CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 35-year-old male
with a history of substance abuse with subarachnoid
intercerebral hemorrhage.  By report on [**12-9**], he was
initially found down on the grounds of [**University/College 25203**]and
was intoxicated.  Later that day he had a witnessed fall with
loss of consciousness.  He was taken to [**Hospital6 **], where he was described as being combative and
agitated, however, his initial [**Location (un) 2611**] coma score was 15.  He
eventually required intubation for airway protection due to
his extreme combativeness and agitation.  A head CT
subsequently revealed bilateral left greater than right
subarachnoid hemorrhage and intracerebral hemorrhage.  There
was no documented hypotension or hypoxia at [**Hospital6 **].  He was therefore transferred to [**Hospital1 346**] for further care.

MEDICAL HISTORY: 1. Polysubstance abuse.
2. Prior head trauma.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Alcohol abuse, continuous,Pneumonia, organism unspecified,Closed fracture of lumbar vertebra without mention of spinal cord injury,Unspecified fall,Cerebral edema,Aphasia
Cl skul base fx-coma NOS,Alcohol abuse-continuous,Pneumonia, organism NOS,Fx lumbar vertebra-close,Fall NOS,Cerebral edema,Aphasia
Admission Date:  [**2148-12-10**]       Discharge Date:  [**2148-12-26**]

Date of Birth:   [**2113-7-5**]       Sex:  M

Service:  Neurosurgery and Trauma SICU

HISTORY OF PRESENT ILLNESS:  Patient is a 35-year-old male
with a history of substance abuse with subarachnoid
intercerebral hemorrhage.  By report on [**12-9**], he was
initially found down on the grounds of [**University/College 25203**]and
was intoxicated.  Later that day he had a witnessed fall with
loss of consciousness.  He was taken to [**Hospital6 **], where he was described as being combative and
agitated, however, his initial [**Location (un) 2611**] coma score was 15.  He
eventually required intubation for airway protection due to
his extreme combativeness and agitation.  A head CT
subsequently revealed bilateral left greater than right
subarachnoid hemorrhage and intracerebral hemorrhage.  There
was no documented hypotension or hypoxia at [**Hospital6 **].  He was therefore transferred to [**Hospital1 346**] for further care.

PAST MEDICAL HISTORY:
1. Polysubstance abuse.
2. Prior head trauma.

MEDICATIONS:  None.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAM ON ADMISSION:  Is reported as temperature of
99.8, blood pressure 150/palp, pulse 105, O2 saturation 100%
intubated and ventilated.  In general, he was intubated and
sedated.  His HEENT examination showed no hemotympanum.  His
cardiac examination showed a regular rate and rhythm without
murmurs, rubs, or gallops.  His lungs were clear to
auscultation bilaterally.  His abdomen was soft, nontender,
nondistended.  His extremities showed no deformities.  On
neurologic examination, his pupils are 2 mm and trace
reactive bilaterally.  His eyes were opened spontaneously.
He moved all four extremities to stimulation.  He has
spontaneous bilateral lower extremity movements, antigravity,
but less spontaneous movements in bilateral upper
extremities.

HOSPITAL COURSE BY SYSTEMS:
1. Neurologic:  Initial head CT showed a large hemorrhage
contusion temporal lobe with edema and subarachnoid
hemorrhage.  There is a small hemorrhagic contusion in the
anterior right frontal lobe.  There was also a nondisplaced
right occipital fracture.  C spine CT was negative for
fracture.  Head CTA showed no evidence of aneurysm.
Therefore, the likely etiology of his intracranial
hemorrhages were traumatic.  An interventricular catheter was
not placed.  The patient was therefore followed clinically
and with serial head CT scans.  His head CT scans were
followed and were stable until [**12-22**].

On [**12-22**], a head CT showed worsening global edema with
new hypoattenuation areas in the left frontal, bilateral
temporal-parietal areas suspicious for infarct.  MRI showed
increased flare signal and DWI in the right insula, right
frontal-temporal region, left internal capsule, and left
temporal regions suspicious for infarct.  This may have been
related to vasospasm induced by the subarachnoid hemorrhage.
Despite the neuroimaging findings, the patient's neurologic
examination slowly improved over the course of his admission.

With regards to his neurologic management, he was initially
loaded with Dilantin, and this was stopped after one week.
His pCO2 was adjusted with a goal of maintaining between 35
and 40.  He had a goal of being euvolemic, but at times was
fluid positive.  His blood pressure was initially tightly
controlled to be less than 130 with continuous hemodynamic
monitoring and this parameters was gradually liberated over
the course of admission.  He initially needed significant
sedation with both propofol and Ativan, and the propofol was
eventually discontinued.

His neurologic examination was followed closely throughout
his admission and slowly improved, although he still
continues to have significant deficits.  At discharge, his
neurologic examination was significant for being awake and
alert, unable to make eye contact and visually track.  He had
no speech output.  He was not able to follow commands.  He
was able to lift his arm up in the air and move his fingers
individually.  He was able to flex at the right elbow and
shrug his shoulder, but did not have antigravity on the
right.  He withdrew both legs spontaneously lifted them off
the bed.

He was seen by the neuro-rehabilitation service, who found
this to be consistent with global aphasia and mild right
hemiparesis mostly in the arm.  They expected that the blood
and edema in the left temporal-parietal area resolved.  That
he had a significant chance of recovering language and right
arm function.  They expected that he would be ambulatory
after recovery.  They expect that he would obtain significant
benefit from OT, PT, and Speech Therapy at rehab.

2. Cardiovascular:  There were no significant issues.  His
blood pressures were controlled as above as needed.  At
discharge, he was on Lopressor prn.

3. Respiratory:  He was initially intubated and ventilated.
He had significant problems with secretions due to either
sinusitis or pneumonia.  Chest x-ray on [**12-20**] revealed
a right lung base infiltrate consistent with pneumonia.  He
was treated with both Vancomycin and ceftriaxone.  The
infiltrate had resolved on x-ray by [**12-25**].  The
patient had two trials of extubation, but failed due to
significant respiratory secretions.  He therefore underwent
tracheostomy placement on [**12-24**], and was successfully
weaned off the ventilator.  At discharge, he was receiving
albuterol and acetylcysteine nebulizers as needed.  He was
stable from a respiratory standpoint on a trache mask.

4. Fluids, electrolytes, and nutrition:  The patient as above
had a goal of being euvolemic, but was at times fluid
positive.  His electrolytes were repleted as needed.  His
sugars were followed closely and controlled with an
insulin-sliding scale.

5. GI:  Patient initially had nasogastric tube feedings and
on [**12-24**], a PEG was placed.  His goal feedings are
Impact with fiber at 40 cc/hour at this time.  Reglan was
given to promote GI motility.

6. Infectious disease:  The patient was persistently febrile
for most of his admission.  Cultures were obtained.  Blood
culture on [**12-10**] from his arterial line showed alpha
Strep.  Sputum from [**12-10**] grew hemophilus influenzae,
MRSA and beta Strep.  He was treated with Vancomycin from
[**12-12**] to [**12-25**].  He was also treated with
ceftriaxone from [**12-16**] to [**7-26**].  He had been
afebrile for the day prior to discharge.

7. Orthopedics:  He did sustain a right sided transverse
process fractures of L3, L4, and L5.

8. Prophylaxis:  He is on subcutaneous Heparin for DVT
prophylaxis.

DISCHARGE CONDITION:  Stable.

DISCHARGE STATUS:  [**Hospital **] [**Hospital **] Hospital.

DISCHARGE DIAGNOSES:
1. Bilateral left greater than right intracerebral hemorrhage
and subarachnoid hemorrhage.
2. Right lumbar three, four, and five transverse process
fractures.
3. Status post trache.
4. Status post PEG.
5. Pneumonia.
6. Alcohol abuse.

MEDICATIONS:
1. Heparin 5,000 units subQ b.i.d.
2. Reglan q.8.
3. Regular insulin-sliding scale.
4. Medications prn including Tylenol, Mucomyst nebulizers,
albuterol nebulizers, magnesium supplementation, potassium
supplementation, calcium supplementation, and Lacrilube
ointment.



                            [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Name8 (MD) 33494**]
MEDQUIST36

D:  [**2148-12-26**]  10:49
T:  [**2148-12-26**]  12:01
JOB#:  [**Job Number 33495**]


Name:  [**Known lastname 4359**], [**Known firstname **]                     Unit No:  [**Numeric Identifier 5861**]

Admission Date:  [**2148-12-10**]     Discharge Date:  [**2149-1-3**]

Date of Birth:   [**2113-7-5**]     Sex:  M

Service: Neurosurgery

ADDENDUM:  Initial dictated for discharge date [**12-26**].
The discharge date was delayed until [**2149-1-3**] due to
lack of rehabilitation bed.

The patient's condition remained stable.  He was
neurologically improving, following commands, and moving all
extremities.  His vital signs have been stable.  He was to be
transferred to acute rehabilitation with follow up with Dr.
[**First Name8 (NamePattern2) **] [**Name (STitle) 365**] in one month with a repeat head computed
tomography and was to follow up with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] in two
to three weeks for lumbar fractures.

CONDITION AT DISCHARGE:  Condition on discharge was stable.





                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 5862**]

Dictated By:[**Last Name (NamePattern1) 366**]

MEDQUIST36

D:  [**2149-1-3**]  12:18
T:  [**2149-1-4**]  00:44
JOB#:  [**Job Number 5863**]
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Alcohol abuse, continuous,Pneumonia, organism unspecified,Closed fracture of lumbar vertebra without mention of spinal cord injury,Unspecified fall,Cerebral edema,Aphasia'}


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: Patient is a 35-year-old male
with a history of substance abuse with subarachnoid
intercerebral hemorrhage.  By report on [**12-9**], he was
initially found down on the grounds of [**University/College 25203**]and
was intoxicated.  Later that day he had a witnessed fall with
loss of consciousness.  He was taken to [**Hospital6 **], where he was described as being combative and
agitated, however, his initial [**Location (un) 2611**] coma score was 15.  He
eventually required intubation for airway protection due to
his extreme combativeness and agitation.  A head CT
subsequently revealed bilateral left greater than right
subarachnoid hemorrhage and intracerebral hemorrhage.  There
was no documented hypotension or hypoxia at [**Hospital6 **].  He was therefore transferred to [**Hospital1 346**] for further care.

MEDICAL HISTORY: 1. Polysubstance abuse.
2. Prior head trauma.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration,Alcohol abuse, continuous,Pneumonia, organism unspecified,Closed fracture of lumbar vertebra without mention of spinal cord injury,Unspecified fall,Cerebral edema,Aphasia'}
