CHIEF COMPLAINT: elective admission for radionecrosis resection due to
radiosurgery of AVM

PRESENT ILLNESS: Presents for resection of radionecrosis s/p radiosurgery for AVM

MEDICAL HISTORY: seizures,h/o radio therapy for avm has resid edema causing
seizures; Dysrhythmia (palps w/ panic attacks), Recent Upper
Respiratory Infection

MEDICATION ON ADMISSION: Acetaminophen, Effexor 50 [**Hospital1 **], Ibuprofen [Motrin, Advil], Keppra
(Levetiracetam) (25oomg

ALLERGIES: Codeine

PHYSICAL EXAM: Upon discharge:
The patient was alert and oriented. She followed commands
easily.
PERRL, EOMs intact.
Face symmetric, tongue midline.
Strength was full throughout and sensation was intact to light
touch.
Incision was clean, dry, and intact.

FAMILY HISTORY: NC

SOCIAL HISTORY: NC
Other ill-defined cerebrovascular disease,Anomalies of cerebrovascular system,Cerebral edema,Late effect of radiation,Epilepsy, unspecified, without mention of intractable epilepsy
Cerebrovasc disease NEC,Cerebrovascular anomaly,Cerebral edema,Late effect of radiation,Epilep NOS w/o intr epil
Admission Date:  [**2118-8-10**]              Discharge Date:   [**2118-8-12**]

Date of Birth:  [**2073-12-25**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
elective admission for radionecrosis resection due to
radiosurgery of AVM

Major Surgical or Invasive Procedure:
Left craniotomy for radionecrosis resection


History of Present Illness:
Presents for resection of radionecrosis s/p radiosurgery for AVM

Past Medical History:
seizures,h/o radio therapy for avm has resid edema causing
seizures; Dysrhythmia (palps w/ panic attacks), Recent Upper
Respiratory Infection


Social History:
NC

Family History:
NC

Physical Exam:
Upon discharge:
The patient was alert and oriented. She followed commands
easily.
PERRL, EOMs intact.
Face symmetric, tongue midline.
Strength was full throughout and sensation was intact to light
touch.
Incision was clean, dry, and intact.

Pertinent Results:
[**2118-8-10**] 02:09PM   GLUCOSE-161* UREA N-10 CREAT-0.8 SODIUM-142
POTASSIUM-3.9 CHLORIDE-105 TOTAL CO2-28 ANION GAP-13
[**2118-8-10**] 02:09PM   WBC-12.2*# RBC-4.03* HGB-11.5* HCT-34.5*
MCV-86 MCH-28.4 MCHC-33.2 RDW-13.3

Pathology Report from [**2118-8-10**]:
DIAGNOSIS:
1.  Brain, left frontal (A):
    1.  Vascular malformation consistent with arteriovenous
malformation
    of cortical [**Doctor Last Name 352**] and white matter with radiation induced
fibrinoid
    necrosis.
    2.  Focal hemosiderin deposition suggesting prior
hemorrhages.
2.  Left frontal radionecrosis and residual AVM (B):
    1.  Vascular malformation consistent with arteriovenous
malformation
    of cortical [**Doctor Last Name 352**] and white matter with radiation induced
fibrinoid
    necrosis.
    2.  Focal hemosiderin deposition suggesting prior
hemorrhages.
Clinical:  Radionecrosis.

CT Head post-op [**8-10**]:
FINDINGS: There is a left-sided frontal craniotomy with surgical
resection of the enhancing "mass" noted in previous studies.
There is extensive confluent hypodensity in the left
frontoparietal region, that likely represents post-radiation
vasogenic edema with resultant 8.5-mm shift of normally-midline
structures, not significantly changed from the previous MR.
There is a tiny focus of hyperdensity in the postoperative field
which may represent a small amount of hemorrhage. There is
expost-operative pneumocephalus and subcutaneous air noted.

IMPRESSION: Status post left craniotomy and resection of AVM and
possible
"mass"-like radiation necrosis, with small hyperdense focus in
the operative bed, likely representing very small hemorrhage.
Extensive vasogenic edema persists.




Brief Hospital Course:
Post-operatively she was admitted to the ICU for observation s/p
resection. Her Post-op head CT was negative for bleeding. She
remained intubated immediately post-op. She was weaned and
extubated on [**8-11**] and did very well neurologically. The patient
was transferred out of the ICU later that day. She was
ambulating without difficulty, her pain was well-controlled, and
she was taking in food with no nausea/vomiting. Her
post-operative MRI was done on [**8-12**] and showed expected
post-operative changes. She was discharged on [**2118-8-12**].

Medications on Admission:
Acetaminophen, Effexor 50 [**Hospital1 **], Ibuprofen [Motrin, Advil], Keppra
(Levetiracetam) (25oomg

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*0*
2. Venlafaxine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for pain: No driving while on this medication.
Disp:*50 Tablet(s)* Refills:*0*
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. Dexamethasone 1 mg Tablet Sig: Three (3) Tablet PO Q8H (every
8 hours) for 1 doses: Taper to 2mg TID x 3 doses on [**8-13**].
Taper to 1mg TID x 3 doses on [**8-14**].
Disp:*12 Tablet(s)* Refills:*0*

She will continue her Keppra and has a prescription at home.


Discharge Disposition:
Home

Discharge Diagnosis:
AVM
Radionecrosis


Discharge Condition:
Neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????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 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 in 7
days and fax results to [**Telephone/Fax (1) 87**].
??????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 RETURN TO THE OFFICE IN 8 DAYS FOR REMOVAL OF YOUR
SUTURES

PLEASE CALL [**Telephone/Fax (1) **] TO SCHEDULE AN APPOINTMENT WITH DR.
[**Last Name (STitle) **] TO BE SEEN IN 4 WEEKS.
YOU WILL NEED A CAT SCAN OF THE BRAIN WITHOUT CONTRAST PRIOR TO
THE APPOINTMENT



Completed by:[**2118-8-12**]
{'Other ill-defined cerebrovascular disease,Anomalies of cerebrovascular system,Cerebral edema,Late effect of radiation,Epilepsy, unspecified, without mention of intractable epilepsy'}


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: elective admission for radionecrosis resection due to
radiosurgery of AVM

PRESENT ILLNESS: Presents for resection of radionecrosis s/p radiosurgery for AVM

MEDICAL HISTORY: seizures,h/o radio therapy for avm has resid edema causing
seizures; Dysrhythmia (palps w/ panic attacks), Recent Upper
Respiratory Infection

MEDICATION ON ADMISSION: Acetaminophen, Effexor 50 [**Hospital1 **], Ibuprofen [Motrin, Advil], Keppra
(Levetiracetam) (25oomg

ALLERGIES: Codeine

PHYSICAL EXAM: Upon discharge:
The patient was alert and oriented. She followed commands
easily.
PERRL, EOMs intact.
Face symmetric, tongue midline.
Strength was full throughout and sensation was intact to light
touch.
Incision was clean, dry, and intact.

FAMILY HISTORY: NC

SOCIAL HISTORY: NC 

### Response:
{'Other ill-defined cerebrovascular disease,Anomalies of cerebrovascular system,Cerebral edema,Late effect of radiation,Epilepsy, unspecified, without mention of intractable epilepsy'}
