CHIEF COMPLAINT: Sudden onset headache after blowing nose

PRESENT ILLNESS: Patient is a 57F who reports blowing her nose this morning
with a subsequent "worst HA of life" that was in a "helmet-like"
cranial distribution. She also reports having vomited once, and
associated near syncope event.  She was then taken to OSH where
a
CT was performed that revealed a SAH.

MEDICAL HISTORY: 1. Depression
2. s/p Spinal Surgery
3. s/p Deviated Septum repair
4. Bilateral tubal ligation

MEDICATION ON ADMISSION: 1. Buspar prn HS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
O: T: 99.3  BP:107/58    HR:84   RR:16    O2Sats: 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: normocephalic, atraumatic
Pupils: PERRL         EOMs: intact
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-22**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Resides at home with family
Subarachnoid hemorrhage,Hemorrhage complicating a procedure,Urinary tract infection, site not specified,Depressive disorder, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other constipation
Subarachnoid hemorrhage,Hemorrhage complic proc,Urin tract infection NOS,Depressive disorder NEC,Abn react-surg proc NEC,Enterococcus group d,Constipation NEC
Admission Date:  [**2140-6-29**]              Discharge Date:   [**2140-7-8**]

Date of Birth:  [**2083-6-21**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Sudden onset headache after blowing nose

Major Surgical or Invasive Procedure:
1. Embolization of basilar artery aneurysm
2. Embolization of acomm aneurysm


History of Present Illness:
Patient is a 57F who reports blowing her nose this morning
with a subsequent "worst HA of life" that was in a "helmet-like"
cranial distribution. She also reports having vomited once, and
associated near syncope event.  She was then taken to OSH where
a
CT was performed that revealed a SAH.


Past Medical History:
1. Depression
2. s/p Spinal Surgery
3. s/p Deviated Septum repair
4. Bilateral tubal ligation


Social History:
Resides at home with family

Family History:
non-contributory

Physical Exam:
On Admission:
O: T: 99.3  BP:107/58    HR:84   RR:16    O2Sats: 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: normocephalic, atraumatic
Pupils: PERRL         EOMs: intact
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-22**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 4mm to 3mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**4-25**] throughout. No pronator drift.
Mild Kernig's sign.

Sensation: Intact to light touch, proprioception.

Reflexes: B T Br Pa Ac
Right     2 2 2  2  2
Left      2 2 2  2  2

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger.


Pertinent Results:
Head CT/CTA([**6-29**])
IMPRESSION:
1. 7 mm aneurysm at the apex of the basilar artery. 4 mm
aneurysm of the
anterior communicating artery. 4 mm aneurysm at the origin of
the left
posterior communicating artery. Small infundibula at the origins
of the right posterior communicating artery and the right
lateral lenticulostriate artery.
2. Small amount of intraventricular hemorrhage within the fourth
ventricle
and tiny layering intraventricular hemorrhage within the
occipital horns of the lateral ventricles. A small amount of
subarachnoid blood in the right sylvian fissure and prepontine
cistern.

Head CT [**7-1**]:
1. Diffuse subarachnoid high density material; likely a
combination of
extravasated contrast material from the vascular coiling
procedure of three hours earlier, as well as subarachnoid
hemorrhage. No evidence of mass effect. Followup examination
recommended.

Head CT [**7-2**]:
Considerable reolution of SAH. No hydrocephalus or new
hemorrhage. Changes from previous coiling.

CT Brain Perfusion [**7-4**]:
Residual diffuse subarachnoid hemorrhage with layering of
hemorrhage in the dependent region of the lateral ventricles
bilaterally.
There is no evidence of new hemorrhagic areas. The CTA
demonstrates mild
narrowing of the caliber of the vessels in the circle of [**Location (un) 431**]
suggesting
mild vasospasm as described in detail above. Focal outpouching
is identified at the origin of the right posterior communicating
artery, likely consistent with a prominent infundibulum.

Labs:

[**2140-6-29**] 12:34PM BLOOD WBC-11.1* RBC-3.90* Hgb-12.6 Hct-36.9
MCV-95 MCH-32.4* MCHC-34.3 RDW-13.3 Plt Ct-227
[**2140-6-29**] 12:34PM BLOOD PT-12.4 PTT-21.5* INR(PT)-1.0
[**2140-6-29**] 12:34PM BLOOD Glucose-134* UreaN-14 Creat-0.8 Na-141
K-4.3 Cl-106 HCO3-27 AnGap-12
[**2140-6-29**] 12:34PM BLOOD cTropnT-<0.01

Brief Hospital Course:
Patient was admitted to neurosurgery for a subarachnoid
hemorrhage.  Angiography revealed the presence of both a basilar
and anterior communicating artery (ACOMM) aneurysms.  She was
preoped and consented for embolization of the basilar and
anterior communicating artery anyeurysms.  Patient went to to
the angio suite on [**2140-6-28**] for coiling of the basilar artery
aneurysm.  She tolerated the procedure well, was extubated, and
returned the SICU for Q1hour neurochecks.  She underwent coiling
for the ACOMM aneurysm on [**2140-7-1**].  She again tolerated the
procedure well, was extubated, and returned to the SICU for Q1hr
neuro checks.  She was placed on nimodipine 60mg Q4 hours for
vasospasm prophylaxis.  Her neuro exam was stable during her
entire SICU stay.  On [**7-4**] she underwent a CT perfusion study of
the brain, which showed minimal cerebral vasospasm and a
resolving SAH.  On [**2140-7-6**] she was transferred to the neuro step
down unit for Q2 hour neuro checks.  She continued to do well
wihout signs or symptoms of cerebral vasospasm.  She did
continue to have a headache with photophobia, but was
well-controlled with IV dilaudid and oxycodone.
Neuro exam prior to discharge: she had no focal neurodeficits
continued with persistent headache. Her angio site was well
healed. She was tolerating a regular diet and voiding without
difficultly a UA was sent prior to discharge which was negative.
She was ambulating without difficulty.

Medications on Admission:
1. Buspar prn HS

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed: No more than 4GMs per day.
2. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed.
Disp:*60 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): Use with oxycodone.
Disp:*60 Capsule(s)* Refills:*0*
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
5. Buspirone 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).

6. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day) for 30 days.
Disp:*180 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
1. SAH/Intraventricular hemorrhage
2. Basilar aneurysm
3. acomm aneurysm


Discharge Condition:
Neurologically stable


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal)
??????	After 1 week, you may resume sexual activity
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room


Followup Instructions:
Follow up Appointments/Imaging
-Please call [**Telephone/Fax (1) 1669**] to schedule a follow-up appointment
with Dr. [**First Name (STitle) **] for 4 weeks post-op.
-You will need a CTA scheduled prior to this appointment and can
be arranged by our office.



Completed by:[**2140-7-8**]
{'Subarachnoid hemorrhage,Hemorrhage complicating a procedure,Urinary tract infection, site not specified,Depressive disorder, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other constipation'}


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: Sudden onset headache after blowing nose

PRESENT ILLNESS: Patient is a 57F who reports blowing her nose this morning
with a subsequent "worst HA of life" that was in a "helmet-like"
cranial distribution. She also reports having vomited once, and
associated near syncope event.  She was then taken to OSH where
a
CT was performed that revealed a SAH.

MEDICAL HISTORY: 1. Depression
2. s/p Spinal Surgery
3. s/p Deviated Septum repair
4. Bilateral tubal ligation

MEDICATION ON ADMISSION: 1. Buspar prn HS

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
O: T: 99.3  BP:107/58    HR:84   RR:16    O2Sats: 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: normocephalic, atraumatic
Pupils: PERRL         EOMs: intact
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**2-22**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Resides at home with family 

### Response:
{'Subarachnoid hemorrhage,Hemorrhage complicating a procedure,Urinary tract infection, site not specified,Depressive disorder, not elsewhere classified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Streptococcus infection in conditions classified elsewhere and of unspecified site, streptococcus, group D [Enterococcus],Other constipation'}
