CHIEF COMPLAINT: difficulty with left sided coordination.

PRESENT ILLNESS: 66y RH man usually in good health, transferred from [**Hospital3 11531**] with NCHCT showing R frontal lobe intraparenchymal
hemorrhage, probable hemorrhagic mass.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: Aspirin 81mg daily (see above re: recent doses)

ALLERGIES: Latex

PHYSICAL EXAM: Exam:
T-97.6 BP-166-177/71-81  HR-81 RR-15 O2Sat97% RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple
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, cool
Skin: No concerning lesions on partial exposure only

FAMILY HISTORY: FH: Mother died in 80s-HTN and DM; father died 64y after CVA
(also had colon Ca)

SOCIAL HISTORY: SH: Retired Science teacher. Lives alone. Previously married,
now
divorced.  3 Children ([**Country 2560**]/x2 in US, not local). Denies
tobacco/EtOH/drugs.
Subarachnoid hemorrhage
Subarachnoid hemorrhage
Admission Date:  [**2114-5-20**]              Discharge Date:   [**2114-6-1**]

Date of Birth:  [**2048-3-10**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Latex

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
difficulty with left sided coordination.

Major Surgical or Invasive Procedure:
steriotactic biopsy, craniotomy for cavernoma resection


History of Present Illness:
66y RH man usually in good health, transferred from [**Hospital3 11531**] with NCHCT showing R frontal lobe intraparenchymal
hemorrhage, probable hemorrhagic mass.

2 days ago the patient noted onset of difficulty with left sided
coordination. He was having some trouble walking (no falls) and
manouvering the left hand, feeling slightly clumsy. He also
described left foot felt "asleep" and slight altered feeling in
the left hand.
Not feeling frankluy weak. No headaches, back pain, dysarthria,
diplopia, facial droop, dizzyness, N/V/adbo pain, urinary
symptoms, respiratory symptoms, rash, weight loss or appetite
change.

He usually takes aspirin daily, and has not had any for the last
2 weeks while he has been on holiday. Today took 162mg as was
concerned about possible stroke.


Past Medical History:
none

Social History:
SH: Retired Science teacher. Lives alone. Previously married,
now
divorced.  3 Children ([**Country 2560**]/x2 in US, not local). Denies
tobacco/EtOH/drugs.

Family History:
FH: Mother died in 80s-HTN and DM; father died 64y after CVA
(also had colon Ca)

Physical Exam:
Exam:
T-97.6 BP-166-177/71-81  HR-81 RR-15 O2Sat97% RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple
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, cool
Skin: No concerning lesions on partial exposure only

Neurologic examination:
Mental status: Awake and alert, cooperative with exam, normal
affect.  Oriented to person, place, and date.  [**Doctor Last Name 1841**] backwards
leaving out 2 separate months.  Speech is fluent with normal
comprehension and repetition; naming intact except for stem. No
dysarthria. Registers [**3-3**], recalls [**3-3**] in 5 minutes.  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. 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 or
tremor
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 upgoing on right; down on L

Coordination: finger-nose-finger sl ataxia on L, RAMs normal
bilat.

Romberg/Gait deferred


Pertinent Results:
[**2114-5-20**] 01:12AM   WBC-6.7 RBC-4.34* HGB-14.6 HCT-41.6 MCV-96
MCH-33.7* MCHC-35.2* RDW-13.2
[**2114-5-20**] 01:12AM   NEUTS-63.7 LYMPHS-28.2 MONOS-6.4 EOS-1.1
BASOS-0.5
[**2114-5-20**] 01:12AM   PLT COUNT-177
[**2114-5-20**] 01:12AM   PT-13.3* PTT-32.1 INR(PT)-1.2*
[**2114-5-20**] 01:12AM   GLUCOSE-102 UREA N-13 CREAT-1.2 SODIUM-142
POTASSIUM-4.0 CHLORIDE-107 TOTAL CO2-27 ANION GAP-12
[**2114-5-20**] 01:12AM   CALCIUM-9.7 PHOSPHATE-3.8 MAGNESIUM-2.3
[**2114-5-20**] 03:53AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.017
[**2114-5-20**] 03:53AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
Imaging
OSH NCHCT shows rounded heterogeneous hyperdense lesion in R
frontal lobe with significant surrounding edema, without midline
shift, concerning for hemorrhagic mass.  Right ventricular
system
mildly dilated versus left. Small rounded area right cerebellar
vermis of questionable significance -fold of normal cerebellum?


Brief Hospital Course:
Pt was admitted to the neurosurgery service.  His neuro exam was
monitored closely.  His vital signs remained stable. He was
started on dilantin for seizure prophylaxis. He underwent
metastatic workup and CT of chest, abdomen and pelvis which did
not reveal malignancy. MRI of brain showed Right frontal
hemorrhagic mass with minimal surrounding enhancement and a mild
margin of edema. Although no neoplasm is detected on this
examination, the possibility of an underlying tumor cannot be
excluded. Alternate possibilities include an arteriovenous
malformation or a cavernous angioma presenting with a large
hemorrhage.

The has good PO intake with no N/V and his pain is under
control. He has been afebile and has been working with physical
therapy. The patient is deemed ready for rehab. His dilantin was
therapeutic at 10.9 on discharge.

Medications on Admission:
Aspirin 81mg daily (see above re: recent doses)

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
Injection ASDIR (AS DIRECTED).
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day) as needed for sbp>140.
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed for pain.
7. Heparin (Porcine) 5,000 unit/mL Solution Sig: [**1-2**]  Injection
TID (3 times a day).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Phenytoin 50 mg Tablet, Chewable Sig: Four (4) Tablet,
Chewable PO BID (2 times a day).
10. Dexamethasone 1.5 mg Tablet Sig: Two (2) Tablet PO ONCE
(Once) for 1 doses.
11. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q8H (every
8 hours) for 2 days.
12. Dexamethasone 2 mg Tablet Sig: 0.5 Tablet PO Q8H (every 8
hours) for 2 days.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Brain mass


Discharge Condition:
Neurologically stable


Discharge Instructions:
??????	Have a family member check your incision daily for signs of
infection
??????	Take your pain medicine as prescribed
??????	Exercise should be limited to walking; no lifting, straining,
excessive bending
??????	You may wash your hair only after sutures and/or staples have
been removed
??????	You may shower before this time with assistance and use of a
shower cap
??????	Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING:

??????	New onset of tremors or seizures
??????	Any confusion or change in mental status
??????	Any numbness, tingling, weakness in your extremities
??????	Pain or headache that is continually increasing or not
relieved by pain medication
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
Please have your sutures removed in 8 days at rehab.

Follow-up with Dr. [**Last Name (STitle) **] in 4 weeks with a head CT. Please call
[**Telephone/Fax (1) 1669**] to make an appointment.



Completed by:[**2114-6-1**]
{'Subarachnoid hemorrhage'}


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: difficulty with left sided coordination.

PRESENT ILLNESS: 66y RH man usually in good health, transferred from [**Hospital3 11531**] with NCHCT showing R frontal lobe intraparenchymal
hemorrhage, probable hemorrhagic mass.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: Aspirin 81mg daily (see above re: recent doses)

ALLERGIES: Latex

PHYSICAL EXAM: Exam:
T-97.6 BP-166-177/71-81  HR-81 RR-15 O2Sat97% RA
Gen: Lying in bed, NAD
HEENT: NC/AT, moist oral mucosa
Neck: No tenderness to palpation, normal ROM, supple
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, cool
Skin: No concerning lesions on partial exposure only

FAMILY HISTORY: FH: Mother died in 80s-HTN and DM; father died 64y after CVA
(also had colon Ca)

SOCIAL HISTORY: SH: Retired Science teacher. Lives alone. Previously married,
now
divorced.  3 Children ([**Country 2560**]/x2 in US, not local). Denies
tobacco/EtOH/drugs. 

### Response:
{'Subarachnoid hemorrhage'}
