CHIEF COMPLAINT: none

PRESENT ILLNESS: The patient is a 57 year old woman who was referred to the
neurosurgical service for evaluation of a newly diagnosed Left
temporal mass. She has had occasional episodes of vertigo and
was treated with good success with Meclizine in the past. She
denied headache, nausea, vomiting, or seizures. She has no
systemic complaints or pain. She electively presented to undergo
a craniectomy and resection of this mass.

MEDICAL HISTORY: Breast Cancer
Lung Cancer

MEDICATION ON ADMISSION: Lorazepam prn, Vit D,C, Omega Ac

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Taken from an office note by Dr [**Last Name (STitle) **] [**2105-2-4**]:
HEENT; WNL and no LNN
RRR
CTA
NTTP
warm peripherals

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, retired
Secondary malignant neoplasm of brain and spinal cord,Subarachnoid hemorrhage,Iatrogenic cerebrovascular infarction or hemorrhage,Secondary malignant neoplasm of lung,Aphasia,Malignant neoplasm of breast (female), unspecified,Dizziness and giddiness,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Sec mal neo brain/spine,Subarachnoid hemorrhage,Iatrogen CV infarc/hmrhg,Secondary malig neo lung,Aphasia,Malign neopl breast NOS,Dizziness and giddiness,Abn react-surg proc NEC
Admission Date:  [**2105-2-12**]              Discharge Date:   [**2105-2-15**]

Date of Birth:  [**2047-3-28**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
none

Major Surgical or Invasive Procedure:
[**2105-2-12**]: Left craniotomy and resection of lesion


History of Present Illness:
The patient is a 57 year old woman who was referred to the
neurosurgical service for evaluation of a newly diagnosed Left
temporal mass. She has had occasional episodes of vertigo and
was treated with good success with Meclizine in the past. She
denied headache, nausea, vomiting, or seizures. She has no
systemic complaints or pain. She electively presented to undergo
a craniectomy and resection of this mass.


Past Medical History:
Breast Cancer
Lung Cancer

Social History:
married, retired

Family History:
non-contributory

Physical Exam:
Taken from an office note by Dr [**Last Name (STitle) **] [**2105-2-4**]:
HEENT; WNL and no LNN
RRR
CTA
NTTP
warm peripherals

Neurol: nl MS
AAOx3
CN: WNL
Full strength; no drift
[**Last Name (un) **]: no deficit; no parestesias
Stable gait and stand
No extrapyramidal signs.
Nl Reflexes

On the Day of discharge [**2105-2-15**]: The patient was oriented to
person, place, and time.She was independently ambulating with a
steady gait. The patient incision was well aproximated with
disolvable sutures, there was no drainage.  There was no
pronator drift. pupils were reactive. face was symetric.

Pertinent Results:
MR HEAD W/ CONTRAST Study Date of [**2105-2-12**] 5:12 AM Radiology
IMPRESSION:
1. Redemonstration of the left parietal extra-axial lesion, with
involvement of the adjacent bone and mild enhancement and
heterogeneous appearance as described above. The lesion is
better assessed on the prior MR [**First Name (Titles) **] [**Last Name (Titles) **] studies.

CT HEAD W/O CONTRAST Study Date of [**2105-2-12**] 10:50 AM CONCLUSION:

1. No evidence of acute hemorrhage in surgical field.
2. An extra-axial cystic area underlying craniotomy site might
represent
postoperative fluid collection versus residual extraaxial
portion of the
lesion. Attention on follow up MRI is recommended.

MR HEAD W & W/O CONTRAST Study Date of [**2105-2-13**] 2:39 PM
RADIOLOGY IMPRESSION:
1. Since the previous study, the patient has undergone resection
of left
parietal skull lesion. Although there is some restricted
diffusion remaining at the posterior aspect of the surgical
site, it is unclear whether this is due to residual lesion or
due to artifacts. Followup study can help for further
assessment.
2. Increased signal in the adjacent brain near the surgical site
and some
subarachnoid signal could be due to subarachnoid blood and small
area of brain edema, but evaluation remains limited secondary to
artifacts.
3. No evidence of large territorial infarcts, mass effect or
hydrocephalus.  No abnormal enhancement.

Pathology Report Tissue: left sided tumor. Study Date of
[**2105-2-12**]
Report not finalized.

[**2105-2-12**] 10:53AM   GLUCOSE-142* UREA N-15 CREAT-0.7 SODIUM-137
POTASSIUM-3.7 CHLORIDE-100 TOTAL CO2-28 ANION GAP-13
[**2105-2-12**] 10:53AM   estGFR-Using this
[**2105-2-12**] 10:53AM   CALCIUM-8.9 PHOSPHATE-3.4 MAGNESIUM-2.1
[**2105-2-12**] 10:53AM   WBC-4.5 RBC-4.59 HGB-12.8 HCT-37.5 MCV-82
MCH-28.0 MCHC-34.3 RDW-13.2
[**2105-2-12**] 10:53AM   PLT COUNT-185
[**2105-2-12**] 10:53AM   PT-11.0 PTT-27.0 INR(PT)-1.0
[**2105-2-14**] 04:50AM BLOOD WBC-10.7 RBC-4.01* Hgb-11.1* Hct-32.8*
MCV-82 MCH-27.8 MCHC-33.9 RDW-13.2 Plt Ct-156
[**2105-2-14**] 04:50AM BLOOD Plt Ct-156
[**2105-2-12**] 10:53AM BLOOD PT-11.0 PTT-27.0 INR(PT)-1.0
[**2105-2-14**] 04:50AM BLOOD Glucose-106* UreaN-12 Creat-0.5 Na-141
K-3.5 Cl-105 HCO3-27 AnGap-13
[**2105-2-14**] 04:50AM BLOOD Calcium-8.7 Phos-2.0*# Mg-1.9

Brief Hospital Course:
This is a 57 year old patient taht was electively admitted and
underwent a left craniotomy and resection of the left sided
lesion. Surgery was complicated by a traumatic aneurysm that
developed when removing the lesion from the brain surface. This
was treated with an aneurysmal clip. Post operatively she was
noted to have word finding difficulties but was otherwise
non-focal and feeling well. Her head CT revealed no acute
hemorrhage or obvious infarct.

On POD#1 she was neurologically stable. She was cleared for
transfer to the floor and for her decadron to be weaned. Post op
MRI revealed expected post operative changes.

Physical and occupational therapy evaluated the patient and
discharged her from acute PT/OT and did not feel that she would
require any services at home.

On the day of discharge, the patient was ambulating
independently with a steady gait.  She was tolerating a regular
diet and voiding independently.  The patient was able to perform
her activities of daily living independently.  She exhibited
full strength and sensation.  She was oriented to person, place,
and time and was very interactive.  The patient constinued to
exhibit mild word finding difficulties but these were slightly
improved.  The patient was given a a perscription for outpatient
speech therapy for evaluation and treatment.  The patient was
discharged to home with a decadron wean, pantoproxole, and
keppra 750 mg [**Hospital1 **], as well as pain medicine and stool softeners.
 She was also given indtructions to follow up in the Brain [**Hospital 341**]
Clinic on [**3-9**].  The sutures were dislovable and will not need
to be removed.

Medications on Admission:
Lorazepam prn, Vit D,C, Omega Ac


Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours as
needed for Pain for 1 weeks: do not drive while taking this
medication, take with a stool softener.
Disp:*40 Tablet(s)* Refills:*0*
2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for Pain or fever > 101.4.
3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
4. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*28 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) for 2 weeks.
Disp:*28 Capsule(s)* Refills:*0*
6. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
7 days: while taking steroid medication.
Disp:*7 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
7. levetiracetam 250 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
8. dexamethasone 1 mg Tablet Sig: Three (3) Tablet PO three
times a day for 1 doses: at 1600-last 3 mg dose.
Disp:*3 Tablet(s)* Refills:*0*
9. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) for 3 doses: start [**2105-2-16**]- MONDAY.
Disp:*3 Tablet(s)* Refills:*0*
10. dexamethasone 0.5 mg Tablet Sig: Two (2) Tablet PO Q8H
(every 8 hours) for 3 doses: Start Tuesday [**2105-2-17**].
Disp:*6 Tablet(s)* Refills:*0*
11. dexamethasone 0.5 mg Tablet Sig: Two (2) Tablet PO Q12H
(every 12 hours) for 2 doses: Start Wednesday [**2105-2-18**].
Disp:*4 Tablet(s)* Refills:*0*
12. Outpatient Speech/Swallowing Therapy
Outpatient speech Therapy evaluation and treatment to begin this
week- please call for an appointment Monday morning.


Discharge Disposition:
Home

Discharge Diagnosis:
left temporal mass


Discharge Condition:
alert and oriented
eyes open spontaneously
independently ambulatory
difficulty naming objects, word finding difficulty
strength is full
incision is well approximated and closed with disolvable sutures
incision is clean, dry , intact


Discharge Instructions:
General Instructions/Information

??????	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 have dissolvable sutures you may wash your hair and get
your incision wet day 3 after surgery.  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) &
Senna 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.
??????	You have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	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.
Your last day on the steroid medication will be on [**2105-2-18**].
??????	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.


Followup Instructions:
Follow-Up Appointment Instructions
??????You have an appointment in the Brain [**Hospital 341**] Clinic on
[**2105-3-9**]  09:30a   [**Last Name (LF) **],[**First Name3 (LF) **] TUMOR
  SC [**Hospital Ward Name **] CLINICAL CTR, [**Location (un) **]
  NEUROLOGY UNIT CC8 (SB)
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.

As you know you are having difficulty with word finding.  Please
see Speech Therapy as an outpatient for evaluation and
treatment. Please call for an appointment this week.



Completed by:[**2105-2-15**]
{'Secondary malignant neoplasm of brain and spinal cord,Subarachnoid hemorrhage,Iatrogenic cerebrovascular infarction or hemorrhage,Secondary malignant neoplasm of lung,Aphasia,Malignant neoplasm of breast (female), unspecified,Dizziness and giddiness,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: none

PRESENT ILLNESS: The patient is a 57 year old woman who was referred to the
neurosurgical service for evaluation of a newly diagnosed Left
temporal mass. She has had occasional episodes of vertigo and
was treated with good success with Meclizine in the past. She
denied headache, nausea, vomiting, or seizures. She has no
systemic complaints or pain. She electively presented to undergo
a craniectomy and resection of this mass.

MEDICAL HISTORY: Breast Cancer
Lung Cancer

MEDICATION ON ADMISSION: Lorazepam prn, Vit D,C, Omega Ac

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Taken from an office note by Dr [**Last Name (STitle) **] [**2105-2-4**]:
HEENT; WNL and no LNN
RRR
CTA
NTTP
warm peripherals

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: married, retired 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Subarachnoid hemorrhage,Iatrogenic cerebrovascular infarction or hemorrhage,Secondary malignant neoplasm of lung,Aphasia,Malignant neoplasm of breast (female), unspecified,Dizziness and giddiness,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
