CHIEF COMPLAINT: visual disturbance, word finding difficulty

PRESENT ILLNESS: 65M transferred from OSH after complaints of difficulty driving
due to visual disturbances, and word finding difficulty and a CT
scan of the head revealing a left occipital parietal mass with
edema.

MEDICAL HISTORY: DM II

MEDICATION ON ADMISSION: Micronase
Glucophage

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
T:98.0  BP: 123 /85         HR:75    R: 11      O2Sats: 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 7 mm NR bilaterally ( dilated by optho)
EOMs: intact
Neck: Supple.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married and living with his wife and four children
[**Name (NI) 8003**] teacher in Middle school
Remote history of Tobacco
No ETOH
Malignant neoplasm of other parts of brain,Cerebral edema,Aphasia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Homonymous bilateral field defects
Malig neo brain NEC,Cerebral edema,Aphasia,DMII wo cmp nt st uncntr,Homonymous hemianopsia
Admission Date:  [**2137-9-27**]              Discharge Date:   [**2137-10-5**]

Date of Birth:  [**2071-11-18**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
visual disturbance, word finding difficulty

Major Surgical or Invasive Procedure:
[**2137-9-30**]: Left craniotomy for mass resection

History of Present Illness:
65M transferred from OSH after complaints of difficulty driving
due to visual disturbances, and word finding difficulty and a CT
scan of the head revealing a left occipital parietal mass with
edema.

He reported visual disturbances for approximately two months
time, often finding himself driving in the middle of two lanes.
He was seen by an opthalmologist on [**9-27**] and CT scan of the
head was ordered. He was transferred to [**Hospital1 18**] for definitive
treatment of intracranial findings.

Past Medical History:
DM II

Social History:
Married and living with his wife and four children
[**Name (NI) 8003**] teacher in Middle school
Remote history of Tobacco
No ETOH


Family History:
Non-contributory

Physical Exam:
On Admission:
T:98.0  BP: 123 /85         HR:75    R: 11      O2Sats: 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 7 mm NR bilaterally ( dilated by optho)
EOMs: intact
Neck: Supple.

Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**1-29**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. Perioperative and expansive speech, exhibited
some
word finding difficulties.

Cranial Nerves:
I: Not tested
II: Pupils : as above
Visual fields : Right sided hemianopsia
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 [**4-2**] throughout. No pronator drift

Sensation: Intact to light touch, proprioception, pinprick and
vibration bilaterally.

Coordination: Slight dysmetria on right

Exam on Discharge:
Alert, oriented to person, place and date. Pupils are equal and
reactive. Face symmetric, tongue is midline. No pronator drift.
Full strength and sensation in upper and lower extremities.

Pertinent Results:
Labs on Admission:
[**2137-9-27**] 08:42PM BLOOD WBC-10.8 RBC-4.32* Hgb-12.1* Hct-37.3*
MCV-87 MCH-28.1 MCHC-32.5 RDW-13.5 Plt Ct-216
[**2137-9-27**] 08:42PM BLOOD Neuts-89.6* Lymphs-8.5* Monos-1.0*
Eos-0.5 Baso-0.5
[**2137-9-27**] 08:42PM BLOOD PT-13.5* PTT-25.9 INR(PT)-1.2*
[**2137-9-27**] 08:42PM BLOOD Glucose-231* UreaN-9 Creat-0.8 Na-139
K-4.5 Cl-104 HCO3-30 AnGap-10
[**2137-9-27**] 08:42PM BLOOD Calcium-9.4 Phos-3.2 Mg-1.9
[**2137-9-27**] 08:42PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

Labs on Discharge:
[**2137-10-4**] 04:45AM BLOOD WBC-7.8 RBC-3.33* Hgb-9.6* Hct-28.6*
MCV-86 MCH-28.8 MCHC-33.6 RDW-13.4 Plt Ct-217
[**2137-10-4**] 04:45AM BLOOD PT-12.5 PTT-25.5 INR(PT)-1.1
[**2137-10-4**] 04:45AM BLOOD Glucose-95 UreaN-8 Creat-0.8 Na-140 K-3.9
Cl-101 HCO3-31 AnGap-12
[**2137-10-4**] 04:45AM BLOOD Calcium-8.6 Phos-3.1 Mg-2.0
[**2137-10-4**] 04:45AM BLOOD Phenyto-12.6

IMAGING:
CT Head [**9-27**](OSH):Right occipital supratentorial mass extending
to the parietal lobe with extensive edema and MLS.

MRI Head (Post-op): showing adequate resection of intracranial
mass


Brief Hospital Course:
Patient was admitted to the neurosurgery service on [**2137-9-27**]
after being found to have a left occipital parietal mass, and
neurologic symptoms of word finding difficulty, and visual
disturbance. He was given loading dose of decadron, and started
on 4mg Q6h. MRI of the head was obtained to further characterize
the mass. He went to the operating room on [**2137-9-30**] for left
sided craniotomy to resect the mass. Post-operatively he was
transferred to the ICU for routine post-surgical monitoring.
After an uneventful night in the ICU; he was transferred to the
neurosurgery floor. Post-op MRI was obtained on [**10-1**] revealing
appropriate surgical resection of intracranial lesion. He was
further seen and evaluated by physical and occupational therapy,
who recommended home dispostion without the need for further
services.

Medications on Admission:
Micronase
Glucophage


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(s)* Refills:*0*
2. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. 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*
4. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO TID (3 times a day).
Disp:*90 Capsule(s)* Refills:*0*
5. Metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO bid () for 2
days.
7. Dexamethasone 0.5 mg Tablet Sig: Two (2) Tablet PO bid () for
2 days.
8. Diabetic meds
you may resume your home dosing of diabetes medications, as
previously prescribed


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Left Occipital-Parietal Mass

Discharge Condition:
Neurologically Stable

Discharge Instructions:
GENERAL INSTRUCTIONS
WOUND CARE:
??????	You or a family member should inspect your wound every day and
report any of the following problems to your physician.
??????	Keep your incision clean and dry.
??????	You may wash your hair with a mild shampoo 24 hours after your
[**Hospital1 2729**] are removed.
??????	Do NOT apply any lotions, ointments or other products to your
incision.
??????	DO NOT DRIVE until you are seen at the first follow up
appointment.
??????	Do not lift objects over 10 pounds until approved by your
physician.

DIET
Usually no special diet is prescribed after a craniotomy. A
normal well balanced diet is recommended for recovery, and you
should resume any specially prescribed diet you were eating
before your surgery.  Be sure however, to remain well hydrated,
and increase your consumption of fiber, as pain medications may
cause constipation.

MEDICATIONS:
??????	Take all of your medications as ordered.  You do not have to
take pain medication unless it is needed.  It is important that
you are able to cough, breathe deeply, and is comfortable enough
to walk.
??????	Do not use alcohol while taking pain medication.
??????	Medications that may be prescribed include:
o	Narcotic pain medication such as Dilaudid (hydromorphone).
o	An over the counter stool softener for constipation (Colace or
Docusate). If you become constipated, try products such as
Dulcolax, Milk of Magnesia, first, and then Magnesium Citrate or
Fleets enema if needed). Often times, pain medication and
anesthesia can cause constipation.
??????	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**].
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc, as this can increase your chances of bleeding.
??????	You are being sent home on steroid medication(taper to off),
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.

ACTIVITY:
The first few weeks after you are discharged you may feel tired
or fatigued. This is normal. You should become a little stronger
every day. Activity is the most important measure you can take
to prevent complications and to begin to feel like yourself
again. In general:
??????	Follow the activity instructions given to you by your doctor
and therapist.
??????	Increase your activity slowly; do not do too much because you
are feeling good.
??????	You may resume sexual activity as your tolerance allows.
??????	If you feel light headed or fatigued after increasing
activity, rest, decrease the amount of activity that you do, and
begin building your tolerance to activity more slowly.
??????	DO NOT DRIVE until you speak with your physician.
??????	Do not lift objects over 10 pounds until approved by your
physician.
??????	Avoid any activity that causes you to hold your breath and
push, for example weight lifting, lifting or moving heavy
objects, or straining at stool.
??????	Do your breathing exercises every two hours.
??????	Use your incentive spirometer 10 times every hour,  that you
are awake.

WHEN TO CALL YOUR SURGEON:
With any surgery there are risks of complications. Although your
surgery is over, there is the possibility of some of these
complications developing. These complications include:
infection, blood clots, or neurological changes. Call your
Physician Immediately if you Experience:

??????	Confusion, fainting, blacking out, extreme fatigue, memory
loss, or difficulty speaking.
??????	Double, or blurred vision. Loss of vision, either partial or
total.
??????	Hallucinations
??????	Numbness, tingling, or weakness in your extremities or face.
??????	Stiff neck, and/or a fever of 101.5F or more.
??????	Severe sensitivity to light. (Photophobia)
??????	Severe headache or change in headache.
??????	Seizure
??????	Problems controlling your bowels or bladder.
??????	Productive cough with yellow or green sputum.
??????	Swelling, redness, or tenderness in your calf or thigh.

Call 911 or go to the Nearest Emergency Room if you Experience:
??????	Sudden difficulty in breathing.
??????	New onset of seizure or change in seizure, or seizure from
which you wake up confused.
??????	A seizure that lasts more than 5 minutes.

Important Instructions Regarding Emergencies and After-Hour
Calls
??????	If you have what you feel is a true emergency at any time,
please present immediately to your local emergency room, where a
doctor there will evaluate you and contact us if needed. Due to
the complexity of neurosurgical procedures and treatment of
neurosurgical problems, effective advice regarding emergency
situations cannot be given over the telephone.
??????	Should you have a situation which is not life-threatening, but
you feel needs addressing before normal office hours or on the
weekend, please present to the local emergency room, where the
physician there will evaluate you and contact us if needed.


Followup Instructions:
FOLLOW UP APPOINTMENT INSTRUCTIONS

??????Please return to the office in [**6-7**] days (from your date of
surgery) for removal of your staples/[**Date Range 2729**] and a wound check.
Although we try to be thorough, we may miss [**First Name (Titles) 2730**] [**Last Name (Titles) 2729**] or
staples. This appointment can be made with the Nurse
Practitioner.  Please make this appointment by calling
[**Telephone/Fax (1) 2731**]. If you live quite a distance from our office,
please make arrangements for the same, with your PCP.
??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**11-4**] @9:30am.  The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 5074**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. This is a
multi-disciplinary appointment. Their phone number is
[**Telephone/Fax (1) 1844**]. Please call if you need to change your
appointment, or require additional directions.
??????You will not need an MRI of the brain as this was completed
during your acute hospitalization



Completed by:[**2137-10-4**]
{'Malignant neoplasm of other parts of brain,Cerebral edema,Aphasia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Homonymous bilateral field defects'}


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: visual disturbance, word finding difficulty

PRESENT ILLNESS: 65M transferred from OSH after complaints of difficulty driving
due to visual disturbances, and word finding difficulty and a CT
scan of the head revealing a left occipital parietal mass with
edema.

MEDICAL HISTORY: DM II

MEDICATION ON ADMISSION: Micronase
Glucophage

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
T:98.0  BP: 123 /85         HR:75    R: 11      O2Sats: 100% RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 7 mm NR bilaterally ( dilated by optho)
EOMs: intact
Neck: Supple.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married and living with his wife and four children
[**Name (NI) 8003**] teacher in Middle school
Remote history of Tobacco
No ETOH 

### Response:
{'Malignant neoplasm of other parts of brain,Cerebral edema,Aphasia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Homonymous bilateral field defects'}
