CHIEF COMPLAINT: Coma

PRESENT ILLNESS: 78yo RH woman with recent admission for right MCA stroke,
followed by PCA infarction which led to emergent right-sided
hemicraniectomy for worsening edema and herniation, and pt was
transferred to extended care with residual eyelid apraxia,
left-sided neglect and autotopagnosia and left hemiparesis, now
readmitted to neurologic ICU in coma, due to massive left-sided
hemispheric hemorrhagic stroke.

MEDICAL HISTORY: -prior strokes: Roughly 10 years ago and again in
[**2138-1-28**] she had strokes.  The first event started with
a dull headache and was followed by transient (minutes-long)
left hand clumsiness. The next episode occurred when she was
playing cards and she transiently lost vision in the right half
of space. Apparently, she was admitted to [**Hospital6 33**]
and was told she had a stroke.  She was noted to have possible
cardiac source was on warfarin.
-migraine headaches: Since about the age of 30 years.  Headaches
consisted of bifrontal dull aching, preceded by aura of
scintillations and sometimes by right field cut.
-hypertension
-hyperlipidemia

MEDICATION ON ADMISSION: Heparin 5,000 SQ, Zocor 40, Amiodarone 400 [**Hospital1 **], Lopressor
37.5 tid, ASA 325 and Senna and Colace

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam:
P 65 BP 113/38 Ox: 100% R 20 on volume control to Vt 600cc Peak
pressures in
upper 20's, 20bpm, 5 peep

FAMILY HISTORY: Notable for many female family members with migraine headache.

SOCIAL HISTORY: The pt lived at home before her prior, recent admission for
stroke.  She is a former clerical worker.  She smoked roughly
[**12-29**] pack of cigarettes per day for twenty years, but quit about
40 years ago.  She had an occasional glass of wine with dinner.
No history of IVDU.
Intracerebral hemorrhage,Atrial fibrillation,Coma,Unspecified essential hypertension
Intracerebral hemorrhage,Atrial fibrillation,Coma,Hypertension NOS
Admission Date:  [**2139-6-28**]              Discharge Date:   [**2139-7-13**]

Date of Birth:  [**2061-4-30**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8747**]
Chief Complaint:
Coma

Major Surgical or Invasive Procedure:
None

History of Present Illness:
78yo RH woman with recent admission for right MCA stroke,
followed by PCA infarction which led to emergent right-sided
hemicraniectomy for worsening edema and herniation, and pt was
transferred to extended care with residual eyelid apraxia,
left-sided neglect and autotopagnosia and left hemiparesis, now
readmitted to neurologic ICU in coma, due to massive left-sided
hemispheric hemorrhagic stroke.

Past Medical History:
-prior strokes: Roughly 10 years ago and again in
[**2138-1-28**] she had strokes.  The first event started with
a dull headache and was followed by transient (minutes-long)
left hand clumsiness. The next episode occurred when she was
playing cards and she transiently lost vision in the right half
of space. Apparently, she was admitted to [**Hospital6 33**]
and was told she had a stroke.  She was noted to have possible
cardiac source was on warfarin.
-migraine headaches: Since about the age of 30 years.  Headaches
consisted of bifrontal dull aching, preceded by aura of
scintillations and sometimes by right field cut.
-hypertension
-hyperlipidemia


Social History:
The pt lived at home before her prior, recent admission for
stroke.  She is a former clerical worker.  She smoked roughly
[**12-29**] pack of cigarettes per day for twenty years, but quit about
40 years ago.  She had an occasional glass of wine with dinner.
No history of IVDU.




Family History:
Notable for many female family members with migraine headache.


Physical Exam:
Exam:
P 65 BP 113/38 Ox: 100% R 20 on volume control to Vt 600cc Peak
pressures in
upper 20's, 20bpm, 5 peep

Gen: elderly woman unresponsive to all noxious stimuli, with no
observed spontaneous movements, intubated
CV: RRR
Abd: soft
Ext: no edema

Neuro:
CN: pupils pinpoint and unreactive to light, gaze is midline
with
no extraocular movement to oculocephalic maneuver. Corneal
reflexes not tested

Motor: no response in any extremity to sternal rub or pressure
on
nailbed

Reflexes: toes upgoing bilaterally


Brief Hospital Course:
The patient was admitted to the ICU with a very poor prognosis.
CT on admission showed "massive new areas of intraparenchymal
hemorrhage in both hemispheres causing subfalcine and
transtentorial herniation." She was intubated and, at the
family's insistence, full measures were taken to sustain her
life. This plan was altered upon the family's finding of her
will, which stated that she would not want her life prolonged in
this state, including such invasive procedures with intravenous
lines and a ventilator. At this point, she was extubated at the
family's request. Her care was focused on comfort measures.

The patient expired on [**2139-7-13**] at 10:31PM of respiratory arrest,
related to her intracranial hemorrhage.  She was CMO at the
time.  There were no breath sounds, heart sounds, or brainstem
reflexes, pupils were fixed and dilated.

Her son and daughter were informed and extensively involved in
the decisions of her medical care throughout her hospital
course.  Extensive family meetings were held to keep them
updated and assist in medical decision making.

Medications on Admission:
Heparin 5,000 SQ, Zocor 40, Amiodarone 400 [**Hospital1 **], Lopressor
37.5 tid, ASA 325 and Senna and Colace

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired:
Respiratory arrest secondary to cerebral hemorrhage

Discharge Condition:
expired

Discharge Instructions:
expired

Followup Instructions:
expired


Completed by:[**2139-7-14**]
{'Intracerebral hemorrhage,Atrial fibrillation,Coma,Unspecified essential hypertension'}


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: Coma

PRESENT ILLNESS: 78yo RH woman with recent admission for right MCA stroke,
followed by PCA infarction which led to emergent right-sided
hemicraniectomy for worsening edema and herniation, and pt was
transferred to extended care with residual eyelid apraxia,
left-sided neglect and autotopagnosia and left hemiparesis, now
readmitted to neurologic ICU in coma, due to massive left-sided
hemispheric hemorrhagic stroke.

MEDICAL HISTORY: -prior strokes: Roughly 10 years ago and again in
[**2138-1-28**] she had strokes.  The first event started with
a dull headache and was followed by transient (minutes-long)
left hand clumsiness. The next episode occurred when she was
playing cards and she transiently lost vision in the right half
of space. Apparently, she was admitted to [**Hospital6 33**]
and was told she had a stroke.  She was noted to have possible
cardiac source was on warfarin.
-migraine headaches: Since about the age of 30 years.  Headaches
consisted of bifrontal dull aching, preceded by aura of
scintillations and sometimes by right field cut.
-hypertension
-hyperlipidemia

MEDICATION ON ADMISSION: Heparin 5,000 SQ, Zocor 40, Amiodarone 400 [**Hospital1 **], Lopressor
37.5 tid, ASA 325 and Senna and Colace

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Exam:
P 65 BP 113/38 Ox: 100% R 20 on volume control to Vt 600cc Peak
pressures in
upper 20's, 20bpm, 5 peep

FAMILY HISTORY: Notable for many female family members with migraine headache.

SOCIAL HISTORY: The pt lived at home before her prior, recent admission for
stroke.  She is a former clerical worker.  She smoked roughly
[**12-29**] pack of cigarettes per day for twenty years, but quit about
40 years ago.  She had an occasional glass of wine with dinner.
No history of IVDU. 

### Response:
{'Intracerebral hemorrhage,Atrial fibrillation,Coma,Unspecified essential hypertension'}
