CHIEF COMPLAINT: Fell and hit head

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 74-year-old woman with a history of
hypertension and postherpetic neuralgia of her left foot who
presents with headache and dizziness after a mechanical fall.
She was in her usual state of good health until developing
shingles in her left foot and leg in [**Month (only) 956**]; this left her
with post-herpetic neuralgia in her foot,which has made it
difficult to walk and has caused her to feel ??????off-balance.??????
Close to midnight on the night of admission she was carrying
laundry upstairs when she lost her balance, fell backwards, and
hit her head on the carpeted floor. She does not believe she
lost consciousness. She did not have light-headedness,
dizziness, chest pain, or palpitations prior to the fall, and
did not lose bowel or bladder control or feel confused
afterwards. She has no history of seizures. After the fall she
felt very dizzy and crawled up the stairs to alert her husband.
On the way she felt an urgent need to have a BM and went to the
bathroom.

MEDICAL HISTORY: Hypertension
Zoster L leg and foot, now with postherpetic neuralgia
Chronic low back pain

MEDICATION ON ADMISSION: Neurontin 100mg qhs
HCTZ 25mg po qam
Nortriptyline 50mg q24h
Celebrex 200mg qam

ALLERGIES: Benzodiazepines

PHYSICAL EXAM: Vitals: Tc 99.1, Tm 99.1, BP 143/91, P 108, R 20, O2 Sat 96% on
RA
Gen: Alert, NAD, lying in bed with lights off
HEENT: No JVD or LAD
Cards: RRR, no m/g/r
Pulm: CTAB
Abd: Soft, NT, ND
Ext: No LE edema. L great toe slightly erythematous.
Neuro: MS [**First Name (Titles) 20691**] [**Last Name (Titles) 5235**]. CN II-XII [**Last Name (Titles) 5235**]. Strength 5/5 in UE
and LE. Sensation [**Last Name (Titles) 20691**] [**Last Name (Titles) 5235**] except for area of numbess on
outer LLE. Reflexes brisk and symmetric at biceps,
brachioradialis, and patella. Babinski negative bilaterally.

FAMILY HISTORY: HTN and DM2 in father

SOCIAL HISTORY: Lives at home with husband and puppy. Former yoga teacher.
Remote history of smoking (1 pack per week for 5 years). Two to
three glasses of wine per week. No drugs. Three daughters in the
area.
Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Other disorders of neurohypophysis,Herpes zoster with other nervous system complications,Accidental fall on or from other stairs or steps,Unspecified essential hypertension
Cl skl fx NEC/mening hem,Neurohypophysis dis NEC,H zoster nerv syst NEC,Fall on stair/step NEC,Hypertension NOS
Admission Date:  [**2197-6-17**]              Discharge Date:   [**2197-6-26**]

Date of Birth:  [**2122-7-28**]             Sex:   F

Service: MEDICINE

Allergies:
Benzodiazepines

Attending:[**First Name3 (LF) 689**]
Chief Complaint:
Fell and hit head

Major Surgical or Invasive Procedure:
CT head
MRI/MRA head and carotid/vertebral
CTA head
L subclavian line placement


History of Present Illness:
[**Known firstname **] [**Known lastname **] is a 74-year-old woman with a history of
hypertension and postherpetic neuralgia of her left foot who
presents with headache and dizziness after a mechanical fall.
She was in her usual state of good health until developing
shingles in her left foot and leg in [**Month (only) 956**]; this left her
with post-herpetic neuralgia in her foot,which has made it
difficult to walk and has caused her to feel ??????off-balance.??????
Close to midnight on the night of admission she was carrying
laundry upstairs when she lost her balance, fell backwards, and
hit her head on the carpeted floor. She does not believe she
lost consciousness. She did not have light-headedness,
dizziness, chest pain, or palpitations prior to the fall, and
did not lose bowel or bladder control or feel confused
afterwards. She has no history of seizures. After the fall she
felt very dizzy and crawled up the stairs to alert her husband.
On the way she felt an urgent need to have a BM and went to the
bathroom.

After reaching her husband, EMS was called and the patient was
taken to the [**Location (un) 620**] ED, where a head CT showed a possible small
subarachnoid hemorrhage in the right temporal lobe and old
frontal hygromas. She was transferred to the [**Hospital1 18**], where a
repeat head CT showed a subarachnoid hemorrhage within the
bilateral parietal sulci and right temporal lobe anteriorly, as
well as within the ventricular system. In the ER she complained
of vertigo, nausea, and bifrontal and occipital headaches. She
was evaluated by neurosurgery, who felt no need for surgical
intervention. She was admitted to medicine for further workup
and monitoring.

Past Medical History:
Hypertension
Zoster L leg and foot, now with postherpetic neuralgia
Chronic low back pain

Social History:
Lives at home with husband and puppy. Former yoga teacher.
Remote history of smoking (1 pack per week for 5 years). Two to
three glasses of wine per week. No drugs. Three daughters in the
area.

Family History:
HTN and DM2 in father

Physical Exam:
Vitals: Tc 99.1, Tm 99.1, BP 143/91, P 108, R 20, O2 Sat 96% on
RA
Gen: Alert, NAD, lying in bed with lights off
HEENT: No JVD or LAD
Cards: RRR, no m/g/r
Pulm: CTAB
Abd: Soft, NT, ND
Ext: No LE edema. L great toe slightly erythematous.
Neuro: MS [**First Name (Titles) 20691**] [**Last Name (Titles) 5235**]. CN II-XII [**Last Name (Titles) 5235**]. Strength 5/5 in UE
and LE. Sensation [**Last Name (Titles) 20691**] [**Last Name (Titles) 5235**] except for area of numbess on
outer LLE. Reflexes brisk and symmetric at biceps,
brachioradialis, and patella. Babinski negative bilaterally.

Pertinent Results:
Na 142, K 3.4, Cl 104, HCO3 28, BUN 29, Cre 0.9
WBC 12.4, HGB 11.6, HCT 35.9, MCV 93, RDW 13.9, PLT 280
PT 12.1, PTT 18.6, INR 1.0

Head CT w/o contrast [**6-17**]: Subarachnoid hemorrhage within the
bilateral parietal sulci and about the right temporal lobe
anteriorly, as well as within the ventricular system as
described above. The age of this hemorrhage is unclear. Further
evaluation could be performed with a lumbar puncture or an MRI
with FLAIR imaging.

CXR [**6-17**]: No acute cardiopulmonary abnormality.

Brief Hospital Course:
1) Neurology:
a) Subarachnoid hemorrhage/occipital fracture: An intitial head
CT showed a subarachnoid hemorrhage within the bilateral
parietal sulci and about the right temporal lobe anteriorly, as
well as within the ventricular system. The patient was evaluated
by neurosurgery in the ED, who felt there was no urgent need for
intervention. A repeat head CT the day after admission showed no
interval change in the patient's subarachnoid hemorrhage. A
brain and carotid/vertebral MRI/MRA showed no dissection but did
show findings suggestive of an arteriovenous
malformation/fistula in the right frontal lobe. A CTA was done
on hospital day 4 for further characterization of this AVM. It
showed findings suggestive of a dural malformation, a stable
appearance of the subarachnoid hemorrhage, as well as a
nondisplaced fracture of the left occipital bone. Neurosurgery
felt there was no need for inpatient intervention, and the
patient will follow up with them on an outpatient basis.
b) Vertigo: The patient complained of severe vertigo, which was
partially releaved by Anzemet and Scopolamine patch. Epley
maneuvers provided some additional relief. At the time of
discharge to rehab, she continued to have vertigo and will
require vestibular physical therapy.
c) Headaches: The patient complained of occipital and frontal
headaches, which were managed with Tylenol and low-dose
Tramadol.
d) Postherpetic neuralgia: The patient's left foot postherpetic
neuralgia was initially managed with her outpatient regimen of
Neurontin and Nortryptiline, which were discontinued due to
hyponatremia. They can be restarted on an outpatient basis.

2) Hyponatremia: On admission, the patient's sodium was 142. It
continued to be within normal limits until the morning of
hospital day 4, when it fell to 124. The patient was then fluid
restricted to 1500cc/day. Urine lytes were sent and were
consistent with SIADH (urine Osm 542, serum Osm 260, urine Na
134), which was felt to be due to the patient's SAH. Despite
fluid restriction, the patient's sodium fell to 120 during the
course of the day and she developed mental status changes. She
was then transferred to the MICU, where she was given 3% saline
via a subclavian central line at 20cc/hr for 24 hours. She was
also placed on a 500cc/day fluid restriction, and her HCTZ,
Neurontin, Nortryptiline, and naproxen were discontinued. Her
sodium rose to 133 over 48 hours and she was transferred back to
the floor. There, her fluid restriction was decreased to
1000cc/day and her sodium remained above 140. She was discharged
on a 1000cc/day fluid restriction, which can be liberalized as
an outpatient if her sodium remains within normal limits.

3) Hypertension: The patient takes HCTZ at home, which was
discontinued due to hyponatremia. She was placed on metoprolol
25mg po bid. HCTZ can be restarted on an outpatient basis when
the patient's SIADH is resolved.

4) Low back pain: The patient takes Celebrex at home. As this is
a non-formulary drug, she was initially treated with naproxen
while in-house, but this was discontinued due to hyponatremia.
Celebrex can be restarted on an outpatient basis when the
patient's SIADH is resolved.

5) Full code

Medications on Admission:
Neurontin 100mg qhs
HCTZ 25mg po qam
Nortriptyline 50mg q24h
Celebrex 200mg qam


Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day) as needed for constipation.
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO BID (2 times a day).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for Headache.
7. Dolasetron Mesylate 100 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day) as needed for Dizziness, nausea.
8. Scopolamine Base 1.5 mg Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q3DAYS PRN () as needed for Nausea,dizziness.
9. Tramadol 50 mg Tablet Sig: [**1-8**] Tablet PO every 4-6 hours as
needed for headache: Please use only if Tylenol is not
effective.


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
Subarachnoid hemorrhage
SIADH
Hyponatremia
Hypertension
Post-herpetic neuralgia


Discharge Condition:
Ambulating with assistance, urinating/BMing on own, eating
1000cc/day fluid-restricted diet.

Discharge Instructions:
Alert your doctor if you have worsening headache, dizziness, or
nausea, or other symptoms of concern to you.

Followup Instructions:
-- Please call your primary care doctor for a follow-up
appointment within one week after discharge from rehab. You will
need to have your blood pressure and sodium checked and review
your medications.
-- Please follow up with neurosurgery within one month to
discuss management of an arteriovenous malformation seen on your
MRI. Call [**Telephone/Fax (1) 1669**] to make an appointment with any of the
neurosurgery attendings.



Completed by:[**2197-6-26**]
{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Other disorders of neurohypophysis,Herpes zoster with other nervous system complications,Accidental fall on or from other stairs or steps,Unspecified essential hypertension'}


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: Fell and hit head

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 74-year-old woman with a history of
hypertension and postherpetic neuralgia of her left foot who
presents with headache and dizziness after a mechanical fall.
She was in her usual state of good health until developing
shingles in her left foot and leg in [**Month (only) 956**]; this left her
with post-herpetic neuralgia in her foot,which has made it
difficult to walk and has caused her to feel ??????off-balance.??????
Close to midnight on the night of admission she was carrying
laundry upstairs when she lost her balance, fell backwards, and
hit her head on the carpeted floor. She does not believe she
lost consciousness. She did not have light-headedness,
dizziness, chest pain, or palpitations prior to the fall, and
did not lose bowel or bladder control or feel confused
afterwards. She has no history of seizures. After the fall she
felt very dizzy and crawled up the stairs to alert her husband.
On the way she felt an urgent need to have a BM and went to the
bathroom.

MEDICAL HISTORY: Hypertension
Zoster L leg and foot, now with postherpetic neuralgia
Chronic low back pain

MEDICATION ON ADMISSION: Neurontin 100mg qhs
HCTZ 25mg po qam
Nortriptyline 50mg q24h
Celebrex 200mg qam

ALLERGIES: Benzodiazepines

PHYSICAL EXAM: Vitals: Tc 99.1, Tm 99.1, BP 143/91, P 108, R 20, O2 Sat 96% on
RA
Gen: Alert, NAD, lying in bed with lights off
HEENT: No JVD or LAD
Cards: RRR, no m/g/r
Pulm: CTAB
Abd: Soft, NT, ND
Ext: No LE edema. L great toe slightly erythematous.
Neuro: MS [**First Name (Titles) 20691**] [**Last Name (Titles) 5235**]. CN II-XII [**Last Name (Titles) 5235**]. Strength 5/5 in UE
and LE. Sensation [**Last Name (Titles) 20691**] [**Last Name (Titles) 5235**] except for area of numbess on
outer LLE. Reflexes brisk and symmetric at biceps,
brachioradialis, and patella. Babinski negative bilaterally.

FAMILY HISTORY: HTN and DM2 in father

SOCIAL HISTORY: Lives at home with husband and puppy. Former yoga teacher.
Remote history of smoking (1 pack per week for 5 years). Two to
three glasses of wine per week. No drugs. Three daughters in the
area. 

### Response:
{'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness,Other disorders of neurohypophysis,Herpes zoster with other nervous system complications,Accidental fall on or from other stairs or steps,Unspecified essential hypertension'}
