CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 87-year-old
woman who fell down on a flight of stairs with no loss of
consciousness, with severe neck pain, no headache, and
baseline dementia.  Husband now reports increased confusion.

MEDICAL HISTORY: Hypertension, atrial fibrillation,
Paget's disease, and dementia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Acute kidney failure, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Congestive heart failure, unspecified,Accidental fall on or from other stairs or steps,Long-term (current) use of anticoagulants,Pure hypercholesterolemia,Unspecified essential hypertension,Other disorders of neurohypophysis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Osteitis deformans without mention of bone tumor
Subdural hem w/o coma,Atrial fibrillation,Acute kidney failure NOS,Crbl art ocl NOS w infrc,CHF NOS,Fall on stair/step NEC,Long-term use anticoagul,Pure hypercholesterolem,Hypertension NOS,Neurohypophysis dis NEC,Alzheimer's disease,Dementia w/o behav dist,Osteitis deformans NOS
Admission Date: [**2151-10-28**]        Discharge Date: [**2151-11-9**]


Service:  NSU


HISTORY OF PRESENT ILLNESS:  The patient is an 87-year-old
woman who fell down on a flight of stairs with no loss of
consciousness, with severe neck pain, no headache, and
baseline dementia.  Husband now reports increased confusion.

PAST MEDICAL HISTORY:  Hypertension, atrial fibrillation,
Paget's disease, and dementia.

PHYSICAL EXAMINATION:  Blood pressure was 170/80, heart rate
103, and saturation 94 percent.  The patient was confused and
screaming.  Pupils were 3 mm and 2 mm bilaterally.  Cranial
nerves appeared grossly intact; unable to assess specific
muscle tone.  Breasts were equal.  Deep tendon reflexes 1
plus in the upper and lower extremities.  Toes were down
running; no clonus.

HOSPITAL COURSE:  CT showed a large right frontal parietal
subdural hematoma with the extension into the anterior
hemispheric fissure with midline shift.  The patient was
admitted to the ICU for close neurologic observation.  She
was given FFP, vitamin K, and factor 7; loaded with Dilantin;
taken emergently to the OR for an emergent evacuation of the
subdural hematoma.  She had a postoperative head CT that
showed interhemispheric hemorrhage plus herniation and new
pneumocephalus.  On [**2151-10-29**], the patient had a repeat head
CT that showed decreased pneumocephalus and less mass effect.
The patient continued to require FFP for INR greater than
1.4; neurologically continued to be intubated and sedated.
She did not follow commands, has random purposeful movement
of all extremities, more so in the arms than left leg.
Withdraws all extremities to pain, has a positive cough,
gagged corneas, and blank reflex.  Pupils are equal, round
and reactive to light.

On [**2151-10-30**], the patient was extubated.  She had a head CT
that remained stable.  On [**2151-10-30**], she was hyponatremic
requiring fluid restriction.  Renal was consulted for acute
renal failure.  Three percent saline was stopped.  The
patient was transferred to the step-down unit on [**2151-10-31**].
Neurologically, she remained in waxing and [**Doctor Last Name 688**] mental
status; sometimes answering questions.  C-collar remained in
place.  She was placed on swish and swallow study; she
remained in atrial fibrillation.  She was on Lopressor.
Chest x-ray showed worsening pneumonia.  She was started on
levofloxacin for raising white count and chest x-ray was
consistent with infiltrates.  She was evaluated by swish and
swallow who felt the patient was aspirating and was at high
risk for continued aspiration.  The patient had her TL spine
cleared.  She was discontinued off her nimodipine.  Renal
felt her acute renal failure was contrast related.  Head CT
was stable.  She was at her baseline neurologic function
being confused and agitated at times, moving all extremities.
She continued to have waxing and [**Doctor Last Name 688**] mental status.

On [**2151-11-2**], she was lethargic, rarely opening her eyes to
name, oriented to person only; able to state her husband's
name and town she lived in.  Answering simple questions at
time and consistently following some simple commands.  On
[**2151-11-4**], the patient had decreased saturation, and was
transferred back to the ICU.  At that time, there was a
discussion here with the family and the patient was made a
DNR/DNI.  Cardiology was consulted for atrial flutter who
recommended titrating the Metoprolol and hold anticoagulation
at this point.  She had a head CT on [**2151-11-1**] that had no
change.  Chest x-ray on [**2151-11-5**] showed bilateral pulmonary
edema.  Renal continued to follow the patient and recommended
giving Lasix.  The patient was still being followed by
Cardiology for chronic atrial fibrillation and flutter.
Neurologically, she was nonverbal, localizing 30 percent on
the left, trace movement on the right upper extremity
withdrawal, trace movement of bilateral lower extremities.
On [**2151-11-6**], the patient had an MRI of her brain, which
showed water shade at subacute infarctions involving both
posterior parietal lobes and the left frontal lobe.
Neurology was consulted.  The patient's blood pressure was
controlled and they have recommended a blood transfusion for
a low hematocrit.  The patient was transferred to the step-
down unit again on [**2151-11-5**].  Stroke service continued to
follow the patient and continued to recommend blood
transfusion, treating infections, and TEE to help assess
cardiac pump status.  Neurologically, the patient was
unresponsive verbally, unable to assess orientation.  Her
pupils were 3 mm and reactive.  Right upper extremity flaccid
and left upper extremity moved on the bed; nonpurposeful
movement of the lower extremities to painful stimulation.

On [**2151-11-8**], discussion was held with the family regarding
the patient's severe deterioration of neurologic status.
Both the husband and son were spoken to.  The husband agreed
to make the patient comfort measures only and then an hour
later resented that order.  The patient remained decreased
neurologically with decreasing saturation and decreasing
blood pressure.  The patient expired on [**2151-11-9**] at 11:28
a.m.



                        [**Name6 (MD) **] [**Last Name (NamePattern4) 1359**], [**MD Number(1) 1360**]

Dictated By:[**Last Name (NamePattern1) 6583**]
MEDQUIST36
D:  [**2151-12-9**] 12:08:33
T:  [**2151-12-10**] 07:07:38
Job#:  [**Job Number 99396**]
{"Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Acute kidney failure, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Congestive heart failure, unspecified,Accidental fall on or from other stairs or steps,Long-term (current) use of anticoagulants,Pure hypercholesterolemia,Unspecified essential hypertension,Other disorders of neurohypophysis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Osteitis deformans without mention of bone tumor"}


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 87-year-old
woman who fell down on a flight of stairs with no loss of
consciousness, with severe neck pain, no headache, and
baseline dementia.  Husband now reports increased confusion.

MEDICAL HISTORY: Hypertension, atrial fibrillation,
Paget's disease, and dementia.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{"Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Atrial fibrillation,Acute kidney failure, unspecified,Cerebral artery occlusion, unspecified with cerebral infarction,Congestive heart failure, unspecified,Accidental fall on or from other stairs or steps,Long-term (current) use of anticoagulants,Pure hypercholesterolemia,Unspecified essential hypertension,Other disorders of neurohypophysis,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Osteitis deformans without mention of bone tumor"}
