CHIEF COMPLAINT: headache

PRESENT ILLNESS: HPI: 51yo F with h/o migraines for years, presented to ED today
because of "different" HA and multiple episodes of vomiting.  CT
showed large bifrontal heterogeneous mass with calcification,
mass effect, concerning for meningioma.

MEDICAL HISTORY: migraines

MEDICATION ON ADMISSION: Medications prior to admission: Amitryptiline, Fiuricet, vaginal
estrogen suppository

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T: 97.6   BP: 151/78    HR: 88     R: 18    97%RA
Gen: WD/WN, comfortable, NAD
Lungs: CTA bilaterally.
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: [**3-16**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Family Hx: 1 brother died [**2152**] @ 28 [**Name2 (NI) **] of brain tumor
(?astrocytoma)

SOCIAL HISTORY: Social Hx: 4 glasses wine/week, no tobacco
Benign neoplasm of cerebral meninges,Other specified complications of procedures not elsewhere classified,Compression of brain
Ben neo cerebr meninges,Oth spcf cmplc procd NEC,Compression of brain
Admission Date:  [**2176-10-31**]              Discharge Date:   [**2176-11-10**]

Date of Birth:  [**2125-9-12**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

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

Major Surgical or Invasive Procedure:
Bifrontal Craniotomy


History of Present Illness:
HPI: 51yo F with h/o migraines for years, presented to ED today
because of "different" HA and multiple episodes of vomiting.  CT
showed large bifrontal heterogeneous mass with calcification,
mass effect, concerning for meningioma.


Past Medical History:
migraines


Social History:
Social Hx: 4 glasses wine/week, no tobacco


Family History:
Family Hx: 1 brother died [**2152**] @ 28 [**Name2 (NI) **] of brain tumor
(?astrocytoma)


Physical Exam:
PHYSICAL EXAM:
T: 97.6   BP: 151/78    HR: 88     R: 18    97%RA
Gen: WD/WN, comfortable, NAD
Lungs: CTA bilaterally.
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: [**3-16**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light.
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 [**6-15**] throughout. No pronator drift
Sensation: Intact to light touch.
Toes downgoing bilaterally


Pertinent Results:
[**10-31**] CT: Large bifrontal heterogeneous mass with calcification
seen, with mass effect predominantly affecting anterior horns of
the lateral ventricles, concerning for a large meningioma.

[**2176-10-31**] 02:00AM   WBC-18.7* RBC-4.24 HGB-14.9 HCT-39.8 MCV-94
MCH-35.1* MCHC-37.4* RDW-13.2
[**2176-10-31**] 02:00AM   NEUTS-56.7 LYMPHS-41.5 MONOS-1.5* EOS-0.1
BASOS-0.2
[**2176-10-31**] 02:00AM   PLT COUNT-237
[**2176-10-31**] 02:00AM   PT-11.5 PTT-24.1 INR(PT)-1.0
[**2176-10-31**] 02:00AM   GLUCOSE-100 UREA N-10 CREAT-0.6 SODIUM-131*
POTASSIUM-4.0 CHLORIDE-94* TOTAL CO2-24 ANION GAP-17

Brief Hospital Course:
Ms [**Known lastname 3708**] was admitted to the Neurosurgical Step Down for close
observation, started on high dose steroids and Mannitol.  Within
24 hours Ms [**Known lastname **] headache completely resolved and she was
neurologically intact.  A CTA was done which showed The
extra-axial dural-based mass of the left frontal lobe is
supplied through the dural vessels. The mass causes secondary
displacement of the anterior cerebral arteries, however, it does
not appear to be supplied by them.

She was offered and accepted surgery to remove the meningioma.
We recommended a diagnostic angiogram with embolization which
was performed on [**11-5**] without difficulty.  On [**11-6**] she underwent
a bilateral frontal craniotomy.  She went to the ICU
post-operative for the first two days.  She developed a low
grade fever and was cultured with no obvious source.  Her
steroids were weaned.

On POD#3 she was transferred to the floor was neurologically
stable, tolerating regular diet.  On discharge the patient was
afebrile walking independently.  She was given follow up
appointment to be seen in the neurology and neurosurgery clincs.

Medications on Admission:
Medications prior to admission: Amitryptiline, Fiuricet, vaginal
estrogen suppository

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): use while on narcotics.
Disp:*40 Capsule(s)* Refills:*1*
2. Amitriptyline 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours): Use
while on Decadron.
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
4. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day): take an additional 1 tablet at mid day.
Disp:*120 Capsule(s)* Refills:*1*
5. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO take 1 tab
[**Hospital1 **] x2 days then 1 tablet QD X2 days then stop.
Disp:*6 Tablet(s)* Refills:*0*
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Meningioma


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 and/or staples 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 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, drainage
??????	Fever greater than or equal to 101?????? F


Followup Instructions:
You have an MRI sheduled for [**2176-12-23**] 11:15 am on the [**Hospital Ward Name 5074**], [**Hospital Ward Name 23**] 4. Phone:[**Telephone/Fax (1) 327**].
You have an appointment with [**Name6 (MD) 5005**] [**Last Name (NamePattern4) 5342**], MD
Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2176-12-23**] 1:00 pm.
Have your staples DC'd on [**2176-11-15**] between 0900-1200 at Dr [**Name (NI) 14232**] office  [**Hospital Unit Name 31391**]
{'Benign neoplasm of cerebral meninges,Other specified complications of procedures not elsewhere classified,Compression of brain'}


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: headache

PRESENT ILLNESS: HPI: 51yo F with h/o migraines for years, presented to ED today
because of "different" HA and multiple episodes of vomiting.  CT
showed large bifrontal heterogeneous mass with calcification,
mass effect, concerning for meningioma.

MEDICAL HISTORY: migraines

MEDICATION ON ADMISSION: Medications prior to admission: Amitryptiline, Fiuricet, vaginal
estrogen suppository

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM:
T: 97.6   BP: 151/78    HR: 88     R: 18    97%RA
Gen: WD/WN, comfortable, NAD
Lungs: CTA bilaterally.
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: [**3-16**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Family Hx: 1 brother died [**2152**] @ 28 [**Name2 (NI) **] of brain tumor
(?astrocytoma)

SOCIAL HISTORY: Social Hx: 4 glasses wine/week, no tobacco 

### Response:
{'Benign neoplasm of cerebral meninges,Other specified complications of procedures not elsewhere classified,Compression of brain'}
