CHIEF COMPLAINT: Dizziness

PRESENT ILLNESS: Patient is a 76 yo RH man with PMH of termporal arteritis
and Cervical spine DJD who presents with acute onset dizziness.
Says that he was feeling at baseline when he stepped out of the
shower at 12:15 and became acutely dizzy.  He has vertigo on
standing which does not remit and lasts more than a full minute.

MEDICAL HISTORY: Temporal arteritis
Cervical spine DJD

MEDICATION ON ADMISSION: Atenolol 25 daily
[**Doctor First Name **] 180 daily
Fluticasone 50 mcg 1-2 puffs/day
Simvastatin 20 daily
Lisinopril 20 daily
augmentin 800 [**Hospital1 **] for sinusitis (2 days out of 15 remaining)
MVI
Tylenol

ALLERGIES: Ibuprofen / Naprosyn / Aspirin

PHYSICAL EXAM: T- pending  BP- 160/60  HR- 72  RR- 16  O2Sat 100 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Mother had breast ca and "pelvic" CA.  Brother had CAD and
TB.

SOCIAL HISTORY: Quit tob [**2069**].  Drinks 2-3 per week.  Retired.
Cerebral aneurysm, nonruptured,Subarachnoid hemorrhage,Giant cell arteritis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cervical spondylosis without myelopathy,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin
Nonrupt cerebral aneurym,Subarachnoid hemorrhage,Giant cell arteritis,Hypertension NOS,Hyperlipidemia NEC/NOS,Cervical spondylosis,Hx-prostatic malignancy,Hx-skin malignancy NEC
Admission Date:  [**2110-5-22**]              Discharge Date:   [**2110-5-22**]

Date of Birth:  [**2034-4-1**]             Sex:   M

Service: NEUROLOGY

Allergies:
Ibuprofen / Naprosyn / Aspirin

Attending:[**First Name3 (LF) 6075**]
Chief Complaint:
Dizziness

Major Surgical or Invasive Procedure:
Angiogram

History of Present Illness:
Patient is a 76 yo RH man with PMH of termporal arteritis
and Cervical spine DJD who presents with acute onset dizziness.
Says that he was feeling at baseline when he stepped out of the
shower at 12:15 and became acutely dizzy.  He has vertigo on
standing which does not remit and lasts more than a full minute.

When lying down at rest, he has dizziness but no vertigo.  Very
soon after onset of the dizziness, he developed a severe
occipital headache which is not the worst of his life.  He now
has [**6-7**] pain.

ROS: Denies any fevers, chills, weakness, parasthesias.  Does
complain of nausea.

Past Medical History:
Temporal arteritis
Cervical spine DJD

Social History:
Quit tob [**2069**].  Drinks 2-3 per week.  Retired.

Family History:
Mother had breast ca and "pelvic" CA.  Brother had CAD and
TB.

Physical Exam:
T- pending  BP- 160/60  HR- 72  RR- 16  O2Sat 100 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

Neurologic examination:
Mental status: Awake and alert but keeps eyes closed for
headache
unless stimulated, cooperative with exam, normal
affect.  Oriented to person, place, and date.  Attentive, says
[**Doctor Last Name 1841**] backwards.  Speech is fluent with normal comprehension and
repetition; naming intact. No dysarthria. Cannot read without
his
glasses.  Registers [**3-31**], recalls [**3-31**] in 5 minutes.  No right
left
confusion. No evidence of apraxia or neglect.

Cranial Nerves:
Pupils equally round and reactive to light, 4 to 2 mm
bilaterally. Visual fields are full to confrontation.
Extraocular
movements intact bilaterally, no nystagmus. Sensation intact
V1-V3.  Facial movement symmetric.  Hearing intact to finger rub
bilaterally.  Palate elevation symmetrical.  Sternocleidomastoid
and trapezius normal bilaterally. Tongue midline, movements
intact

Motor:
Normal bulk bilaterally. Tone normal. No observed myoclonus or
tremor
No pronator drift
  [**Doctor First Name **] Tri [**Hospital1 **]  WF WE FE FF  IP  H  Q DF PF TE TF
R  5   5   5  5  5  5  5   5   5  5  5  5  5  5
L  5   5   5  5  5  5  5   5   5  5  5  5  5  5

Sensation: Intact to light touch, pinprick, vibration and
proprioception throughout. No extinction to DSS

Reflexes:
+2 and symmetric throughout.
Toes downgoing bilaterally

Coordination: finger-nose-finger normal, heel to shin normal,
RAMs normal.

Gait: not tested, as becomes acutely vertiginous.

Pertinent Results:
[**2110-5-22**] 02:00PM BLOOD WBC-12.3* RBC-4.42* Hgb-13.2* Hct-37.0*
MCV-84 MCH-29.7 MCHC-35.6* RDW-13.3 Plt Ct-252
[**2110-5-22**] 02:00PM BLOOD Plt Ct-252
[**2110-5-22**] 02:00PM BLOOD PT-12.0 PTT-23.0 INR(PT)-1.0
[**2110-5-22**] 02:00PM BLOOD Glucose-128* UreaN-12 Creat-0.7 Na-136
K-4.0 Cl-95* HCO3-25 AnGap-20
[**2110-5-22**] 02:00PM BLOOD ALT-12 AST-30 LD(LDH)-257* CK(CPK)-71
AlkPhos-84 TotBili-0.4
[**2110-5-22**] 02:00PM BLOOD cTropnT-<0.01
[**2110-5-22**] 02:00PM BLOOD Albumin-4.6

Brief Hospital Course:
Patient is a 76 y/o RHM with a PMHx of temporal arteritis and
cervical spind DJD who presents with acute onset of dizziness
and vertigo.  Examination was significant only for vertigo on
standing or sitting.  There was no-focal neurologic findings and
intact coordination.  He has a large ammount of intraventricular
blood throughout the lateral, 3rd and 4th ventricles with a
2.4mm left PICA aneurysm as the likely source noted on CTA.
There seems to be a subarachnoid component around the fourth
ventricle.  He was placed on nimodipine for BP and taken for an
angiogram which wasn't able to be coiled.  Therefore he is being
transfered to [**Hospital1 112**] for emergent craniotomy and clipping.

Medications on Admission:
Atenolol 25 daily
[**Doctor First Name **] 180 daily
Fluticasone 50 mcg 1-2 puffs/day
Simvastatin 20 daily
Lisinopril 20 daily
augmentin 800 [**Hospital1 **] for sinusitis (2 days out of 15 remaining)
MVI
Tylenol


Discharge Medications:
1. Nicardipine 2.5 mg/mL Solution Sig: 1-3 mcg/kg/min
Intravenous INFUSION (continuous infusion).
2. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours).
3. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1)
Tablet PO Q8H (every 8 hours) for 2 days.
4. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. Sodium Chloride 0.9%  Flush 3 mL IV PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.
6. Pantoprazole 40 mg IV Q24H


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary Diagnosis:
1. Left PICA aneurysm
2. Subarachnoid hemorrhage

Secondary Diagnosis:
1. Temporal arteritis
2. Cervical DJD


Discharge Condition:
Critical


Discharge Instructions:
Discharge to [**Hospital1 112**] for emergent surgery

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1882**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2110-5-29**] 10:00
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 39**], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 41**]
Date/Time:[**2110-6-5**] 1:15
Provider: [**First Name11 (Name Pattern1) 8122**] [**Last Name (NamePattern4) 8123**], M.D. Phone:[**Telephone/Fax (1) 2977**]
Date/Time:[**2110-6-16**] 1:30
{'Cerebral aneurysm, nonruptured,Subarachnoid hemorrhage,Giant cell arteritis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cervical spondylosis without myelopathy,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin'}


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: Dizziness

PRESENT ILLNESS: Patient is a 76 yo RH man with PMH of termporal arteritis
and Cervical spine DJD who presents with acute onset dizziness.
Says that he was feeling at baseline when he stepped out of the
shower at 12:15 and became acutely dizzy.  He has vertigo on
standing which does not remit and lasts more than a full minute.

MEDICAL HISTORY: Temporal arteritis
Cervical spine DJD

MEDICATION ON ADMISSION: Atenolol 25 daily
[**Doctor First Name **] 180 daily
Fluticasone 50 mcg 1-2 puffs/day
Simvastatin 20 daily
Lisinopril 20 daily
augmentin 800 [**Hospital1 **] for sinusitis (2 days out of 15 remaining)
MVI
Tylenol

ALLERGIES: Ibuprofen / Naprosyn / Aspirin

PHYSICAL EXAM: T- pending  BP- 160/60  HR- 72  RR- 16  O2Sat 100 RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple, no carotid
or vertebral bruit
Back: No point tenderness or erythema
CV: RRR, Nl S1 and S2, no murmurs/gallops/rubs
Lung: Clear to auscultation bilaterally
aBd: +BS soft, nontender
ext: no edema

FAMILY HISTORY: Mother had breast ca and "pelvic" CA.  Brother had CAD and
TB.

SOCIAL HISTORY: Quit tob [**2069**].  Drinks 2-3 per week.  Retired. 

### Response:
{'Cerebral aneurysm, nonruptured,Subarachnoid hemorrhage,Giant cell arteritis,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Cervical spondylosis without myelopathy,Personal history of malignant neoplasm of prostate,Personal history of other malignant neoplasm of skin'}
