CHIEF COMPLAINT: collapse, transfer from OSH in coma

PRESENT ILLNESS: [**Known firstname 87998**] [**Known lastname **] is a 62 yo man working today on [**Hospital3 635**] as a
landscaper when he suddenly collapsed around 1pm.  He was
initially brought to [**Hospital3 **] Hospital and found to be in Afib.
SBP on arrival was in the 160s-180s.  GCS was 3; he was
subsequently intubated and sedated.  CT head showed possible
edema of the posterior fossa.  CTA was then obtained and
demonstrated basilar artery thrombus as well as thrombus in the
left vertebral artery.  IV tPA was given and the patient was
life
flighted to [**Hospital1 18**] for further care.  On arrival here. A repeat
CT
of the head was showed evolution of a left cerebellar infarct
and
a hyper density in the left vertebral artery.  The patient was
taken immediately to the Angio suite for clot retrieval. There,
off of propofol, his pupils where pinpoint and non-reactive;
there was no spontaneous movement. Angiography demonstrated a
clear basilar with clots in the bilateral PCAs and these where
successfully removed.

MEDICAL HISTORY: Have documents from pts pharmacy in [**Location (un) 15158**] NY
(Kraupner Pharmacy- [**Telephone/Fax (1) 87999**]).  This documents listed [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 88000**], MD as his PCP (Phone: ([**Telephone/Fax (1) 88001**]) and was able to
receive the following information.  Pt was last seen in her
office in [**2141-3-2**]. Her past medical history for the
patient was noted as:

MEDICATION ON ADMISSION: Last documented medications:
- Warfarin 5mg/7.5
- Flomax 0.4
- Amlodipine 2.5mg
- Enalapril 10mg daily
- Simcor 500/20

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: (on admission, just prior to angiography procedure)
Extremely limited.  This exam was with the patient off propofol
for 20minutes during prep for angio.
Pupils pinpoint, non-reactive.  No spontaneous movements, no
withdrawal.  Unable to test brainstem reflexes further.

FAMILY HISTORY: nc

SOCIAL HISTORY: Pt was working as a landscaper.  In speaking with
is niece, he has been living on [**Location (un) 945**] since [**Month (only) 958**] or [**Month (only) 547**].
It is unclear if he has been seen by a PCP or as continued to
take his medications.  He is married, wife is [**Name (NI) 88002**] [**Name (NI) **] and
has 2 daughters, [**Name (NI) **] [**Name (NI) **] (who consented to the procedure
today)
and [**Female First Name (un) 88003**], all of whom live in NY.
Cerebral thrombosis with cerebral infarction,Cerebral edema,Acute respiratory failure,Coma,Hematoma complicating a procedure,Obstructive hydrocephalus,Hyperosmolality and/or hypernatremia,Peripheral vascular complications, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Other and unspecified hyperlipidemia,Atrial fibrillation,Unspecified essential hypertension,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Aneurysm of artery of lower extremity
Crbl thrmbs w infrct,Cerebral edema,Acute respiratry failure,Coma,Hematoma complic proc,Obstructiv hydrocephalus,Hyperosmolality,Surg comp-peri vasc syst,Abn react-procedure NEC,Accid in resident instit,Hyperlipidemia NEC/NOS,Atrial fibrillation,Hypertension NOS,TPA adm status 24 hr pta,Lower extremity aneurysm
Admission Date:  [**2141-9-12**]              Discharge Date:   [**2141-9-20**]

Date of Birth:  [**2078-2-12**]             Sex:   M

Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
collapse, transfer from OSH in coma

Major Surgical or Invasive Procedure:
tPA, cerebral angiography, c/b groin/femoral hematoma, resolved
with pressure, pressure-dressing

History of Present Illness:
[**Known firstname 87998**] [**Known lastname **] is a 62 yo man working today on [**Hospital3 635**] as a
landscaper when he suddenly collapsed around 1pm.  He was
initially brought to [**Hospital3 **] Hospital and found to be in Afib.
SBP on arrival was in the 160s-180s.  GCS was 3; he was
subsequently intubated and sedated.  CT head showed possible
edema of the posterior fossa.  CTA was then obtained and
demonstrated basilar artery thrombus as well as thrombus in the
left vertebral artery.  IV tPA was given and the patient was
life
flighted to [**Hospital1 18**] for further care.  On arrival here. A repeat
CT
of the head was showed evolution of a left cerebellar infarct
and
a hyper density in the left vertebral artery.  The patient was
taken immediately to the Angio suite for clot retrieval. There,
off of propofol, his pupils where pinpoint and non-reactive;
there was no spontaneous movement. Angiography demonstrated a
clear basilar with clots in the bilateral PCAs and these where
successfully removed.

Past Medical History:
Have documents from pts pharmacy in [**Location (un) 15158**] NY
(Kraupner Pharmacy- [**Telephone/Fax (1) 87999**]).  This documents listed [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 88000**], MD as his PCP (Phone: ([**Telephone/Fax (1) 88001**]) and was able to
receive the following information.  Pt was last seen in her
office in [**2141-3-2**]. Her past medical history for the
patient was noted as:

- Gunshot wound [**2115**] with bowel injury
- Hypertension
- Hyperlipidemia (last cholesterol 167) simvastatin LDL
- Atrial Fibrillation on Coumadin (last INR by PCP in [**Name9 (PRE) 547**] was
therapeutic at 2.2)
- No known surgeries, implants.

No known allergies

Social History:
Pt was working as a landscaper.  In speaking with
is niece, he has been living on [**Location (un) 945**] since [**Month (only) 958**] or [**Month (only) 547**].
It is unclear if he has been seen by a PCP or as continued to
take his medications.  He is married, wife is [**Name (NI) 88002**] [**Name (NI) **] and
has 2 daughters, [**Name (NI) **] [**Name (NI) **] (who consented to the procedure
today)
and [**Female First Name (un) 88003**], all of whom live in NY.

Family History:
nc

Physical Exam:
(on admission, just prior to angiography procedure)
Extremely limited.  This exam was with the patient off propofol
for 20minutes during prep for angio.
Pupils pinpoint, non-reactive.  No spontaneous movements, no
withdrawal.  Unable to test brainstem reflexes further.

<<See scanned inpatient notes in OMR for progression of
physical/neurologic examination during his 1wk stay in the ICU
[**9-12**] - [**9-20**]>

Pertinent Results:
>>
[**2141-9-12**] 10:05PM   WBC-13.5* RBC-4.86 HGB-15.2 HCT-46.1 MCV-95
MCH-31.3 MCHC-33.0 RDW-14.2
[**2141-9-12**] 10:05PM   PLT COUNT-233
[**2141-9-12**] 08:46PM   %HbA1c-6.0* eAG-126*
[**2141-9-12**] 06:57PM   TYPE-ART PO2-333* PCO2-43 PH-7.40 TOTAL
CO2-28 BASE XS-1
[**2141-9-12**] 06:57PM   GLUCOSE-139* LACTATE-1.7 NA+-141 K+-4.0
CL--101
[**2141-9-12**] 06:57PM   HGB-15.1 calcHCT-45
[**2141-9-12**] 06:57PM   freeCa-1.10*
[**2141-9-12**] 05:45PM   GLUCOSE-116* UREA N-19 CREAT-1.0 SODIUM-140
POTASSIUM-4.3 CHLORIDE-104 TOTAL CO2-26 ANION GAP-14
[**2141-9-12**] 05:45PM   estGFR-Using this
[**2141-9-12**] 05:45PM   cTropnT-<0.01
[**2141-9-12**] 05:45PM   WBC-14.4* RBC-4.75 HGB-15.1 HCT-45.2 MCV-95
MCH-31.7 MCHC-33.3 RDW-14.1
[**2141-9-12**] 05:45PM   NEUTS-86.5* LYMPHS-9.5* MONOS-2.7 EOS-0.9
BASOS-0.4
[**2141-9-12**] 05:45PM   PLT COUNT-223
[**2141-9-12**] 05:45PM   PT-15.8* PTT-46.5* INR(PT)-1.4*

CT brain without contrast on [**2141-9-12**]:
IMPRESSION:
1. Hypodensity within left cerebellar hemisphere may reflect
acute infarct,
although MRI would be more sensitive for this evaluation.
2. Mucosal thickening and air-fluid levels in the sinuses
secondary to
patient's intubated status.

[**2141-9-12**]
Conventional angiogram:
IMPRESSION:
Mr. [**Known firstname 87998**] [**Known lastname **] underwent diagnostic cerebral angiogram, which
demonstrated embolic occlusion of the proximal bilateral P2
segments of the posterior cerebral arteries. The basilar artery
and left vertebral artery were widely patent at the time of the
exam. After discussion with the stroke team, the decision was
made to perform intervention with direct intra-arterial
injection of TPA and mechanical thrombectomy. Post intervention
left vertebral artery angiogram demonstrated widely patent right
PCA and partial recanalization of left PCA.

Due to failure of angioseal device, direct pressure was
necessary for 3-1/2 hours, during which time a large right groin
hematoma formed. Vascular surgery was consulted at the beginning
of the direct pressure procedure and was made aware of the groin
hematoma. The right groin hematoma was stable in size for the
last hour and half of the procedure. The patient was taken to
the ICU and closely monitored by the ICU staff prior to and
after hemostasis.

CT brain on [**2142-9-18**]:
IMPRESSION:
1. Worsening of obstructive hydrocephalus with complete
effacement of the
fourth ventricle and interval dilation of the third and lateral
ventricles
with transependymal flow.
2. Tonsillar herniation.
3. No new hemorrhage identified.




Brief Hospital Course:
Mr. [**Known lastname **] was thought on admission to our Neurology service (in
SICU-B) to have a presentation suggestive of top-of-the-basilar
syndrome, most likely due to cardioembolism from AFib and
subtherapeutic INR. He was given IV/IA tPA and close
neurological monitoring. MRI/DWI confirmed extensive infarction.
He was never extubated, and his exam did not improve and
although he was producing spontaneous respirations while
intubated on a ventilator, his Neurological status, especially
his extensive brainstem infarction and poor airway/secretions
clearance, did not permit extubation. He was maintained on 3%
NaCl IV to minimize intracranial pressure with anticipated
brainstem swelling from his extensive posterior circulation
infarct and reperfusion after tPA. His family was reluctant to
withdraw artificial life support, and a decision re.
tracheostomy was delayed. He developed sepsis and hypotension
overnight 11/2-3, and became pulseless (PEA arrest) [**9-20**]
mid-morning requiring CPR/ACLS as his family had requested that
he remain full-code. He was coded (CPR-ACLS) for roughly 30min
without return of pulse, and I declared death that morning at
8:58am. The family did not request autopsy.

Medications on Admission:
Last documented medications:
- Warfarin 5mg/7.5
- Flomax 0.4
- Amlodipine 2.5mg
- Enalapril 10mg daily
- Simcor 500/20

Discharge Medications:
died [**2141-9-20**]

Discharge Disposition:
Expired

Discharge Diagnosis:
died [**2141-9-20**] in SICU-B with brainstem swelling ([**12-20**] brainstem
stroke) and septic shock

Discharge Condition:
died [**2141-9-20**]

Discharge Instructions:
n/a (died)

Followup Instructions:
n/a (died)


Completed by:[**2142-3-16**]
{'Cerebral thrombosis with cerebral infarction,Cerebral edema,Acute respiratory failure,Coma,Hematoma complicating a procedure,Obstructive hydrocephalus,Hyperosmolality and/or hypernatremia,Peripheral vascular complications, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Other and unspecified hyperlipidemia,Atrial fibrillation,Unspecified essential hypertension,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Aneurysm of artery of lower extremity'}


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: collapse, transfer from OSH in coma

PRESENT ILLNESS: [**Known firstname 87998**] [**Known lastname **] is a 62 yo man working today on [**Hospital3 635**] as a
landscaper when he suddenly collapsed around 1pm.  He was
initially brought to [**Hospital3 **] Hospital and found to be in Afib.
SBP on arrival was in the 160s-180s.  GCS was 3; he was
subsequently intubated and sedated.  CT head showed possible
edema of the posterior fossa.  CTA was then obtained and
demonstrated basilar artery thrombus as well as thrombus in the
left vertebral artery.  IV tPA was given and the patient was
life
flighted to [**Hospital1 18**] for further care.  On arrival here. A repeat
CT
of the head was showed evolution of a left cerebellar infarct
and
a hyper density in the left vertebral artery.  The patient was
taken immediately to the Angio suite for clot retrieval. There,
off of propofol, his pupils where pinpoint and non-reactive;
there was no spontaneous movement. Angiography demonstrated a
clear basilar with clots in the bilateral PCAs and these where
successfully removed.

MEDICAL HISTORY: Have documents from pts pharmacy in [**Location (un) 15158**] NY
(Kraupner Pharmacy- [**Telephone/Fax (1) 87999**]).  This documents listed [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 88000**], MD as his PCP (Phone: ([**Telephone/Fax (1) 88001**]) and was able to
receive the following information.  Pt was last seen in her
office in [**2141-3-2**]. Her past medical history for the
patient was noted as:

MEDICATION ON ADMISSION: Last documented medications:
- Warfarin 5mg/7.5
- Flomax 0.4
- Amlodipine 2.5mg
- Enalapril 10mg daily
- Simcor 500/20

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: (on admission, just prior to angiography procedure)
Extremely limited.  This exam was with the patient off propofol
for 20minutes during prep for angio.
Pupils pinpoint, non-reactive.  No spontaneous movements, no
withdrawal.  Unable to test brainstem reflexes further.

FAMILY HISTORY: nc

SOCIAL HISTORY: Pt was working as a landscaper.  In speaking with
is niece, he has been living on [**Location (un) 945**] since [**Month (only) 958**] or [**Month (only) 547**].
It is unclear if he has been seen by a PCP or as continued to
take his medications.  He is married, wife is [**Name (NI) 88002**] [**Name (NI) **] and
has 2 daughters, [**Name (NI) **] [**Name (NI) **] (who consented to the procedure
today)
and [**Female First Name (un) 88003**], all of whom live in NY. 

### Response:
{'Cerebral thrombosis with cerebral infarction,Cerebral edema,Acute respiratory failure,Coma,Hematoma complicating a procedure,Obstructive hydrocephalus,Hyperosmolality and/or hypernatremia,Peripheral vascular complications, not elsewhere classified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Accidents occurring in residential institution,Other and unspecified hyperlipidemia,Atrial fibrillation,Unspecified essential hypertension,Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility,Aneurysm of artery of lower extremity'}
