CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 46-year-old
gentleman who fell down 20 stairs.  He was sent to an outside
hospital.  Reportedly not moving his lower extremities and
unresponsive at the scene.

MEDICAL HISTORY: Ethanol abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate [1-24 hours] loss of consciousness,Alcohol abuse, unspecified,Accidental fall on or from other stairs or steps,Unspecified acquired hypothyroidism,Unspecified disorder of muscle, ligament, and fascia
Opn skul/oth fx-mod coma,Alcohol abuse-unspec,Fall on stair/step NEC,Hypothyroidism NOS,Muscle/ligament dis NOS
Admission Date:  [**2115-3-5**]     Discharge Date: [**2115-3-5**]

Date of Birth:                  Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 46-year-old
gentleman who fell down 20 stairs.  He was sent to an outside
hospital.  Reportedly not moving his lower extremities and
unresponsive at the scene.

PAST MEDICAL HISTORY:  Ethanol abuse.

PHYSICAL EXAMINATION ON PRESENTATION:  The patient was
intubated, previously sedated and paralyzed.  Localizing at
both upper extremities.  Withdraws lower extremities.  His
pupils were 1.5 cm and nonreactive.  Vital signs revealed
blood pressure was 110/66.  His pulse was 74.  The patient
was on a ventilator with oxygen saturations of 100%.
Temperature was 98.8.  The patient had blood in his left ear.

PERTINENT RADIOLOGY/IMAGING:  A head computed tomography
showed acute left epidural hematoma and right subarachnoid
hemorrhage.

BRIEF SUMMARY OF HOSPITAL COURSE:   The patient was to the
operating room for an emergent evacuation of the epidural
hematoma.  Postoperatively, the patient was sedated.  Blood
pressure was 123/64 on Neo-Synephrine, heart rate was 70, and
respiratory rate was 19.  Saturations of 100%.
Neurologically, pupils were 3.5 down to 2.5.  Grimaced to
pain with slight elevation of the upper and lower extremities
to deep painful stimulation.  The toes were downgoing.
Slight withdrawal to pain.

The patient was to the operating room on [**2114-10-14**].
He underwent a craniotomy and evacuation of the epidural
hematoma, repair of dural tear, elevation of depressed skull
fracture.  There was a cerebrospinal fluid leak at the time
of surgery.  ENT was consulted for a question of
facial nerve injury due to temporal bone fracture from the
fall.  Preliminary findings from a computed tomography of the
temporal bone showed no fracture involving the seventh
cranial nerve, positive fracture of the left EAC and left
comminuted fracture of the lateral left temporal bone with no
involvement of the carotid or jugular bulb.

Postoperatively the patient was awake, confused, combative,
responding to questions, moving all extremities to command
involving contusions on head computed tomography frontal/
temporal area.  The patient was extubated on postoperative
day one.  Moving all extremities.  Following verbal commands.
Localizing in the bilateral upper extremities.  Pupils were
2.5 and reactive.

The patient was transferred to the regular floor on [**2114-10-17**].  Continued in a hard collar until cervical spine
could be cleared clinically.  Continued to be awake, alert,
and confused.  Following commands.  Extraocular movements
were full.  Pupils were equal, round, and reactive to light.
Followed by Physical Therapy and Occupational Therapy.

The patient had a swallow evaluation and video swallow which
he passed and was able tolerate thin liquid and soft solid
diet.

Postoperatively, had left facial weakness, left lip weakness,
and left tongue weakness.  Also with difficulty keeping his
left eye closed.  Followup as an outpatient with
Ophthalmology and Ear/Nose/Throat.

CONDITION AT DISCHARGE:  The patient was discharged on
[**2114-10-24**] in stable condition.

DISCHARGE INSTRUCTIONS/FOLLOWUP:  Followup in one month with
Dr. [**Last Name (STitle) 739**] with a repeat head computed tomography.

DISCHARGE DISPOSITION:  The patient was discharged home on
[**2114-10-24**] with 24-hour supervision provided by his
mother with followup with Ophthalmology and Ear/Nose/Throat
as an outpatient.




                           [**Name6 (MD) 742**] [**Name8 (MD) **], M.D.

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

MEDQUIST36

D:  [**2115-3-5**]  11:28
T:  [**2115-3-5**]  12:09
JOB#:  [**Job Number 51421**]
{'Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate [1-24 hours] loss of consciousness,Alcohol abuse, unspecified,Accidental fall on or from other stairs or steps,Unspecified acquired hypothyroidism,Unspecified disorder of muscle, ligament, and fascia'}


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 a 46-year-old
gentleman who fell down 20 stairs.  He was sent to an outside
hospital.  Reportedly not moving his lower extremities and
unresponsive at the scene.

MEDICAL HISTORY: Ethanol abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate [1-24 hours] loss of consciousness,Alcohol abuse, unspecified,Accidental fall on or from other stairs or steps,Unspecified acquired hypothyroidism,Unspecified disorder of muscle, ligament, and fascia'}
