CHIEF COMPLAINT: Seizure

PRESENT ILLNESS: The patient is a 40 yo R-handed man with hx of IVDU, HepC, GTC
in the past in the setting of withdrawal, who is brought to the
ED by [**Location (un) **] Police for question of seizures.

MEDICAL HISTORY: -hepC
-explorative abdominal surgery for knife wound
-GTC x2 in the setting of heroin withdrawal (mid 90's); been on
dilantin

MEDICATION ON ADMISSION: None reported

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.3 BP 120/80  HR 68  Pox 98% RA
Gen NAD
HEENT: no lesions, MMM
CHEST: lungs clear bilaterally, heart sounds normal with no
m/r/g
Abd: soft nt nd +bs
ext: no c/c/e
Neuro: a/o x3. speech fluent without errors.
EOMI without nystagmus, PERRLA, VFFC. No facial weakness or
asymmetry. Facial sensation intact. Tongue midline, uvula
midline.
Motor exam with full strength in all major muscle groups.
Coordination intact - normal in UE and LE.
Senastion intact throughout without extinction. Gati: normal.

FAMILY HISTORY: Married: no children. Father with MI.

SOCIAL HISTORY: Occupation: no work; says he lives in [**Location 86**]. Smoking: 1 ppd,
unkown how long EthOH. Denied IV drug use at admission. Recently
incarcerated.
Other convulsions,Opioid abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Urinary tract infection, site not specified
Convulsions NEC,Opioid abuse-unspec,Chrnc hpt C wo hpat coma,Urin tract infection NOS
Admission Date:  [**2135-10-23**]              Discharge Date:   [**2135-10-25**]

Date of Birth:  [**2095-3-22**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5868**]
Chief Complaint:
Seizure

Major Surgical or Invasive Procedure:
None

History of Present Illness:
The patient is a 40 yo R-handed man with hx of IVDU, HepC, GTC
in the past in the setting of withdrawal, who is brought to the
ED by [**Location (un) **] Police for question of seizures.

The patient was taken off the street [**10-21**] for shoplifting and
was found to carry needles. He denied any IVDU and said he had
IDDM (also gave a false name and DOB). He was doing fine [**10-21**].
On [**10-22**] early pm, he reportedly was seen "shaking". No
information is available regarding this event. He was not
lethargic following the event. At 10pm he had another episode;
his arms and legs were shaking (twitching and moving, and looked
rigid when he was doing it), lasting about 3 minutes. Reportedly
he was not lethargic, but non-cooperative. He was brought to the
ED where he had a similar episode at 1.40 (few minutes). Another
episode occured at 2.50 when I was examining him: he put his R-
hand behind is head, would not respond to vocal stimuli, turned
his head to the L. He then started making rhythmic movements in
his arms and legs, before going into a GTC sz that lasted about
30s, incontinent for urine. He received 2mg ativan at that
point. He continued shaking in his arms and legs and received
further ativan inj. while he was being loaded on dilantin.

Before the seizure, the patient denied any IVDU and denied any
medical problems. [**Name (NI) **] felt cold and tired and was yawning a lot.

Review of systems:
denies any fever, visual changes, hearing changes, headache,
neckpain, nausea, vomiting, dysphagia, weakness, tingling,
numbness, bowel-bladder dysfunction, chest pain, shortness of
breath, abdominal pain, dysuria, hematuria, or bright red blood
per rectum.


Past Medical History:
-hepC
-explorative abdominal surgery for knife wound
-GTC x2 in the setting of heroin withdrawal (mid 90's); been on
dilantin


Social History:
Occupation: no work; says he lives in [**Location 86**]. Smoking: 1 ppd,
unkown how long EthOH. Denied IV drug use at admission. Recently
incarcerated.


Family History:
Married: no children. Father with MI.

Physical Exam:
T 99.3 BP 120/80  HR 68  Pox 98% RA
Gen NAD
HEENT: no lesions, MMM
CHEST: lungs clear bilaterally, heart sounds normal with no
m/r/g
Abd: soft nt nd +bs
ext: no c/c/e
Neuro: a/o x3. speech fluent without errors.
EOMI without nystagmus, PERRLA, VFFC. No facial weakness or
asymmetry. Facial sensation intact. Tongue midline, uvula
midline.
Motor exam with full strength in all major muscle groups.
Coordination intact - normal in UE and LE.
Senastion intact throughout without extinction. Gati: normal.

Pertinent Results:
2211/22/05 06:10AM BLOOD WBC-11.9* RBC-4.61 Hgb-13.5* Hct-38.1*
MCV-83 MCH-29.2 MCHC-35.3* RDW-14.0 Plt Ct-230
[**2135-10-23**] 09:30AM CEREBROSPINAL FLUID (CSF)  PROTEIN-26
GLUCOSE-96
[**2135-10-23**] 09:30AM CEREBROSPINAL FLUID (CSF)  WBC-3 RBC-1*
POLYS-71 LYMPHS-7 MONOS-[**2135-10-23**] 06:45AM   PHENYTOIN-19.4
[**2135-10-23**] 05:15AM   LACTATE-2.0
[**2135-10-23**] 06:45AM   HBsAg-NEGATIVE HBs Ab-NEGATIVE
[**2135-10-23**] 05:00AM   GLUCOSE-132* UREA N-14 CREAT-0.6 SODIUM-139
POTASSIUM-3.0* CHLORIDE-106 TOTAL CO2-20* ANION GAP-16
[**2135-10-22**] 11:55PM   LIPASE-31
[**2135-10-22**] 11:55PM   VIT B12-716
[**2135-10-22**] 11:55PM   TSH-0.22*
[**2135-10-22**] 11:55PM   HBsAg-NEGATIVE HBs Ab-NEGATIVE
[**2135-10-22**] 11:55PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2135-10-22**] 11:55PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2135-10-22**] 11:55PM   WBC-16.4*# RBC-4.87 HGB-15.0 HCT-39.7*
MCV-81*# MCH-30.7 MCHC-37.7* RDW-13.8
[**2135-10-22**] 11:55PM   PLT COUNT-287
[**2135-10-22**] 11:55PM URINE  BLOOD-SM NITRITE-NEG PROTEIN-30
GLUCOSE-NEG KETONE-50 BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2135-10-22**] 11:55PM URINE  RBC-[**5-13**]* WBC-[**5-13**]* BACTERIA-MOD
YEAST-NONE EPI-1

[**2135-10-23**] 9:30 am CSF;SPINAL FLUID Site: LUMBAR PUNCTURE  TUBE
#3. GRAM STAIN (Final [**2135-10-23**]): NO POLYMORPHONUCLEAR LEUKOCYTES
SEEN. NO MICROORGANISMS SEEN.

URINE CULTURE (Final [**2135-10-24**]):    NO GROWTH.

Head CT:IMPRESSION: No evidence for acute intracranial
abnormality including hemorrhage or mass effect. Right maxillary
sinus mucus retention cyst.

MRI with gadolinium brain [**2135-10-25**]: No mass lesion noted. There
is T2 flair hypodensity in the posterior frontal lobe
bilaterally that is likely secondary to chronic white matter
changes. There is no obvious evidence of intracranial abscess.
The ventricles appear to be normal in size. (Neurology Resident
Read).

CXR Chest: A single upright AP view of the chest shows an
endotracheal tube with the tip at the level of T3 and a NG tube
with its tip below the diaphragm. The lungs are clear. There is
no evidence of pneumothorax. The
cardiomediastinal silhouette and the costophrenic sulci appear
normal.

EEG: This is an abnormal EEG due to the presence of overlying
beta activity with suppressive periods during times when
Propafol medication was being administered. With the alleviation
of Propafol, what was seen was a pattern similar to a spindle
coma with beta being the primary rhythm observed. There was no
evidence of statusepilepticus. There is no evidence of any focal
or sharp activity seenthroughout this recording suggesting
ongoing seizures. Repeat EEG with the alleviation of medication
in the future to better assess the presence of background
activity should be performed if clinically required.


Brief Hospital Course:
Mr [**Known lastname 8976**] is a 40 year old with history of seizures in the
setting of alcohol withdrawal, known IVDU (Heroin), Hepatitis C,
was interrogated by police for shoplifting, on the same day
developed episode of shaking in all four limbs. Patient
proceeded to have several such episodes upon arrival at the
[**Hospital1 18**]. He had reported seizures of left side with generalization
to entiure body with loss of consciousness. He received 10mg of
lorazepam and was loaded with pheyntoin in the ED. The patient
was intubated for airway protection as we was poorly responsive
after at least 3 seizure events. He was transferred to the Neuro
ICU for monitoring. He was not noted to have any focal deficits
however was inattentive and somewhat uncooperative. He was found
to have a UTI and received antibiotics. He was administered
methadone for heroin withdrawal.

NEURO: patient stabilized and was extubated on [**2135-10-23**].
Dilantin level was 19.4. THe patient received methadone 20mg [**Hospital1 **]
for opiate withdrawal. His dilantin was discontinued on
[**2135-10-24**]. A LP was performed which revealed CSF: WBC 3 RBC 1
Protein 26 and Glucose 96. CSF gram stain was negative and there
were no organisms visualized. Head CT was negative for
intracranial mass. Given the pt.'s use of IV drugs and his
seizures, an MRI was performed with gadolinium: no abscesses or
mass lesions are seen and there are no enhancing structures. An
EEG was performed while pt was intubated and revealed
predominant beta rhythm. Status epilepticus was not observed.

CV: The pt. received IV hydrazaline in the ICU for high blood
pressures but was ablt to be weaned and the pt. did not require
anti-hypertensives to maintain normal BPs.

RESP: no acute issues. Pt. is stable on room air.

ID: urinalysis was consistent with borderline UTI (6-10 WBCs,
nitrite negative) and the patient was started on oral Bactrim
DS. Urine culture is negative however pt will complete a three
day course. Pt. was negative for HBsAg. HIV test was sent but
the results are pending at time of discharge. There has been no
growth x2days in three sets of blood cultures. His WBC count has
fallen to 11.9 from >16 while on Bactrim.

Heme: no active issues

Dispo: pt. is currently incarcerated and will return to police
custody at discharge.

Discharge Condition: Stable
Discharge Diagnoses:
1. Generalized tonic-clonic seizures
2. Opiate withdrawal
3. UTI

Medications on Admission:
None reported

Discharge Medications:
Bactrim DS 1tab [**Hospital1 **] x 1 day post-discharge

Discharge Disposition:
Home

Discharge Diagnosis:
Generalized tonic-clonic Seizure
Opiate addiction/withdrawal
UTI

Discharge Condition:
Stable

Discharge Instructions:
Please take bactrim for one more day
Addiction counseling
Please take methadone 20mg [**Hospital1 **]
Refrain from use of IV heroin (or other drugs of abuse)
Methadone not given at Sherrif office - spoke with Medical Staff
@[**Telephone/Fax (1) 8977**]
BE AWARE THAT PATIENT [**Month (only) **] HAVE WITHDRAWAL SEIZURES.

Followup Instructions:
No neurology follow-up required
Pt. will follow-up with medical team at prison facility.
{'Other convulsions,Opioid abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Urinary tract infection, site not specified'}


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: Seizure

PRESENT ILLNESS: The patient is a 40 yo R-handed man with hx of IVDU, HepC, GTC
in the past in the setting of withdrawal, who is brought to the
ED by [**Location (un) **] Police for question of seizures.

MEDICAL HISTORY: -hepC
-explorative abdominal surgery for knife wound
-GTC x2 in the setting of heroin withdrawal (mid 90's); been on
dilantin

MEDICATION ON ADMISSION: None reported

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 99.3 BP 120/80  HR 68  Pox 98% RA
Gen NAD
HEENT: no lesions, MMM
CHEST: lungs clear bilaterally, heart sounds normal with no
m/r/g
Abd: soft nt nd +bs
ext: no c/c/e
Neuro: a/o x3. speech fluent without errors.
EOMI without nystagmus, PERRLA, VFFC. No facial weakness or
asymmetry. Facial sensation intact. Tongue midline, uvula
midline.
Motor exam with full strength in all major muscle groups.
Coordination intact - normal in UE and LE.
Senastion intact throughout without extinction. Gati: normal.

FAMILY HISTORY: Married: no children. Father with MI.

SOCIAL HISTORY: Occupation: no work; says he lives in [**Location 86**]. Smoking: 1 ppd,
unkown how long EthOH. Denied IV drug use at admission. Recently
incarcerated. 

### Response:
{'Other convulsions,Opioid abuse, unspecified,Chronic hepatitis C without mention of hepatic coma,Urinary tract infection, site not specified'}
