CHIEF COMPLAINT: [**Age over 90 **] yo M transferred from [**Location (un) 28318**] w/ reported subdural
hemorrhage

PRESENT ILLNESS: [**Age over 90 **] year-old man with a history of complex partial seizures
followed by Dr. [**Last Name (STitle) **] transferred from OSH with 5-10 minute
GTC seizure this AM and head CT with subdural bleed.

MEDICAL HISTORY: Pacemaker ('[**78**] for sinus bradycardia)-per EMS had appt w/ CARDS
this a.m. for pacemaker dysfunction
absence seizures
prior grand mal x 1
Gout
GI bleed s/p endoscopic banding '[**85**]
HTN (atenolol d/c'd recently [**1-31**] bradycardia)
s/p subtotal gastrectomy
s/p R knee ORIF / bone graft

MEDICATION ON ADMISSION: Nexium
Folate
LAMICTAL 25MG--4 by mouth twice a day

ALLERGIES: Penicillins / Aspirin / Codeine / Dilantin

PHYSICAL EXAM: 100.6, 70, 156/74 , 16, 96%
Alert and orientedx 3
Normocephalic, atraumatic
Pupils 3mm-> 2mm bilaterally, reactive to light and accomodation

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives w/ wife in [**Name (NI) 28318**]. Independent in ADL's. Decreased MS in
Subdural hemorrhage,Other convulsions,Hyposmolality and/or hyponatremia,Pneumonitis due to inhalation of food or vomitus,Unspecified essential hypertension,Gout, unspecified,Compression of brain,Cardiac pacemaker in situ
Subdural hemorrhage,Convulsions NEC,Hyposmolality,Food/vomit pneumonitis,Hypertension NOS,Gout NOS,Compression of brain,Status cardiac pacemaker
Admission Date:  [**2187-8-7**]              Discharge Date:   [**2187-8-24**]


Service: NEUROSURGERY

Allergies:
Penicillins / Aspirin / Codeine / Dilantin

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
[**Age over 90 **] yo M transferred from [**Location (un) 28318**] w/ reported subdural
hemorrhage

Major Surgical or Invasive Procedure:
Left craniotomy and evacuation of subdural hemorrhage [**2187-8-14**]

History of Present Illness:
[**Age over 90 **] year-old man with a history of complex partial seizures
followed by Dr. [**Last Name (STitle) **] transferred from OSH with 5-10 minute
GTC seizure this AM and head CT with subdural bleed.

Per wife, pt felt "jittery" and uncomfortable yesterday, with
increased sleepiness and some nausea. He did not eat dinner last
night due to nausea. Then, ~5:30 am wife was awake but still in
bed when pt suddenly groaned or screamed and then began to have
clonic movements of all 4 extremities. Wife does not recall head
deviation and his eyes were closed. Seizure lasted 5-10 minutes,
and may have had tonic movements at the end. After shaking
resolved, pt was unrsponsive to wife calling his name, gently
touching his face or gently shaking him. EMS arrived ~20 minutes
after seizure ended, and pt still unresponsive. Per wife, EMS
put O2 mask on him and he started to arouse. She says he was not
blue prior to O2. He was confused and post-ictal for a few
hours, and remains sleepy still as well as being somewhat
fidgety. At OSH,
had head CT with subdural hemorrhage (by report) and was
transferred to [**Hospital1 18**].


Past Medical History:
Pacemaker ('[**78**] for sinus bradycardia)-per EMS had appt w/ CARDS
this a.m. for pacemaker dysfunction
absence seizures
prior grand mal x 1
Gout
GI bleed s/p endoscopic banding '[**85**]
HTN (atenolol d/c'd recently [**1-31**] bradycardia)
s/p subtotal gastrectomy
s/p R knee ORIF / bone graft

Social History:
Lives w/ wife in [**Name (NI) 28318**]. Independent in ADL's. Decreased MS in

last several months per wife. [**Name (NI) 28319**] how to perform basic
tasks e.g. putting on a sweater. Walks with a walker @ home.
ETOH
x 1 qday, never smoked

Family History:
non-contributory



Physical Exam:
100.6, 70, 156/74 , 16, 96%
Alert and orientedx 3
Normocephalic, atraumatic
Pupils 3mm-> 2mm bilaterally, reactive to light and accomodation

EOMI
neck supple
mucous membranes pink and moist
RRR nl s1 s2
soft, well healed midline scar, NT, ND +BS, No HSM
GU: deferred
ext: cap refill< 1sec
no c/c/e
Neuro:
speech clear and fluent
Motor:
B T WE WF grip IP [**Initials (NamePattern5) 12643**] [**Last Name (NamePattern5) 938**] TA GS
L 5 5 4+ 5 4+ 5 5 5 5 5 5
R 5 5 4+ 5 5 5 5 5 5 5 5
DTR's
B BR K ankle
L 2 2 2 2
R 2 2 2 2
coord: FTN intact/ heel to shin intact
sensation intact to light touch bilat
toes downgoing bilaterally


Pertinent Results:
[**2187-8-7**] 11:44AM   GLUCOSE-101 UREA N-13 CREAT-1.0 SODIUM-134
POTASSIUM-3.6 CHLORIDE-97 TOTAL CO2-28 ANION GAP-13
[**2187-8-7**] 11:44AM   ALT(SGPT)-12 AST(SGOT)-26 ALK PHOS-80 TOT
BILI-0.6
[**2187-8-7**] 11:44AM   CALCIUM-8.6 PHOSPHATE-2.9 MAGNESIUM-1.7
[**2187-8-7**] 11:44AM   WBC-6.8 RBC-3.63* HGB-11.1* HCT-32.8* MCV-90
MCH-30.6 MCHC-33.9 RDW-13.4
[**2187-8-7**] 11:44AM   NEUTS-74.9* LYMPHS-15.5* MONOS-8.5 EOS-0.5
BASOS-0.4
[**2187-8-7**] 11:44AM   PLT COUNT-195
[**2187-8-7**] 11:44AM   PT-13.2 PTT-32.4 INR(PT)-1.2

[**8-7**] CT head:Bilateral frontoparietal subdural hemorrhage, great
on the right, probably representing mixture of acute and chronic
hemorrhage.

[**8-8**] CT head: Unchanged appearance of bilateral frontoparietal
subdural hematoma.

[**8-9**] EEG: This 24-hour video EEG telemetry captured no
pushbutton
activations. There are no electrographic seizures noted during
this
recording. Automated and routine sampling otherwise demonstrated
a
fairly normal [**8-7**] Hz posterior predominant alpha rhythm. This is
a
largely normal EEG.

[**8-10**] EEG: This 24-hour video EEG telemetry captured no
pushbutton
activations. There were no electrographic seizures. Automated
and
routine sampling demonstrated a fairly symmetric [**9-8**] Hz
posterior
predominant alpha rhythm. There were rare or few sharp
transients noted
over the L>R frontal temporal regions. Occasional slowing was
also
noted over these areas.

[**8-11**] EEG: This 24-hour video EEG telemetry captured no
pushbutton
activations. There were no electrographic seizures recorded.
Automated
and routine sampling demonstrated a fairly symmetric posterior
predominant 10 Hz alpha rhythm. There were occasional episodes
of L>R
temporal slowing.

[**8-12**] EEG: This 24-hour video EEG telemetry captured no
pushbutton
activations. There are no electrographic seizures. The recording

interval spanned only from approximately 8 in the morning until
1:30 in
the afternoon. Automated and routine sampling demonstrated
fairly
symmetric [**10-9**] Hz posterior predominant alpha rhythm.

[**8-13**] CT head: Bilateral subdural hematomas, increased in size on
the left compared to [**2187-9-8**]. Local mass effect without shift of
normally midline structures

[**8-14**] CT head: There has been a dramatic change from the previous
examination with very marked increase in the left-sided subdural
hematoma with very severe shift of the brain from left to right,
measuring approximately 27 mm at the level of the foramen of
[**Last Name (un) 2044**]. There is a small parafalcine component. There is some
obliteration of the ambient cistern and some uncal herniation as
suspected.
IMPRESSION: Substantial increase in the size of left subdural
hematoma with substantial subfalcine and probable uncal
herniation.

[**8-15**] CT head: Reduction, but not complete elimination of the
left subdural hemorrhage, with dramatic reduction in mass effect
but appearance of new areas of hemorrhage within the right basal
ganglia and likely body of the corpus callosum as well.

Brief Hospital Course:
Hospital Course by System:

Neuro: The patient was admitted to Neurology on [**2187-8-7**] from an
OSH for further management of a subdural hematoma in the setting
of a recent generalized tonic-clonic seizure.  Head CT obtained
at the [**Hospital1 18**] at the time of admission confirmed a bilateral
frontoparietal subdural hemorrhage, with mixed density on CT,
probably representing mixture of acute and chronic hemorrhage. A
neurosurgery consult was obtained on the day of admission.  No
neurosurgical intervention was recommended at the time.  Repeat
head CT on [**2187-8-8**] showed an unchanged appearance of bilateral
subdural hematoma.  For prophylaxis of seizures, the patient
home dose of Lemictal was increased from 100 [**Hospital1 **] to 150 [**Hospital1 **].
The patient was also started on a standing dose of Ativan.  On
HD #2, Ativan was tapered and Keppra 250 mg [**Hospital1 **] was added to
seizure prophylaxis regimen. Work-up for infectious/metabolic
causes of seizure, which included CBC, Chem-12, UA, LFT was
unrevealing.   The patient was placed on EEG long-term
monitoring.  During this hospitalization, the patient complained
of no symptomatic seizures and four days of EEG telemetry showed
no epileptiform discharges.

On [**2187-8-13**] the patient complained of headache and was noted to
be slightly more tired per his wife.  A repeat head CT was
subsequently obtained to evaluate for change in the size of the
subdural hematoma. The CT revealed an increase in size of the
left subdural hematoma without shift.  The following morning the
patient was slightly better; he was more conversant and less
sleepy. In the early afternoon however he was noted by
cardiology to have become "unresponsive" while they were
evaluating him for a battery change of his pacemaker scheduled
for the following day.  He was found to have minimally reactive
pupils and was posturing to painful stimuli.  A stat CT head
revealed a large left sided hemorrhage with significant midline
shift.  The patient was intubated and taken emergently for
craniotomy and evacuation of the subdural hematoma which was
arterial in nature. subdural drain was in place after SDH
evacuation ([**8-14**]). He was transferred to the SICU for
observation and management following this surgery.  A follow-up
CT on post-op day #1 showed a decrease in the hemorrhage and a
decrease in shift, but a new small right basal ganglia bleed.
His neurologic exam was poor on post-op day 1 with extensor
posturing in his upper extremeties and withdrawl spontaneous
movements in lowers.  He had hyponatremia which improved
initially with fluid restriction and salt tabs.

On Post-op day 3 his neurologic exam remained the same Mr
[**Known lastname 28320**] did not respond to commands he continued in to
posture in his upper extremeties and withdrew in lowers.  A EEG
was performed which ruled out seizure activity and
encephalopathy but showed delta slowing.  A family meeting was
held with representatives from both Neurology, Neurosurgery and
SICU team to discuss Mr [**Known lastname 28321**] prognosis which was felt to
be poor.  His family requested to wait 2 more days before
considering or instituting comfort care measures.  Supportive
measures were continued. Flagyl and levo discontinued on [**8-16**].
Kefzol started per SICU team.

Patient prognosis remained poor and on [**2187-8-17**] another
family meeting held for further care of plan. Family decided to
wait 2 more days. Family had a second uponion  by another
Neurologist.Patient's neuro exam still remains poor, gradually
declining. Sudural drain removed on [**2187-8-18**] and kefzol
discontinued as drain out.Continued with supportive care,
seizure prophylaxis.Family decided start confort measures only
on [**2187-8-24**] at 0800 Mr [**Known lastname 28320**] was extubated and started on a
Morphine drip unfortunately he passed away at 1245pm his family
was by his side.


Medications on Admission:
Nexium
Folate
LAMICTAL 25MG--4 by mouth twice a day



Discharge Medications:
N/A

Discharge Disposition:
Expired

Discharge Diagnosis:
Subdural Hematoma


Discharge Condition:
Expired


Followup Instructions:
None


                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2187-8-24**]
{'Subdural hemorrhage,Other convulsions,Hyposmolality and/or hyponatremia,Pneumonitis due to inhalation of food or vomitus,Unspecified essential hypertension,Gout, unspecified,Compression of brain,Cardiac pacemaker in situ'}


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: [**Age over 90 **] yo M transferred from [**Location (un) 28318**] w/ reported subdural
hemorrhage

PRESENT ILLNESS: [**Age over 90 **] year-old man with a history of complex partial seizures
followed by Dr. [**Last Name (STitle) **] transferred from OSH with 5-10 minute
GTC seizure this AM and head CT with subdural bleed.

MEDICAL HISTORY: Pacemaker ('[**78**] for sinus bradycardia)-per EMS had appt w/ CARDS
this a.m. for pacemaker dysfunction
absence seizures
prior grand mal x 1
Gout
GI bleed s/p endoscopic banding '[**85**]
HTN (atenolol d/c'd recently [**1-31**] bradycardia)
s/p subtotal gastrectomy
s/p R knee ORIF / bone graft

MEDICATION ON ADMISSION: Nexium
Folate
LAMICTAL 25MG--4 by mouth twice a day

ALLERGIES: Penicillins / Aspirin / Codeine / Dilantin

PHYSICAL EXAM: 100.6, 70, 156/74 , 16, 96%
Alert and orientedx 3
Normocephalic, atraumatic
Pupils 3mm-> 2mm bilaterally, reactive to light and accomodation

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Lives w/ wife in [**Name (NI) 28318**]. Independent in ADL's. Decreased MS in 

### Response:
{'Subdural hemorrhage,Other convulsions,Hyposmolality and/or hyponatremia,Pneumonitis due to inhalation of food or vomitus,Unspecified essential hypertension,Gout, unspecified,Compression of brain,Cardiac pacemaker in situ'}
