BLOOD CK-MB-4
[**2107-10-25**] 02:43AM BLOOD Calcium-8.9 Phos-2.3* Mg-2.1
[**2107-10-24**] 03:55PM BLOOD TotProt-6.5

EKG [**10-24**]: Sinus bradycardi.  Left bundle branch block

CT head:
1. 1.5 cm hyperdense lesion in the right cerebellar hemisphere,
with
surrounding edema, and mild effacement of the fourth ventricle.
Differential considerations include hyperdense or hemorrhagic
metastasis, versus vascular malformation, or other source of
hemorrhage, including hypertensive bleed. MRI with contrast is
recommended for further evaluation.

2. 1.3 cm probable small calcified meningioma right middle
cranial fossa.
This could also be more definitively characterized by MRI.

3. Vascular calcifications, and bilateral basal ganglia chronic
lacunar
infarcts, and right frontal chronic infarction.

MR head: Approximately 1.5-cm lesion in the right cerebellar
hemisphere
with surrounding edema most consistent with a hemorrhagic tumor.
Adjacent
enhancement in the cerebellar sulci may be leptomeningeal
seeding from a
tumor. These findings are most consistent with a malignant
hemorrhagic tumor.

[**2107-11-8**] 11:20AM BLOOD WBC-22.7* RBC-4.08* Hgb-12.7* Hct-37.4*
MCV-92 MCH-31.1 MCHC-33.9 RDW-13.9 Plt Ct-373
[**2107-11-5**] 07:20AM BLOOD Neuts-94.3* Lymphs-3.9* Monos-1.8* Eos-0
Baso-0
[**2107-11-2**] 09:10AM BLOOD PT-13.0 PTT-28.1 INR(PT)-1.1
[**2107-11-8**] 11:20AM BLOOD Glucose-166* UreaN-38* Creat-1.0 Na-136
K-4.3 Cl-96 HCO3-26 AnGap-18
[**2107-11-5**] 07:20AM BLOOD Glucose-125* UreaN-32* Creat-0.8 Na-139
K-4.2 Cl-100 HCO3-28 AnGap-15
[**2107-11-3**] 06:20AM BLOOD Glucose-107* UreaN-34* Creat-0.8 Na-138
K-4.5 Cl-103 HCO3-24 AnGap-16
[**2107-11-5**] 07:20AM BLOOD ALT-24 AST-17 LD(LDH)-282* AlkPhos-74
Amylase-65 TotBili-0.8
[**2107-11-5**] 07:20AM BLOOD Albumin-3.6 Calcium-9.0 Phos-4.8* Mg-2.4
[**2107-11-5**] 01:43AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG

MRI Brain [**10-24**]: FINDINGS: There is a well-defined hyperintense
lesion within the right cerebellar hemisphere, measuring
approximately 15 x 12 mm. T1-weighted imaging shows
inhomogeneous signal with a surrounding dark ring. Gradient-echo
sequence shows the lesion to be hypointense. There is a large
area of surrounding edema. On post-contrast images, there is
uniform enhancement of the dura. There is also enhancement of
the cerebellar sulci which could signify leptomeningeal seeding
from a tumor.
IMPRESSION: Approximately 1.5-cm lesion in the right cerebellar
hemisphere with surrounding edema most consistent with a
hemorrhagic tumor. Adjacent enhancement in the cerebellar sulci
may be leptomeningeal seeding from a tumor. These findings are
most consistent with a malignant hemorrhagic tumor.

MRI Brain [**11-7**]: Prelim read: Large decrease in mass effect of
right cerebellar mass on fourth ventricle since MR [**First Name (Titles) **] [**10-24**]
with small improvement in mass effect seen since head CT of
[**11-4**].


Brief Hospital Course:
Patient is a 81 year old LHM with a h/o smoking presents with
recent multiple falls with possible loss of balance per patient.
 He also developed nausea and vomitting plus bifrontal headache.
Patient was found to have 1.5cm R cerebellar hemorrhage with
significant vesogenic edema and some effacement of 4th
ventricle.  He was started on Decadron and initially admitted to
ICU where he remained stable with little neurological findings.


Neurosurgery and neuro-oncology were consulted given the high
index of suspicion for either primary CNS or metastatic tumor.
CT of thorax also performed given hx of smoking and possbile
primary etiology being lung, thyroid, GI and renal which was
unremarkable.  While in the ICU, patient also had
moderate/severe sundowning.  He was given Seroquel as needed.
On HD #3, he was transferred to general service.

On the general service he had a fairly uneventful course.  His
major issue initially was significant sun-downing which improved
with a regemin of scheduled seroquel and trazadone.  Lately he
has been much improved without significant trouble, although he
does have some confusion worse at night and early morning.  He
has had significant improvement in his dysarthria as well.  Over
the past week he was noted to have a persistent elevated WBC
count.  An exhaustive work-up was done including  several
negative blood and urine cultures, chest-xray and lower
extremity dopplers.  This leukocytosis is likely due to steroids
and not an acute infection.  He has been afebrile throuhgout the
hospital course.

Recently his biopsy results returned as inconclusive.  He had a
repeat MRI which showed stable lesion with decreased swelling.
He was discussed at tumor board and it was decided to wean the
steroids and have a follow-up MRI in [**1-12**] months to evaluate
progression.  He will follow-up in Brain [**Hospital 341**] Clinic as
scheduled.

It should be noted that he had evidence of a right subdural
hygroma on his initial and follow-up scans, deemed incidental to
his presentation.

His exam upon discharge is significant for oriented to person
and year, often not to place.  He is mildly dysarthric.  He has
surgical pupils bilateral.  EOMI are full with few beats of
nystagmus on right end gaze.  Face is symmetric.  He has full
strength throuhgout.  He has slight asterixis L>R.  His right
sided is mildly dysmetric with finger-nose-finger and he has
slight overshoot on rapid actions.  He has a steady gait with
assistance.

Medications on Admission:
Fosamax
Advair
Serevent
Albuterol as needed

Discharge Medications:
1. Dexamethasone 2 mg Tablet Sig: as directed Tablet PO three
times a day for 2 days: From [**Date range (1) 68310**], take 8mg in the
morning, 6mg in the afternoon, and 8mg at night.
Disp:*qs Tablet(s)* Refills:*0*
2. Dexamethasone 2 mg Tablet Sig: as directed Tablet PO three
times a day for 2 days: From [**Date range (1) **], take 8mg in the
morning, 6mg in the afternoon and 6mg at night.
Disp:*qs Tablet(s)* Refills:*0*
3. Dexamethasone 2 mg Tablet Sig: as directed Tablet PO three
times a day for 2 days: From [**Date range (1) 79900**], take 6mg three times a
day.
Disp:*qs Tablet(s)* Refills:*0*
4. Dexamethasone 2 mg Tablet Sig: as dir Tablet PO three times a
day for 2 days: From [**Date range (1) 25351**], take 6mg in the morning, 4mg in
the afternoon, and 6mg at night.
Disp:*qs Tablet(s)* Refills:*0*
5. Dexamethasone 2 mg Tablet Sig: Two (2) Tablet PO three times
a day for 2 days: From 11/6-7, take 6mg in the morning and 4mg
in the afternoon and at night. Tablet(s)
6. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO three times
a day for 2 days: From [**Date range (1) 21385**], take 4mg TID.
7. Dexamethasone 2 mg Tablet Sig: 1-2 Tablets PO three times a
day for 2 days: From [**2110-11-20**], take 4mg in the morning, 2mg in
the afternoon, 4mg at night.
8. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 days: Take from [**2112-11-22**].
9. Dexamethasone 2 mg Tablet Sig: 1-2 Tablets PO twice a day for
2 days: Take 4mg in the morning and 2mg at night from [**2014-11-23**].

10. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO twice a day
for 2 days: Take from [**2016-11-25**].
11. Dexamethasone 1 mg Tablet Sig: Two (2) Tablet PO twice a day
for 2 days: Take from [**2018-11-27**].
12. Dexamethasone 1 mg Tablet Sig: One (1) Tablet PO once a day
for 2 days: Take from [**2020-11-29**] then discontinue dexamethasone.
13. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
14. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
15. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
16. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
17. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed.
18. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
19. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
20. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
21. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
22. Ondansetron HCl (PF) 4 mg/2 mL Solution Sig: One (1)
Injection Q8H (every 8 hours) as needed.
23. Nystatin 50,000,000 unit Powder Sig: One (1)  PO five times
a day: swish and swallow.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 25759**] & Rehab Center - [**Location (un) **]

Discharge Diagnosis:
Cerebellar hemorrhage


Discharge Condition:
Stable


Discharge Instructions:
You were admitted to the hospital with a cerebellar bleed. Brain
biopsy failed to reveal a diagnosis, which may be tumor or
amyloid angiopathy. You will be sent to rehab and return for
follow-up.

Followup Instructions:
Provider: [**Name10 (NameIs) 5005**] [**Last Name (NamePattern4) 5342**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2107-12-19**] 1:00
Provider: [**Name10 (NameIs) 706**] MRI Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2107-12-19**]
11:15
{'Intracerebral hemorrhage,Compression of brain,Hallucinations,Neoplasm of uncertain behavior of brain and spinal cord,Lack of coordination,Dysphagia, pharyngeal phase,Asthma, unspecified type, unspecified,Other second degree atrioventricular block,Other specified cardiac dysrhythmias,Osteoporosis, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Accidental fall from bed,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco 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: Falls - found to have R cerebellar hemorrhage at OSH

PRESENT ILLNESS: Mr [**Known lastname 61509**] is a LHM, and is a retired printer (former veteran),
who normally does cross-word puzzles, Sodoku and plays Game Boy.
He was in his usual state of health until 3 am on [**10-24**]. His
step-son, [**Name (NI) **] [**Name (NI) 36913**], whom he lives with, found him sitting
by the front door, drenched in blood, and trying to get out. Mr
[**Name13 (STitle) 36913**] cleaned his step-father up, and noticed that he had hit
the right side of his forehead and right forearm. Mr [**Name13 (STitle) 36913**]
took his father back to bed, at around 4 am. Mr [**Known lastname 61509**] [**Last Name (Titles) **] up
around 6:30 am, and had breakfast around 7 am which consisted of
his usual bowl of cereal and two cups of coffee. Mr [**Known lastname 79898**]
daughter-in-law [**Doctor First Name **] noticed that he had made a mess in the
kitchen earlier that morning, taken the kitchen rug and tried to
wrap the table in it. However, both Mr and Mrs [**Last Name (STitle) 36913**] left for
work, requesting their daughter ([**Name (NI) **]) to look in on Mr
[**Name (NI) 61509**]. [**Doctor First Name **] came by to give Mr [**Known lastname 61509**] lunch, and
found that there was more blood in the house, in addition, he
had vomited his breakfast up on the living room sofa. She
noticed that while he was eating his bowl of soup, his soup
spoon kept missing his mouth. In addition, she noticed that her
grand-father's speech was slurred. [**Doctor First Name **] took her Grand-father
to the [**Hospital3 **] [**Name (NI) **]. He had a CT of his brain which
showed a right cerebellar hemorrhagic lesion with vasogenic
edema and some compression of the fourth ventricle, so he was
transferred to [**Hospital1 18**] ED. At the ED he was reviewed by
Neurosurgery.

MEDICAL HISTORY: 1. Asthma
2. Osteoporosis
3. Osteoarthritis
4. s/p bilateral catarect surgery

MEDICATION ON ADMISSION: Fosamax
Advair
Serevent
Albuterol as needed

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T99, HR 40, BP 157/60, RR 16, SpO2 96% on room air
General: right forehead and right arm bruises noted.
HEENT: complained that it tickled when trying to examine the
cervical lymph nodes.
Resp: Poor air entry in the right middle zone
CVS: difficult to hear the heart sounds clearly, as he would not
stop talking
GI: Soft, non-tender with normal bowel sounds.

FAMILY HISTORY: Not known

SOCIAL HISTORY: Lives with his step-son who is his only child and his HCP, his
name is [**Name (NI) **] [**Name (NI) 36913**] and his cell phone number is: [**Telephone/Fax (1) 79899**]. According to Mr [**Last Name (Titles) 36913**], his step-father is DNR/DNI. His
PCP is Dr [**Last Name (STitle) 27542**] at [**Location (un) **]. He is an
ex-smoker, smoking up to two packs per day (not known over the
number of years). Mr [**Known lastname 61509**] does not drink alcohol. His bedroom
is on the [**Location (un) 1773**], and he normally manages his ADLs. 

### Response:
{'Intracerebral hemorrhage,Compression of brain,Hallucinations,Neoplasm of uncertain behavior of brain and spinal cord,Lack of coordination,Dysphagia, pharyngeal phase,Asthma, unspecified type, unspecified,Other second degree atrioventricular block,Other specified cardiac dysrhythmias,Osteoporosis, unspecified,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Accidental fall from bed,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use'}
