CHIEF COMPLAINT: Intracranial Mass

PRESENT ILLNESS: 

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: He has 3 sisters, 2 of whom have a history of melanoma.  One of
his sisters died from melanoma. His mother was diagnosed with an
ocular melanoma.

SOCIAL HISTORY: He is divorced with 2 children.  He works as a landscaper.  He
does not
currently drink or smoke.
Secondary malignant neoplasm of other parts of nervous system,Intracerebral hemorrhage,Subdural hemorrhage,Cardiac complications, not elsewhere classified,Other convulsions,Cerebral edema,Hemiplegia, unspecified, affecting dominant side,Tachycardia, unspecified,Unspecified hypertensive heart disease without heart failure,Other symbolic dysfunction,Loss of weight,Personal history of malignant melanoma of skin,Family history of other specified malignant neoplasm
Sec malig neo nerve NEC,Intracerebral hemorrhage,Subdural hemorrhage,Surg compl-heart,Convulsions NEC,Cerebral edema,Unsp hemiplga domnt side,Tachycardia NOS,Hyp hrt dis NOS w/o hf,Symbolic dysfunction NEC,Abnormal loss of weight,Hx-malig skin melanoma,Family hx-malignancy NEC
Admission Date:  [**2111-7-22**]              Discharge Date:   [**2111-7-25**]

Date of Birth:  [**2057-4-16**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Intracranial Mass

Major Surgical or Invasive Procedure:
[**7-22**]: Left Craniotomy for resection of intracranial mass


Social History:
He is divorced with 2 children.  He works as a landscaper.  He
does not
currently drink or smoke.


Family History:
He has 3 sisters, 2 of whom have a history of melanoma.  One of
his sisters died from melanoma. His mother was diagnosed with an
ocular melanoma.

Pertinent Results:
Pre-Operative MRI([**2111-7-22**]):
TECHNIQUE: Limited MR imaging of the brain was performed with
axial MP-RAGE
and multiplanar T1 post-contrast images, for surgical planning.
Heterogeneously hyperintense mass, 2.9 x 4.5 cm with surrounding
vasogenic
edema, in the left frontal lobe, with effacement and mass effect
on the left lateral ventricle is redemonstrated for surgical
planning. Mild shift of the midline structures to the right side
by few millimeters is noted. Overall appearance is not
significantly changed compared to [**2111-7-15**], with evolution of the
products within this mass compared to the prior study. No other
abnormal areas of enhancement are noted in the visualized brain
parenchyma.

Post-operative Head CT([**2111-7-22**]):
Findings: The patient is status post resection of left frontal
tumor. There
is pneumocephalus and marked persistent vasogenic edema. The
patient has had a craniectomy. There are tiny areas of focal
high density at the periphery of the surgical bed, which likely
represent tiny foci of hemorrhage. There is 4-mm midline shift,
not significantly changed from preoperative study.

Post-operative MRI ([**2111-7-24**]):
The patient is status post left frontoparietal craniotomy. There
is an
extraaxial fluid collection underlying the craniotomy site.
There are T1
hyperintense blood products in the operative bed, which limit
evaluation for residual neoplasm.
There does appear to be a small focus of enhancement along the
inferior aspect of the resected mass. This could represent a
small amount of residual neoplasm and recommend attention on
short-term followup imaging after resolution of blood products.
No new foci of hemorrhage are seen. There is mild amount of
subfalcine herniation to the right which is unchanged compared
to the preoperative imaging. The ventricles and sulci are
unchanged in size and configuration. There is slightly increased
edema in the left parasagittal frontal lobe, which may be
postoperative in nature. Flow voids are identified in the
superior sagittal sinus. On the diffusion-weighted images, there
is a small focus of slow diffusion along the medial aspect of
the operative bed, which is likely secondary to hemorrhage.

Labs on Admission:
[**2111-7-22**] 07:13PM BLOOD WBC-9.4 RBC-4.18* Hgb-13.0* Hct-36.3*
MCV-87 MCH-31.2 MCHC-35.8* RDW-14.0 Plt Ct-255
[**2111-7-22**] 07:13PM BLOOD PT-13.7* PTT-23.7 INR(PT)-1.2*
[**2111-7-22**] 07:13PM BLOOD Glucose-230* UreaN-22* Creat-1.0 Na-132*
K-4.1 Cl-96 HCO3-24 AnGap-16
[**2111-7-22**] 07:13PM BLOOD Calcium-9.2 Phos-4.8*# Mg-2.2

Labs on Discharge::
XXXXXXXXXXXXXXXXXXXXXX

Brief Hospital Course:
Mr. [**Known lastname 25788**] is a 54 y/o male who was diagnosed with metastatic
melanoma.  He was admitted to [**Hospital1 18**] on [**2111-7-23**] for left frontal
craniotomy and resection of metastatic melanoma.  Following
surgery he was observed in PACU and subsequently transferred to
[**Hospital Ward Name 121**] 11 for neurosurgical observation.  By [**2111-7-25**] he was
ambulating independently, voiding, and tolerating a regular
diet.  He was cleared for d/c by PT, and discharged to home is
stable condition.

Medications on Admission:
unknown


Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
2. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 2 days.
Disp:*6 Tablet(s)* Refills:*0*
5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
6. decadron  Sig: One (1) mg  every eight (8) hours for 2 days:
start on [**2111-7-28**].
Disp:*6 * Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Intracranial mass


Discharge Condition:
Neurologically stable


Discharge Instructions:
General Instructions

??????	Have a friend/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,
or excessive bending.
??????	You may wash your hair only after sutures and/or staples have
been removed.
??????	You may shower before this time using a shower cap to cover
your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
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, or drainage.

Followup Instructions:
Follow-Up Appointment Instructions

??????Please return to the office in [**7-2**] days for removal of your
staples and/or sutures.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast.
??????You wil not need an MRI of the brain, as this was done during
your hospital stay.
- call radiation oncology at [**Telephone/Fax (1) 9710**] on Monday [**7-27**] to
schedule outpatient appointment for radiation therapy



Completed by:[**2111-7-25**]
{'Secondary malignant neoplasm of other parts of nervous system,Intracerebral hemorrhage,Subdural hemorrhage,Cardiac complications, not elsewhere classified,Other convulsions,Cerebral edema,Hemiplegia, unspecified, affecting dominant side,Tachycardia, unspecified,Unspecified hypertensive heart disease without heart failure,Other symbolic dysfunction,Loss of weight,Personal history of malignant melanoma of skin,Family history of other specified malignant neoplasm'}


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: Intracranial Mass

PRESENT ILLNESS: 

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: unknown

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: He has 3 sisters, 2 of whom have a history of melanoma.  One of
his sisters died from melanoma. His mother was diagnosed with an
ocular melanoma.

SOCIAL HISTORY: He is divorced with 2 children.  He works as a landscaper.  He
does not
currently drink or smoke. 

### Response:
{'Secondary malignant neoplasm of other parts of nervous system,Intracerebral hemorrhage,Subdural hemorrhage,Cardiac complications, not elsewhere classified,Other convulsions,Cerebral edema,Hemiplegia, unspecified, affecting dominant side,Tachycardia, unspecified,Unspecified hypertensive heart disease without heart failure,Other symbolic dysfunction,Loss of weight,Personal history of malignant melanoma of skin,Family history of other specified malignant neoplasm'}
