CHIEF COMPLAINT: Dizzyness

PRESENT ILLNESS: [**Age over 90 **] year old male transferred from outside hospital for
evaluation of subdural hematoma. This morning the son noted that
he was garbled in his speech and not acting like himself.
Symptoms resolved prior to arrival at [**Hospital1 18**]. Currently pt denies
headache, nausea, vomiting change in speech altered mental
status
or any complaints.

MEDICAL HISTORY: TIAs, HTN, Carotid stenosis, hyperlipidemia

MEDICATION ON ADMISSION: Plavix 75mg daily, Lisinopril, simvastatin

ALLERGIES: Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 98.6  BP: 170/84 HR: 68 R: 18  O2Sats: 99% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**1-24**] bilat  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: pulses regular
Abd: Soft, NT
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives alone
Subdural hemorrhage,Toxic encephalopathy,Delirium due to conditions classified elsewhere,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diverticulum of esophagus, acquired,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use
Subdural hemorrhage,Toxic encephalopathy,Delirium d/t other cond,Ocl crtd art wo infrct,Acq esophag diverticulum,Chr airway obstruct NEC,Hypertension NOS,Pure hypercholesterolem,Hx TIA/stroke w/o resid,History of tobacco use
Name:  [**Known lastname 14451**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 14452**]

Admission Date:  [**2133-12-21**]              Discharge Date:   [**2133-12-24**]

Date of Birth:  [**2042-9-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Sulfa(Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 40**]
Addendum:
During this admission patient had acute delirium/toxic metabolic
encephalopathy.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Transitional Care and Rehab

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 43**] MD [**MD Number(2) 44**]

Completed by:[**2134-3-3**]

Admission Date:  [**2133-12-21**]              Discharge Date:   [**2133-12-24**]


Service: NEUROSURGERY

Allergies:
Sulfa(Sulfonamide Antibiotics)

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

Major Surgical or Invasive Procedure:
None

History of Present Illness:
[**Age over 90 **] year old male transferred from outside hospital for
evaluation of subdural hematoma. This morning the son noted that
he was garbled in his speech and not acting like himself.
Symptoms resolved prior to arrival at [**Hospital1 18**]. Currently pt denies
headache, nausea, vomiting change in speech altered mental
status
or any complaints.


Past Medical History:
TIAs, HTN, Carotid stenosis, hyperlipidemia

Social History:
Lives alone

Family History:
NC

Physical Exam:
PHYSICAL EXAM:
O: T: 98.6  BP: 170/84 HR: 68 R: 18  O2Sats: 99% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**1-24**] bilat  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: pulses regular
Abd: Soft, NT
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
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, to
mm bilaterally..
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
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. Strength full power [**3-27**] throughout. No pronator drift

On Discharge: He is pleasant and cooperative.  HE AOx3, PERRL,
face symmetric, tongue protrudes at midline.  MAEs with good
strenght.

Pertinent Results:
[**12-22**] Carotid U/S - Right ICA less than 40% stenosis.
Left ICA less than 40% stenosis

[**12-23**] Video Swallow - Large posterior diverticulum in the upper
esophagus consistent with a Zenker's diverticulum. Regurgitation
resulted in trace aspiration of all consistencies .

Brief Hospital Course:
Mr. [**Known lastname 91849**] was admitted to the Neurosugery service for
evaluation and surgial planning.

We obtained a medical consult for surgical clearence given his
age and medical history.

He had Carotid dopplers to evaluate his carotid stenosis in the
setting of reported severe stenosis and TIA's. The study showed
less than 40% stenosis, and he was determined to be relatively
safe to undergo a craniotomy for Subdural hematoma evacutation.

We plan to proceed with surgical evacuation of this subdural in
one week given that he has been taking plavix at home.

A physical therapist evaluated the patient and they felt that
the patient needed to be placed in rehab until he returns for
surgery.  On [**2133-12-24**], pt was stable for discharge to [**Hospital **]
Rehab Hospital.  He will follow-up accordingly.


Medications on Admission:
Plavix 75mg daily, Lisinopril, simvastatin

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).
3. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable
Sig: One (1) Tablet, Chewable PO TID (3 times a day).
5. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. heparin (porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
8. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every
6 hours) as needed for pain.
9. Famotidine 20 mg IV Q12H
10. LeVETiracetam 750 mg IV BID
11. HydrALAzine 10 mg IV Q6H:PRN SBP>160


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Transitional Care and Rehab

Discharge Diagnosis:
subdural hematoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
General Instructions

??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	You have been instructed to hold your Plavix (clopidogrel),
until clearance from Neurosurgery

??????	If you have been discharged on Keppra (Levetiracetam), you
will not require blood work monitoring.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
?????? You are scheduled for the OR on Wednesday [**2131-12-31**] at
9:30 am. Our office will contact you with further information.
If you have any further questions, please call [**Telephone/Fax (1) 1669**].



Completed by:[**2133-12-24**]

Name:  [**Known lastname 14451**],[**Known firstname **]                    Unit No:   [**Numeric Identifier 14452**]

Admission Date:  [**2133-12-21**]              Discharge Date:   [**2133-12-24**]

Date of Birth:  [**2042-9-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Sulfa(Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 40**]
Addendum:
Patient did have acute delirium/toxic metabolic encephalopathy

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] Transitional Care and Rehab

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 43**] MD [**MD Number(2) 44**]

Completed by:[**2134-3-2**]
{'Subdural hemorrhage,Toxic encephalopathy,Delirium due to conditions classified elsewhere,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diverticulum of esophagus, acquired,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,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: Dizzyness

PRESENT ILLNESS: [**Age over 90 **] year old male transferred from outside hospital for
evaluation of subdural hematoma. This morning the son noted that
he was garbled in his speech and not acting like himself.
Symptoms resolved prior to arrival at [**Hospital1 18**]. Currently pt denies
headache, nausea, vomiting change in speech altered mental
status
or any complaints.

MEDICAL HISTORY: TIAs, HTN, Carotid stenosis, hyperlipidemia

MEDICATION ON ADMISSION: Plavix 75mg daily, Lisinopril, simvastatin

ALLERGIES: Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: PHYSICAL EXAM:
O: T: 98.6  BP: 170/84 HR: 68 R: 18  O2Sats: 99% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**1-24**] bilat  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: pulses regular
Abd: Soft, NT
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives alone 

### Response:
{'Subdural hemorrhage,Toxic encephalopathy,Delirium due to conditions classified elsewhere,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diverticulum of esophagus, acquired,Chronic airway obstruction, not elsewhere classified,Unspecified essential hypertension,Pure hypercholesterolemia,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,Personal history of tobacco use'}
