CHIEF COMPLAINT: R temporal lesion

PRESENT ILLNESS: Patient is a 58 y/o F seen today in consultation for R
temporal lesion. Patient presented to OSH ED s/p "blackout" and
fall. She states that she was amnestic to events which occurred
leading to her fall. While in ED, head CT revealed a small R
temporal lesion and she was referred to neurosurgery. She has a
history of falls due to alcohol, but patient states that this
particular event was unlike her other falls. She has a history
of
[**2165-1-26**] headaches, but denies nausea, vomiting, dizziness,
seizure, or blurred vision.

MEDICAL HISTORY: COPD, asthma, hepatitis

MEDICATION ON ADMISSION: albuterol MDI prn, calcium carbonate, dilantin 100mg [**Hospital1 **], folic
acid, spiriva, wellbutrin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Well developed, well nourished, comfortable, no apparent
distress.
RRR
CTA
NTTP
warm peripherals
HEENT:  normocephalic, atraumatic, anicteric sclerae,.

FAMILY HISTORY: nc

SOCIAL HISTORY: +tobacco, social ETOH
Benign neoplasm of cerebral meninges,Chronic obstructive asthma, unspecified,Tobacco use disorder,Epilepsy, unspecified, without mention of intractable epilepsy
Ben neo cerebr meninges,Chronic obst asthma NOS,Tobacco use disorder,Epilep NOS w/o intr epil
Admission Date:  [**2165-11-27**]              Discharge Date:   [**2165-11-30**]

Date of Birth:  [**2107-1-30**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
R temporal lesion

Major Surgical or Invasive Procedure:
[**2165-11-27**]: Right Sided craniotomy for tumor resection


History of Present Illness:
Patient is a 58 y/o F seen today in consultation for R
temporal lesion. Patient presented to OSH ED s/p "blackout" and
fall. She states that she was amnestic to events which occurred
leading to her fall. While in ED, head CT revealed a small R
temporal lesion and she was referred to neurosurgery. She has a
history of falls due to alcohol, but patient states that this
particular event was unlike her other falls. She has a history
of
[**2165-1-26**] headaches, but denies nausea, vomiting, dizziness,
seizure, or blurred vision.


Past Medical History:
COPD, asthma, hepatitis

Social History:
+tobacco, social ETOH

Family History:
nc


Physical Exam:
Well developed, well nourished, comfortable, no apparent
distress.
RRR
CTA
NTTP
warm peripherals
HEENT:  normocephalic, atraumatic, anicteric sclerae,.

Neurological Examination:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension. No dysarthria
or
paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 4 to 3 mm
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.
        Grip    [**Hospital1 **]      Tri     Delt    WE      WF      IP
Quad    Ham     AT      [**First Name9 (NamePattern2) 5040**]        [**Last Name (un) 938**]
Right

Left

Sensation: Intact to light touch.
Stable gait and stance
no extrapyramidal signs

On Discharge:
A&Ox3
PERRL 4-3mm bilaterally
EOMs: intact
Face symmetrical
tongue midline
Negative pronator drift
Motor: [**5-29**] throughout
Incision: c/d/i with dissovable sutures


Pertinent Results:
[**11-27**] CT Head: IMPRESSION: Status post frontotemporal
craniectomy, without evidence of immediate complication.

[**11-28**] Brain MRI:Postoperative appearances in the right temporal
lobe following excision of an extra-axial mass with a shallow
extra-axial fluid/blood and FLAIR, T2 high signal in the right
temporal lobe. No evidence of a residual tumor. No evidence of
acute infarct or hydrocephalus.


Brief Hospital Course:
Patient presented electively on [**2165-11-27**] for a right sided
craniotomy for temporal mass resection. Surgery was without
complication and the patient tolerated it well. She was admitted
to the ICU for close neurological monitoring. Her post op head
CT was stable without hemorrhage. She remained stable overnight.
On POD#1 she was cleared for transfer to the floor. Her decadron
was tapered to off. An MRI was ordered for routine post op
staging. Physical Therapy was consulted for assistance with
discharge planning and subcutaneous heparin was started for DVT
proph. PT worked with patient and she was desatting when
ambulating otherwise intact. On [**11-30**], patient was reaccessed by
PT and was no longer desatting when ambulating. Patient remains
intact and was discharged home.

Medications on Admission:
albuterol MDI prn, calcium carbonate, dilantin 100mg [**Hospital1 **], folic
acid, spiriva, wellbutrin


Discharge Medications:
1. oxycodone-acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q4H (every 4 hours) as needed for SOB,
Wheeze.
5. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO DAILY (Daily).
6. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).
7. bupropion HCl 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO DAILY (Daily).
8. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
9. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

10. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
11. dexamethasone 2 mg Tablet Sig: as directed Tablet PO every
six (6) hours: Please take 3mg (1.5 tablets)every 6 hrs for 1
day, then take 2mg (1 tablet) every 6 hrs for 1 day, then 1mg
(0.5 tablet) every 6 hrs for 1 day, then off.
Disp:*16 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Right Temporal Mass


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge 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. If your wound closure uses dissolvable sutures,
you must keep that area dry for 10 days.
??????	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 Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	If you are being sent home on steroid medication, make sure
you are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home.
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: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
??????Your sutures are dissolvable and do not require removal.

??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**12-9**] @
11:30AM.  The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 516**]
of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone number
is [**Telephone/Fax (1) 1844**]. Please call if you need to change your
appointment, or require additional directions.



Completed by:[**2165-11-30**]
{'Benign neoplasm of cerebral meninges,Chronic obstructive asthma, unspecified,Tobacco use disorder,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: R temporal lesion

PRESENT ILLNESS: Patient is a 58 y/o F seen today in consultation for R
temporal lesion. Patient presented to OSH ED s/p "blackout" and
fall. She states that she was amnestic to events which occurred
leading to her fall. While in ED, head CT revealed a small R
temporal lesion and she was referred to neurosurgery. She has a
history of falls due to alcohol, but patient states that this
particular event was unlike her other falls. She has a history
of
[**2165-1-26**] headaches, but denies nausea, vomiting, dizziness,
seizure, or blurred vision.

MEDICAL HISTORY: COPD, asthma, hepatitis

MEDICATION ON ADMISSION: albuterol MDI prn, calcium carbonate, dilantin 100mg [**Hospital1 **], folic
acid, spiriva, wellbutrin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Well developed, well nourished, comfortable, no apparent
distress.
RRR
CTA
NTTP
warm peripherals
HEENT:  normocephalic, atraumatic, anicteric sclerae,.

FAMILY HISTORY: nc

SOCIAL HISTORY: +tobacco, social ETOH 

### Response:
{'Benign neoplasm of cerebral meninges,Chronic obstructive asthma, unspecified,Tobacco use disorder,Epilepsy, unspecified, without mention of intractable epilepsy'}
