CHIEF COMPLAINT: 

PRESENT ILLNESS: This 61 year-old male with a ten
year history of progressive Parkinson's disease tripped over
his own feet and fell down approximately seven steps.  He
states for a few seconds he was stunned and felt tingling in
all four extremities.  He also noted pain in his legs left
greater then right and in his right chest.  He was taken to
[**Hospital **] Hospital where he was reportedly neurologically
intact.  He was in a cervical collar.  A CT scan of the
cervical spine was obtained.  This showed a fracture of the
anterior arch of C1.  There was a moderately displaced,
comminuted, odontoid fracture extending through the base,
which moderately narrowed the spinal canal.  The dens and C1
were displaced approximately 13 mm.  The patient was able to
void spontaneously times two before a Foley catheter was
placed.  The patient has been followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in
Neurology for his movement disorder.

MEDICAL HISTORY: The patient has a history of bipolar
disorder and Parkinson's syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to Haldol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of first cervical vertebra,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Other pulmonary embolism and infarction,Paralysis agitans,Accidental fall on or from other stairs or steps,Bipolar I disorder, most recent episode (or current) unspecified,Abnormal involuntary movements
Fx c1 vertebra-closed,Food/vomit pneumonitis,Acute respiratry failure,Pulm embol/infarct NEC,Paralysis agitans,Fall on stair/step NEC,Bipolor I current NOS,Abn involun movement NEC
Admission Date:  [**2161-2-14**]       Discharge Date:  [**2161-3-10**]

Date of Birth:   [**2098-9-3**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This 61 year-old male with a ten
year history of progressive Parkinson's disease tripped over
his own feet and fell down approximately seven steps.  He
states for a few seconds he was stunned and felt tingling in
all four extremities.  He also noted pain in his legs left
greater then right and in his right chest.  He was taken to
[**Hospital **] Hospital where he was reportedly neurologically
intact.  He was in a cervical collar.  A CT scan of the
cervical spine was obtained.  This showed a fracture of the
anterior arch of C1.  There was a moderately displaced,
comminuted, odontoid fracture extending through the base,
which moderately narrowed the spinal canal.  The dens and C1
were displaced approximately 13 mm.  The patient was able to
void spontaneously times two before a Foley catheter was
placed.  The patient has been followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in
Neurology for his movement disorder.

PAST MEDICAL HISTORY:  The patient has a history of bipolar
disorder and Parkinson's syndrome.

ALLERGIES:  He is allergic to Haldol.

MEDICATIONS:
1.  Sinemet.
2.  Folate.
3.  Valproic acid.
4.  Seroquel.
5.  Amantadine.

LABORATORIES ON ADMISSION:  White blood cell count of 9.3,
hematocrit 41.4, platelet count 157, amylase 42, sodium 143,
potassium 5.0, chloride 106, CO2 28, BUN 22, creatinine 1.1,
glucose 122, lactacid 1.6.

PHYSICAL EXAMINATION:  The patient is alert and oriented
times three.  He is complaining of a headache, posterior neck
pain and right chest pain.  He has a marked resting tremor
primarily effecting his left upper extremity and left lower
extremity.  There is cogwheel rigidity of both upper
extremities.  His cranial nerves are intact.  He describes
altered sensation and pain to light touch and pin prick over
his left occiput and right chest at approximately the T2 to
T5 levels.  There is no clear sensory level to pin prick,
light touch, position direction or vibration.  The patient's
cervical collar fits well.  His toes are upgoing.  His
reflexes are 2+.  His strength is good in his upper
extremities and lower extremities.

HOSPITAL COURSE:  The patient's management was greatly
complicated by his multiple medical problems.  It was
difficult to reduce his fracture and apply a halo, because of
his movement disorder.  He was initially kept in a cervical
collar.  An MRI scan of the cervical spine was obtained to
rule out an epidural hematoma.  This showed no evidence of
any significant cord compression or epidural bleeding.  He
was placed in a halo traction.  He was noted to have severe
dyskinesias from his Sinemet, which made it difficult to
maintain him in halo traction.  Therefore he was seen once
again by the neurologist who recommended decreasing his
Sinemet and continuing the Amantadine.  The patient was taken
to radiology where he was placed in halo traction under
fluoroscopy.  Once again this was greatly limited by his
dyskinesias and his inability to remain still during the
procedure.  The patient was noted to have multiple episodes,
which seemed to be aspiration.  He began spiking fevers up to
102 and 103.  The patient's chest x-ray showed an infiltrate
consistent with an aspiration pneumonia.  He was kept on
Levaquin.  His white count was as high [**Numeric Identifier 3651**].  He was pan
cultured with no other source apparent.  By [**2-23**] the patient
had two plain films, which showed excellent alignment and
reduction of the C1-C2 subluxation.  The patient was placed
in the halo vest on [**2-23**].  A post procedure film once again
showed excellent alignment.  The patient was intubated for
his inability to clear his secretions.  A second post
reduction film showed a bit more displacement approximately 8
mm at the C1-C2 level.

However, at this point the patient was intubated and sedated.
There is no evidence of any spinal cord compression on the
films.  It was felt safer to leave the patient intubated and
sedated with the halo in that position rather then attempting
to realign the fracture without the patient being monitored
by his neurological examination.  The patient would open his
eyes at times.  He periodically would get Dilaudid 1 to 2 mg
and Ativan.  He was inconsistently following commands.  He
continued to have high fevers up to 102 and 103.  A CT scan
of the abdomen was unremarkable.  The patient was again seen
by neurology.  It was felt that his obtundation was likely
due to his fevers.  A follow up CT scan of the head and
cervical spine were obtained.  This showed no evidence of any
intracranial masses or infection.  The patient had no
evidence of infection at the site of his fracture.  Because
of the need for continued ventilation the patient had a
tracheostomy and G tube placed.  These were well tolerated.
He continued having fevers ranging from 101 to 103.  His
white count remained in the 18 to [**Numeric Identifier 3652**] range.  He really was
not responsive.  A lumbar puncture was recommended, however,
the patient's wife felt strongly she did not want this
procedure done.  The patient was continued on Oxacillin,
Ceftriaxone and Flagyl.  His sputum cultures grew out
Methicillin sensitive staph aureus, Pneumococcus and strep
viridans.  A CT scan once again reconfirmed a dense right
lower lobe infiltrate.  The infectious disease consultant
suggested the differential included a C-diff colitis,
metastatic infection with MMSA, a possible meningitis, a drug
fever or a line infection.  The patient's lines were changed.

At this point his white blood cell count began to come down,
however, he still had nightly fevers.  There was no
improvement in his mental status.  The patient's family felt
strongly they would like him to go to rehab.  Plans were made
for this.

FINAL DISCHARGE DIAGNOSES:
1.  Parkinson's disease.
2.  C1-C2 fracture.
3.  Aspiration pneumonia.
4.  Fever of unknown origin.

CONDITION ON DISCHARGE:  The patient is obtunded.  He is in a
halo.  He will need to remain in the halo for a minimum of
three months.  If he improves neurologically and is awake,
the halo should be readjusted.






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3653**], M.D.  [**MD Number(1) 3654**]

Dictated By:[**Last Name (NamePattern4) 3655**]
MEDQUIST36

D:  [**2161-3-10**]  10:34
T:  [**2161-3-10**]  10:34
JOB#:  [**Job Number 3656**]


Name:  [**Known lastname 440**], [**Known firstname 441**]                        Unit No:  [**Numeric Identifier 442**]

Admission Date:  [**2161-2-14**]     Discharge Date:  [**2161-3-13**]

Date of Birth:   [**2098-9-3**]     Sex:  M

Service:

This is an addendum to a previously dictated discharge
summary.

The patient was evaluated for transfer to the [**Hospital **] Hospital.
From [**2161-3-10**] to [**2161-3-13**], there is absolutely no change in
his neurologic status.  The patient remained obtunded.  He
was tolerating his tube feeds.  He periodically had
temperatures from 99-100 degrees.  His pin sites were clean.
His chest x-ray showed no new infiltrates.

Plans were made to transfer the patient to the [**Hospital6 443**] on [**2161-3-13**].

FINAL DISCHARGE DIAGNOSES:
1. Cervical spine fracture.
2. Parkinson's disease.
3. Fever.
4. Altered mental status.

CONDITION ON DISCHARGE:  Poor.

FOLLOW-UP PLANS:  Patient is being transferred to the [**Hospital6 444**] for further care.



                          [**First Name11 (Name Pattern1) 121**] [**Last Name (NamePattern4) 122**], M.D.  [**MD Number(1) 123**]

Dictated By:[**Last Name (NamePattern4) 445**]

MEDQUIST36

D:  [**2161-4-7**]  12:37
T:  [**2161-4-9**]  07:32
JOB#:  [**Job Number 446**]

 (cclist)
{'Closed fracture of first cervical vertebra,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Other pulmonary embolism and infarction,Paralysis agitans,Accidental fall on or from other stairs or steps,Bipolar I disorder, most recent episode (or current) unspecified,Abnormal involuntary movements'}


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: This 61 year-old male with a ten
year history of progressive Parkinson's disease tripped over
his own feet and fell down approximately seven steps.  He
states for a few seconds he was stunned and felt tingling in
all four extremities.  He also noted pain in his legs left
greater then right and in his right chest.  He was taken to
[**Hospital **] Hospital where he was reportedly neurologically
intact.  He was in a cervical collar.  A CT scan of the
cervical spine was obtained.  This showed a fracture of the
anterior arch of C1.  There was a moderately displaced,
comminuted, odontoid fracture extending through the base,
which moderately narrowed the spinal canal.  The dens and C1
were displaced approximately 13 mm.  The patient was able to
void spontaneously times two before a Foley catheter was
placed.  The patient has been followed by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in
Neurology for his movement disorder.

MEDICAL HISTORY: The patient has a history of bipolar
disorder and Parkinson's syndrome.

MEDICATION ON ADMISSION: 

ALLERGIES: He is allergic to Haldol.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of first cervical vertebra,Pneumonitis due to inhalation of food or vomitus,Acute respiratory failure,Other pulmonary embolism and infarction,Paralysis agitans,Accidental fall on or from other stairs or steps,Bipolar I disorder, most recent episode (or current) unspecified,Abnormal involuntary movements'}
