CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 85 year old
woman with a history of hypertension, atrial fibrillation,
status post a fall a month ago, admitted for one week and
then discharged to rehabilitation.  She was referred to the
Emergency Room by her primary care physician for an episode
of left facial weakness and decreased comprehension and
speech.  The patient's daughter also describes an increase in
lethargy with persistent nausea and episodes of vomiting.  A
head CT scan in the Emergency Department shows an increased
size of the right subdural hematoma with no acute component.

MEDICAL HISTORY: 1.  Hypertension.
2.  Subdural hematoma a month ago.
3.  Heart murmur.
4.  Atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Congestive heart failure, unspecified,Atrial fibrillation,Aortic valve disorders,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling
Traumatic subdural hem,CHF NOS,Atrial fibrillation,Aortic valve disorder,Hypertension NOS,Fall from slipping NEC
Admission Date:  [**2112-7-28**]       Discharge Date:  [**2112-8-3**]


Service:  .

HISTORY OF PRESENT ILLNESS:  The patient is an 85 year old
woman with a history of hypertension, atrial fibrillation,
status post a fall a month ago, admitted for one week and
then discharged to rehabilitation.  She was referred to the
Emergency Room by her primary care physician for an episode
of left facial weakness and decreased comprehension and
speech.  The patient's daughter also describes an increase in
lethargy with persistent nausea and episodes of vomiting.  A
head CT scan in the Emergency Department shows an increased
size of the right subdural hematoma with no acute component.

On arrival the patient was awake and alert, oriented times
three, complaining of nausea and vomiting.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Subdural hematoma a month ago.
3.  Heart murmur.
4.  Atrial fibrillation.

PHYSICAL EXAMINATION:  On physical examination, the patient
was awake and alert, oriented times three, conversing
appropriately.  Extraocular muscles are full.  Pupils equally
round and reactive to light with right down 4 to 3 and the
left 3 to 2.  Strength was five out of five throughout and
reflexes were intact.

Head CT scan shows a right 2 cm subdural hematoma with no
acute component but increase in size compared to head CT scan
from a month prior.  The patient was neurologically stable.

HOSPITAL COURSE:  The patient had twist drill drainage of the
subdural hematoma at the bedside without complication.  The
patient had just slight left facial asymmetry with no
pronator drift, moving all extremities strongly.  The patient
also developed symptoms of transient ischemic attacks prior
to admission.  She had a carotid ultrasound of her neck which
was clear and a transesophageal echocardiogram which revealed
a left atrial appendage thrombus near the aortic arch,
gradient of 2, and four plus tricuspid regurgitation.

She was seen by Cardiology who recommended a rate control for
her atrial fibrillation.  She was started on digoxin and
Lopressor as well as Diltiazem.  She will be followed up as
an outpatient for treatment of the atrial thrombus as an
outpatient.  She will require anti-coagulation but she will
not be able to receive anti-coagulation for one month.

Neurologically, she is awake, alert and oriented times three.
 No drift.  Face is symmetric.  Strength was five out of five
in all muscle groups.  A repeat head CT scan showed good
evacuation of the subdural hematoma and the drain was removed
on [**2112-7-30**].  She was transferred to the Regular Floor.

Carotid ultrasound of her neck did show less than 40%
stenosis of the right internal carotid and 40 to 59% of the
left internal carotid stenosis.

The patient was seen by Physical Therapy and Occupational
Therapy and found to require rehabilitation prior to
discharge to home.  She was discharged to rehabilitation in
stable condition with follow-up with Dr. [**First Name (STitle) **] in one month and
also with Cardiology for treatment of a left atrial thrombus.
Her vital signs were stable at the time of discharge.

DISCHARGE MEDICATIONS:
1.  Diltiazem 180 mg p.o. q. day.
2.  Digoxin 0.125 mg p.o. q. day.  The patient should have a
level drawn and checked on [**2112-8-4**].
3.  Metoprolol 25 mg p.o. twice a day.
4.  Dilantin 100 mg p.o. three times a day.
5.  Levobetaxolol hydrochloride 0.5%, one drop o.u. q. day.
6.  Sodium chloride 1 gram p.o. four times a day.
7.  Protonix 40 mg p.o. q. 24 hours.

CONDITION AT DISCHARGE:   The patient's condition was stable
at the time of discharge.

DISCHARGE INSTRUCTIONS:
1.  She will follow-up with Dr. [**First Name (STitle) **] in one month with a repeat
head CT scan.
2.  She will follow-up with Cardiology in one month for
treatment of her left atrial thrombus.



                            [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 342**], M.D.  [**MD Number(1) 343**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2112-8-3**]  11:20
T:  [**2112-8-3**]  11:24
JOB#:  [**Job Number 43239**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Congestive heart failure, unspecified,Atrial fibrillation,Aortic valve disorders,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling'}


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: The patient is an 85 year old
woman with a history of hypertension, atrial fibrillation,
status post a fall a month ago, admitted for one week and
then discharged to rehabilitation.  She was referred to the
Emergency Room by her primary care physician for an episode
of left facial weakness and decreased comprehension and
speech.  The patient's daughter also describes an increase in
lethargy with persistent nausea and episodes of vomiting.  A
head CT scan in the Emergency Department shows an increased
size of the right subdural hematoma with no acute component.

MEDICAL HISTORY: 1.  Hypertension.
2.  Subdural hematoma a month ago.
3.  Heart murmur.
4.  Atrial fibrillation.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness,Congestive heart failure, unspecified,Atrial fibrillation,Aortic valve disorders,Unspecified essential hypertension,Fall from other slipping, tripping, or stumbling'}
