CHIEF COMPLAINT: headache

PRESENT ILLNESS: 56 yo F with a hx of ALL s/p whole brain RT, essential
tremor, [**Doctor Last Name 9376**] syndrome, ocular myasthenia, various types of
headaches, L sided ataxia, and a hx of episodes of near syncope,
presented 2 days ago with a SAH. She describes the event as a
very sudden worst headache of her life while changing out of her
business clothes after dinner. She did not fall at that time
either before or after the onset of the headache. She also
denies
any hx of head trauma in the preceding days. She called her
husband to call 911 and was taken to [**Hospital6 3105**].
She recived a head CT showing SAH and was transferred to [**Hospital1 18**].
Here, she received a repeat confirmatory head CT and an
angiogram
which was negative for aneurysm. She has been treated with
analgesics and antiemetics.
    This SAH has occurred in the context of an ongoing history
of
episodes of lightheadedness and headaches have been worked up by
Drs. [**Last Name (STitle) 724**] and [**Name5 (PTitle) 10442**] of neurology. She states that these episodes
have been going on for 8-9 years, ever since she had the whole
brain RT. She states they occur roughly weekly, although she can
go for longer periods without one. She states they were worse
when she had been simultaneously on chemotherapy until [**2109**], and
then presented sometimes as frank syncope. More recently
however,
she denies any frank syncopal episodoes. She states that
sometimes these episodes are accompanied by a band-like headache
around her head, she she states that if she gets that headache
first, it is a cue for her to sit down. She states that these
headaches are different that her migraines, which are preceded
by
an aura of funny smells and flashing lights. She received a
brain
MRI in [**2116-1-25**] after presenting to Dr. [**Last Name (STitle) 10442**] with a complaint
of one of these spells, which was negative. In early summer of
[**2115**] she also underwent tilt table testing at [**Hospital6 10443**], which was positive per her report.
   She does not have any history of seizures, and she denies any
focal motor movements or loss of bowel/bladder continence during
these episodes. She denies any other recent focal weakness,
parasthesias, vertigo, or hearing changes. She does state that
she has a history of intermittent diplopia c/w her ocular
myasthenia.

MEDICAL HISTORY: ALL s/p whole brain RT
essential tremor
[**Doctor Last Name 9376**] syndrome
ocular myasthenia
various types of headaches including migraine
L sided ataxia
hx of episodes of near-syncope

MEDICATION ON ADMISSION: Celexa 20 mg PO Qday
Imitrex PRN
MVI Qday
Fish Oil tab Qday
Vitamin D Qday

ALLERGIES: Penicillins / Iodine

PHYSICAL EXAM: T- 98.5 F BP- 121/74 HR- 82 RR- 21 O2Sat 96%RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa, O/P clear
Neck: No tenderness to palpation, normal ROM, able to touch chin
to chest, but states that it is painful of she lingers in this
position, 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: Father with CAD, Sister with [**Name (NI) 9376**] syndrome

SOCIAL HISTORY: Married, works in corporate banking, no tobacco or drugs,
rare EtOH
Subarachnoid hemorrhage,Acute lymphoid leukemia, in remission,Essential and other specified forms of tremor,Disorders of bilirubin excretion,Dermatitis due to drugs and medicines taken internally,Hydantoin derivatives causing adverse effects in therapeutic use
Subarachnoid hemorrhage,Act lym leuk w rmsion,Tremor NEC,Dis bilirubin excretion,Drug dermatitis NOS,Adv eff hydantoin deriv
Admission Date:  [**2116-9-18**]              Discharge Date:   [**2116-9-26**]

Date of Birth:  [**2060-5-16**]             Sex:   F

Service: NEUROLOGY

Allergies:
Penicillins / Iodine

Attending:[**Last Name (NamePattern1) 1838**]
Chief Complaint:
headache

Major Surgical or Invasive Procedure:
Angiogram


History of Present Illness:
56 yo F with a hx of ALL s/p whole brain RT, essential
tremor, [**Doctor Last Name 9376**] syndrome, ocular myasthenia, various types of
headaches, L sided ataxia, and a hx of episodes of near syncope,
presented 2 days ago with a SAH. She describes the event as a
very sudden worst headache of her life while changing out of her
business clothes after dinner. She did not fall at that time
either before or after the onset of the headache. She also
denies
any hx of head trauma in the preceding days. She called her
husband to call 911 and was taken to [**Hospital6 3105**].
She recived a head CT showing SAH and was transferred to [**Hospital1 18**].
Here, she received a repeat confirmatory head CT and an
angiogram
which was negative for aneurysm. She has been treated with
analgesics and antiemetics.
    This SAH has occurred in the context of an ongoing history
of
episodes of lightheadedness and headaches have been worked up by
Drs. [**Last Name (STitle) 724**] and [**Name5 (PTitle) 10442**] of neurology. She states that these episodes
have been going on for 8-9 years, ever since she had the whole
brain RT. She states they occur roughly weekly, although she can
go for longer periods without one. She states they were worse
when she had been simultaneously on chemotherapy until [**2109**], and
then presented sometimes as frank syncope. More recently
however,
she denies any frank syncopal episodoes. She states that
sometimes these episodes are accompanied by a band-like headache
around her head, she she states that if she gets that headache
first, it is a cue for her to sit down. She states that these
headaches are different that her migraines, which are preceded
by
an aura of funny smells and flashing lights. She received a
brain
MRI in [**2116-1-25**] after presenting to Dr. [**Last Name (STitle) 10442**] with a complaint
of one of these spells, which was negative. In early summer of
[**2115**] she also underwent tilt table testing at [**Hospital6 10443**], which was positive per her report.
   She does not have any history of seizures, and she denies any
focal motor movements or loss of bowel/bladder continence during
these episodes. She denies any other recent focal weakness,
parasthesias, vertigo, or hearing changes. She does state that
she has a history of intermittent diplopia c/w her ocular
myasthenia.



Past Medical History:
ALL s/p whole brain RT
essential tremor
[**Doctor Last Name 9376**] syndrome
ocular myasthenia
various types of headaches including migraine
L sided ataxia
hx of episodes of near-syncope



Social History:
Married, works in corporate banking, no tobacco or drugs,
rare EtOH


Family History:
Father with CAD, Sister with [**Name (NI) 9376**] syndrome

Physical Exam:
T- 98.5 F BP- 121/74 HR- 82 RR- 21 O2Sat 96%RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa, O/P clear
Neck: No tenderness to palpation, normal ROM, able to touch chin
to chest, but states that it is painful of she lingers in this
position, 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, cooperative with exam, normal
affect.  Oriented to person, place, and date.  Attentive, says
DOW backwards.  Speech is fluent with normal comprehension and
repetition; naming intact. No dysarthria. [**Location (un) **] and writing
intact.  Registers [**1-27**], recalls [**12-29**] in 5 minutes, and [**1-27**] w/
semantic prompting.  No right left confusion. No evidence of
apraxia or neglect.

Cranial Nerves:
Pupils equally round and reactive to light, 3 to 2 mm
bilaterally. Visual fields are full to confrontation.
Extraocular
movements intact bilaterally, no nystagmus. Right retina showing
sharp disc margin and no hemorrhages, left retina poorly
visualized. No double vision to extended upgaze. 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.
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: (+) tremor on finger-nose-finger bilaterally with
some dysmetria on the right (mildy misses to her right of mark
and corrects), normal heel to shin, RAMs normal, finger tap
normal.

Gait: deferred by pt



Pertinent Results:
[**2116-9-18**] 02:28PM   GLUCOSE-133*
[**2116-9-18**] 02:28PM   ALBUMIN-3.9
[**2116-9-18**] 02:28PM   PHENYTOIN-0.9*
[**2116-9-18**] 02:28PM   HCT-34.1*
[**2116-9-18**] 04:42AM   GLUCOSE-134* UREA N-12 CREAT-0.7 SODIUM-144
POTASSIUM-3.6 CHLORIDE-108 TOTAL CO2-27 ANION GAP-13
[**2116-9-18**] 04:42AM   CALCIUM-8.7 PHOSPHATE-4.1 MAGNESIUM-1.7
[**2116-9-18**] 04:42AM   WBC-8.5 RBC-4.21 HGB-13.3 HCT-36.4 MCV-87
MCH-31.6 MCHC-36.5* RDW-13.6
[**2116-9-18**] 04:42AM   PLT COUNT-309
[**2116-9-18**] 04:42AM   PT-12.7 PTT-20.1* INR(PT)-1.1
[**2116-9-18**] 01:25AM   GLUCOSE-116* UREA N-13 CREAT-0.7 SODIUM-144
POTASSIUM-4.1 CHLORIDE-105 TOTAL CO2-31 ANION GAP-12
[**2116-9-18**] 01:25AM   estGFR-Using this
[**2116-9-18**] 01:25AM   CALCIUM-9.3
[**2116-9-18**] 01:25AM   WBC-9.6 RBC-4.61 HGB-13.9 HCT-39.9 MCV-87
MCH-30.0 MCHC-34.7 RDW-13.3
[**2116-9-18**] 01:25AM   NEUTS-80.2* LYMPHS-16.6* MONOS-2.5 EOS-0.2
BASOS-0.6
[**2116-9-18**] 01:25AM   PLT COUNT-343
[**2116-9-18**] 01:25AM   PT-12.2 PTT-22.6 INR(PT)-1.0

Brief Hospital Course:
56 yo F with hx of of ALL s/p whole brain RT, essential tremor,
[**Doctor Last Name 9376**] syndrome, ocular myasthenia, various types of
headaches, L sided ataxia, and a hx of episodes of near syncope
admitted with a spontaneous SAH that was negative for
aneurysm (negative angiogram).
Her complaints of dizziness and syncope are consistent with the
diagnosis of autonomic disorder (positive tilt-table test from
Caritas [**Hospital6 5016**] was requested and exam performed on
[**2116-2-19**] revealed "patient was progressively tilted from lying
down to 60 degrees. After 17 minutes of tilt at 60 degrees, her
BP dropped to 74/52. She developped a severe headache and began
to "feel funny". Her HR was maintained. The table was tilted to
the Trendelenburg position. Her BP rose over the next minute
from 74/52 to 108/72 and eventually to 131/78".
Neurosurgery recommended the use of dilantin 100mg TID
prophylatically for 1 week. Patient also developed a rash on the
back that was thought to be due to dilantin (which was stopped
on [**2116-9-24**]; she had supratherapeutic levels for 2 days.. She
was oriented to seek medical support in case the rash does not
improve and importantly, if it is on the face.

No seizure or abnormalities on the neurological exam ocurred
during admission. During admission patient complained of
headache, frontal, dull in character, constant, without
worsening factors that was controlled with oxycodone.
Patient also had an echocardiogram which was a normal study
(LVEF >55%).
CT head report ([**2116-9-18**]): 1. Right sided subarachnoid
hemorrhage without hydrocephalus or mass effect.
2. Small amount of left frontal subarachnoid blood is likely due
to
redistribution.
repeat CTA on [**2116-9-24**]: 1. Bilateral subarachnoid hemorrhage
less conspicuous with no new intracranial hemorrhage identified.
Potential new focus of edema in the right
frontal lobe of unclear etiology though MRI can be considered
for further
evaluation. 2. No aneurysm identified.

Brain MRI ([**2116-9-25**]): Bilateral subarachnoid hemorrhage
reidentified with a small amount of subdural hemorrhage noted
along the right convexity. The previously noted right frontal
hypodensity seen on CT, most likely represents hemorrhage within
the
subarachnoid space. However, if this lesion is in fact
intraparenchymal,
contusion or subacute infarct are other diagnostic
possibilities. Recommend
continued attenuation on followup.

Patient's headache improved over time and no change in the
neurological examination occured.

This case was also discussed in Dr.[**Name (NI) 10444**] rounds who
suggested studies of hypercoagulability (which are pending upon
discharge). He also suggested the performance of CSF studies in
a month to investigate for the possibility of the diagnosis of
vasculitis.


Medications on Admission:
Celexa 20 mg PO Qday
Imitrex PRN
MVI Qday
Fish Oil tab Qday
Vitamin D Qday



Discharge Medications:
1. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed: You should take it while on oxycodone to prevent
constipation.
Disp:*60 Tablet(s)* Refills:*0*
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 4-6 hours
as needed for headache.
Disp:*60 Tablet(s)* Refills:*0*
4. Nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4
hours) for 15 days: Please take every 4 hours through [**2116-10-9**].
Disp:*120 Capsule(s)* Refills:*0*
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
6. Atenolol 25 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
Disp:*50 Tablet(s)* Refills:*2*
7. Acyclovir 200 mg Capsule Sig: Two (2) Capsule PO TID (3 times
a day) for 2 days.
Disp:*12 Capsule(s)* Refills:*0*
8. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed.
9. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) as needed.
Disp:*60 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
SAH


Discharge Condition:
Good


Discharge Instructions:
You were admitted with a very severe headache. Your brain
imaging studies revealed the presence of subarachnoid
hemorrhage. In an exam called angiogram, no aneurysms were found
that would explain this hemorrhage and, therefore, no
neurosurgical intervention was made necessary.
Your headache was better controlled with pain medications.
Contact your physician in case you have new symptoms or if your
headache deteriorates or if the rash you have does not improve
or start involving the face.

Followup Instructions:
Neurology: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 640**] [**Last Name (NamePattern4) 3445**], MD Phone:[**Telephone/Fax (1) 44**]
Date/Time:[**2116-10-7**] 4:00
Neurosurgery: [**Name6 (MD) **] [**Last Name (NamePattern4) 7746**], MD Phone:[**Telephone/Fax (1) 3666**]
Date/Time:[**2116-10-8**] 1:30



Completed by:[**2116-9-26**]
{'Subarachnoid hemorrhage,Acute lymphoid leukemia, in remission,Essential and other specified forms of tremor,Disorders of bilirubin excretion,Dermatitis due to drugs and medicines taken internally,Hydantoin derivatives causing adverse effects in therapeutic use'}


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: headache

PRESENT ILLNESS: 56 yo F with a hx of ALL s/p whole brain RT, essential
tremor, [**Doctor Last Name 9376**] syndrome, ocular myasthenia, various types of
headaches, L sided ataxia, and a hx of episodes of near syncope,
presented 2 days ago with a SAH. She describes the event as a
very sudden worst headache of her life while changing out of her
business clothes after dinner. She did not fall at that time
either before or after the onset of the headache. She also
denies
any hx of head trauma in the preceding days. She called her
husband to call 911 and was taken to [**Hospital6 3105**].
She recived a head CT showing SAH and was transferred to [**Hospital1 18**].
Here, she received a repeat confirmatory head CT and an
angiogram
which was negative for aneurysm. She has been treated with
analgesics and antiemetics.
    This SAH has occurred in the context of an ongoing history
of
episodes of lightheadedness and headaches have been worked up by
Drs. [**Last Name (STitle) 724**] and [**Name5 (PTitle) 10442**] of neurology. She states that these episodes
have been going on for 8-9 years, ever since she had the whole
brain RT. She states they occur roughly weekly, although she can
go for longer periods without one. She states they were worse
when she had been simultaneously on chemotherapy until [**2109**], and
then presented sometimes as frank syncope. More recently
however,
she denies any frank syncopal episodoes. She states that
sometimes these episodes are accompanied by a band-like headache
around her head, she she states that if she gets that headache
first, it is a cue for her to sit down. She states that these
headaches are different that her migraines, which are preceded
by
an aura of funny smells and flashing lights. She received a
brain
MRI in [**2116-1-25**] after presenting to Dr. [**Last Name (STitle) 10442**] with a complaint
of one of these spells, which was negative. In early summer of
[**2115**] she also underwent tilt table testing at [**Hospital6 10443**], which was positive per her report.
   She does not have any history of seizures, and she denies any
focal motor movements or loss of bowel/bladder continence during
these episodes. She denies any other recent focal weakness,
parasthesias, vertigo, or hearing changes. She does state that
she has a history of intermittent diplopia c/w her ocular
myasthenia.

MEDICAL HISTORY: ALL s/p whole brain RT
essential tremor
[**Doctor Last Name 9376**] syndrome
ocular myasthenia
various types of headaches including migraine
L sided ataxia
hx of episodes of near-syncope

MEDICATION ON ADMISSION: Celexa 20 mg PO Qday
Imitrex PRN
MVI Qday
Fish Oil tab Qday
Vitamin D Qday

ALLERGIES: Penicillins / Iodine

PHYSICAL EXAM: T- 98.5 F BP- 121/74 HR- 82 RR- 21 O2Sat 96%RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa, O/P clear
Neck: No tenderness to palpation, normal ROM, able to touch chin
to chest, but states that it is painful of she lingers in this
position, 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: Father with CAD, Sister with [**Name (NI) 9376**] syndrome

SOCIAL HISTORY: Married, works in corporate banking, no tobacco or drugs,
rare EtOH 

### Response:
{'Subarachnoid hemorrhage,Acute lymphoid leukemia, in remission,Essential and other specified forms of tremor,Disorders of bilirubin excretion,Dermatitis due to drugs and medicines taken internally,Hydantoin derivatives causing adverse effects in therapeutic use'}
