CHIEF COMPLAINT: Left hand/finger tingling

PRESENT ILLNESS: Patient is a 53 year old gentleman who presents to our clinic
for evaluation and consultation after beign referred after an
episode where he had left cheek and left pinky and ring finger
numbness. He had been worked up with Echocardiogram and Chest Ct
per his report which were both negative and also recieved a head
CT which showed a right extraxial lesion. As a reuslt he
udnerwent an MRI scan of the brain which showed a right extra
axial lesion most likely consistent with a meningioma.
He has no comlaints at this time. he denies nausea, vomtiing,
dizziness, difficulty ambulating, changes in vision, hearing or
speech, numbness or tingling in his extremities.

MEDICAL HISTORY: Kidney Stones, left knee surgery

MEDICATION ON ADMISSION: Lipitor, Vit D3, Fish oil, ASA (held preop),CoQ10

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Stroke

SOCIAL HISTORY: works as Banker
Benign neoplasm of cerebral meninges,Other and unspecified hyperlipidemia
Ben neo cerebr meninges,Hyperlipidemia NEC/NOS
Admission Date:  [**2125-7-11**]              Discharge Date:   [**2125-7-14**]

Date of Birth:  [**2071-6-24**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Left hand/finger tingling

Major Surgical or Invasive Procedure:
Right sided craniotomy for resection of meningioma

History of Present Illness:
Patient is a 53 year old gentleman who presents to our clinic
for evaluation and consultation after beign referred after an
episode where he had left cheek and left pinky and ring finger
numbness. He had been worked up with Echocardiogram and Chest Ct
per his report which were both negative and also recieved a head
CT which showed a right extraxial lesion. As a reuslt he
udnerwent an MRI scan of the brain which showed a right extra
axial lesion most likely consistent with a meningioma.
He has no comlaints at this time. he denies nausea, vomtiing,
dizziness, difficulty ambulating, changes in vision, hearing or
speech, numbness or tingling in his extremities.


Past Medical History:
Kidney Stones, left knee surgery

Social History:
works as Banker

Family History:
Stroke

Physical Exam:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
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, 4mm to
3mm 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 finger rub bilaterally.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk bilaterally. No abnormal movements,
tremors. Strength full power [**3-29**] throughout except trace Left
tricep weakness. No pronator drift.  Slight increased tone on
LEft LE

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

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin


Pertinent Results:
[**2125-7-11**] 11:28AM   freeCa-1.06*
[**2125-7-11**] 11:28AM   HGB-13.4* calcHCT-40 O2 SAT-98
[**2125-7-11**] 11:28AM   GLUCOSE-107* LACTATE-1.3 NA+-133* K+-4.0
CL--102
[**2125-7-11**] 11:28AM   TYPE-ART PO2-114* PCO2-32* PH-7.46* TOTAL
CO2-23 BASE XS-0 INTUBATED-INTUBATED
[**2125-7-11**] 03:01PM   PT-13.8* PTT-23.6 INR(PT)-1.2*
[**2125-7-11**] 03:01PM   PLT COUNT-218
[**2125-7-11**] 03:01PM   WBC-8.5# RBC-4.64 HGB-14.6 HCT-41.2 MCV-89
MCH-31.6 MCHC-35.5* RDW-12.6
[**2125-7-11**] 03:01PM   CALCIUM-8.7 PHOSPHATE-3.9 MAGNESIUM-2.0
[**2125-7-11**] 03:01PM   GLUCOSE-189* UREA N-14 CREAT-1.1 SODIUM-139
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-24 ANION GAP-14

Tissue: Right frontal tumor -dural Study Date of [**2125-7-11**]
Report not finalized.

MR HEAD W/ CONTRAST Study Date of [**2125-7-11**] 6:29 AM MR HEAD WITH
ANDWITHOUT CONTRAST:

This is a limited MR study intended only for pre-operative
planning. Fiducial markers are seen on the surface of the scalp.
Mass seen in the right frontoparietal lobe is now 5.5 cm (AP) x
3.6 cm (TV) x 4.4 cm (CC) which represents a moderate increase
(6 mm) in the craniocaudal dimension; the other dimensions of
the mass are unchanged. There is approximately 6-mm of leftward
midline shift unchanged from previous study.  Vasogenic edema is
seen around the lesion and is essentially unchanged.
Mass is found adjacent to the falx and the right lateral aspect
of the mid
sagittal sinus. Mass abuts and likely invades this portion of
the sagittal
sinus; though there is effacement, the sinus remains patent.
No hemorrhage, edema, infarct or new masses are seen. Normal
flow voids are observed.

IMPRESSIONS: Right frontoparietal extra-axial mass, likely
parafalcine
meningioma, effaces and likely invades the right lateral aspect
of the
mid-portion of the superior sagittal sinus, which remains
patent.

CT HEAD W/O CONTRAST Study Date of [**2125-7-11**] 5:14 PM IMPRESSION:
Uncomplicated postoperative appearance of right craniotomy with
resection of right-sided meningioma. Bifrontal moderate
pneumocephalus with displacement of the frontal lobes
posteriorly-close followup to excldue tension pneumocephalus.
Scattered air and tiny hemorrhage in the surgical bed but
without large intracranial hemorrhage or intraventricular
hemorrhagic extension. Tiny 3-mm leftward shift of midline
structures.

MR HEAD W & W/O CONTRAST Study Date of [**2125-7-12**] 5:36 PM
Shows post op changes and good resection of previously seen
meningioma



Brief Hospital Course:
Mr. [**Known lastname **] was admitted for elective right sided craniotomy for
resection of mass.  He  tolerated the procedure well, was
extubated and transferred to the ICU for Q1 hour neuro checks
and SBP control less than 140.  Postop head CT showed expected
changes without hemorrhage. He was stable on [**7-12**] and he was
transfered to the floor. MRI was done. He was transitioned OOB.
His diet was advanced.He was seen by the physical therapy team
and cleared for home. He was discharged home on [**7-14**] in stable
condition.

Medications on Admission:
Lipitor, Vit D3, Fish oil, ASA (held preop),CoQ10

Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for Pain.
Disp:*75 Tablet(s)* Refills:*0*
2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
3. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) for 1 days.
Disp:*4 Tablet(s)* Refills:*0*
7. dexamethasone 1 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) for 1 days.
Disp:*4 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Right Frontoparietal meningioma


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


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 may wash your hair only after 3 days form surgery. Your
wound closure uses dissolvable sutures, you must keep that area
dry for 3 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:
Follow-Up Appointment Instructions

??????Please return to the office in [**6-3**] days (from your date of
surgery) for a wound check. This appointment can be made with
the Nurse Practitioner.  Please make this appointment by calling
[**Telephone/Fax (1) 1669**]. If you live quite a distance from our office,
please make arrangements for the same, with your PCP.
??????You will be contact[**Name (NI) **] with your appointment for the Brain [**Hospital 341**]
Clinic.  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.
??????You not need an MRI of the brain.



Completed by:[**2125-7-14**]
{'Benign neoplasm of cerebral meninges,Other and unspecified hyperlipidemia'}


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: Left hand/finger tingling

PRESENT ILLNESS: Patient is a 53 year old gentleman who presents to our clinic
for evaluation and consultation after beign referred after an
episode where he had left cheek and left pinky and ring finger
numbness. He had been worked up with Echocardiogram and Chest Ct
per his report which were both negative and also recieved a head
CT which showed a right extraxial lesion. As a reuslt he
udnerwent an MRI scan of the brain which showed a right extra
axial lesion most likely consistent with a meningioma.
He has no comlaints at this time. he denies nausea, vomtiing,
dizziness, difficulty ambulating, changes in vision, hearing or
speech, numbness or tingling in his extremities.

MEDICAL HISTORY: Kidney Stones, left knee surgery

MEDICATION ON ADMISSION: Lipitor, Vit D3, Fish oil, ASA (held preop),CoQ10

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: PERRL        EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused. No C/C/E.

FAMILY HISTORY: Stroke

SOCIAL HISTORY: works as Banker 

### Response:
{'Benign neoplasm of cerebral meninges,Other and unspecified hyperlipidemia'}
