CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 59 yo F hx migraines presents with worsening HA over the past 24
hrs.  Husband brought pt to ED today with worst HA of her life.
On arrival at OSH pt had an episode of syncope, after which
episode she was neuro intact.  CT head revealed hemorrhagic
right sided mass with significant edema and MLS.  Pt given
Dexamethasone 10mg IV and Keppra 500mg IV and was transferred to
[**Hospital1 18**] for further care.  C/o Headache that is [**9-5**].  Denies
weakness, numbness tingling, blurred vision, double vision,
nausea or vomiting.

MEDICAL HISTORY: Migraines, carpal tunnel syndrome s/p repair, s/p hysterectomy,
anxiety/depression

MEDICATION ON ADMISSION: Fiorinal PRN, Vicodin PRN, Zoloft

ALLERGIES: Augmentin / Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: O: T:  97.4  HR: 66  BP: 131/76  RR: 16  Sat: 99% ra
Gen:  WD/WN, comfortable, NAD.
HEENT: normocephalic, atraumatic
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Slightly sleepy but participates fully in exam.
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.

FAMILY HISTORY: unknown

SOCIAL HISTORY: denies illicit drugs
Benign neoplasm of cerebral meninges,Unspecified intracranial hemorrhage,Dysthymic disorder,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Esophageal reflux
Ben neo cerebr meninges,Intracranial hemorr NOS,Dysthymic disorder,Migrne unsp wo ntrc mgrn,Esophageal reflux
Admission Date:  [**2149-7-27**]              Discharge Date:   [**2149-8-1**]

Date of Birth:  [**2089-11-11**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Augmentin / Sulfa(Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Headache


Major Surgical or Invasive Procedure:
[**2149-7-28**] Diagnostic Angiogram
[**2149-7-29**] R craniotomy for resection


History of Present Illness:
59 yo F hx migraines presents with worsening HA over the past 24
hrs.  Husband brought pt to ED today with worst HA of her life.
On arrival at OSH pt had an episode of syncope, after which
episode she was neuro intact.  CT head revealed hemorrhagic
right sided mass with significant edema and MLS.  Pt given
Dexamethasone 10mg IV and Keppra 500mg IV and was transferred to
[**Hospital1 18**] for further care.  C/o Headache that is [**9-5**].  Denies
weakness, numbness tingling, blurred vision, double vision,
nausea or vomiting.


Past Medical History:
Migraines, carpal tunnel syndrome s/p repair, s/p hysterectomy,
anxiety/depression


Social History:
denies illicit drugs


Family History:
unknown


Physical Exam:
O: T:  97.4  HR: 66  BP: 131/76  RR: 16  Sat: 99% ra
Gen:  WD/WN, comfortable, NAD.
HEENT: normocephalic, atraumatic
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Slightly sleepy but participates fully in exam.
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, 3 to 2
mm 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 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 [**5-31**] throughout. No pronator drift

Sensation: Intact to light touch bilaterally.

Toes mute bilaterally

Coordination: normal on finger-nose-finger bilat

Handedness Right

PHYSICAL EXAM UPON DISCHARGE: **

Pertinent Results:
CT HEAD W/O CONTRAST [**2149-7-27**]:
Hyperdense right frontotemporal mass with marked surrounding
edema
and associated heterotopic irregular bone formation abutting the
right
anterior clinoid processes, causing leftward subfalcine
herniation and
possibly early downward transtentorial herniation.
Intralesional hyperdensity could represent hemorrhage or
mineralization.

MR HEAD W/ CONTRAST [**2149-7-27**]:
1.  Large extra-axial mass lesion on the right temporal fossa
and right
sphenoid [**Doctor First Name 362**], likely consistent with a meningioma, associated
with  significant vasogenic edema and mass effect as described
in detail above. No significant change in comparison with the
prior head CT examination.
2.  Significant midline shifting with uncal herniation and
transfalcine
herniation is demonstrated with approximately 14.1 mm of
shifting towards the left.

CEREBRAL ANGIOGRAM [**2149-7-28**]:
The right middle cerebral artery was superior and posterior to
the tumor. The right internal carotid artery was medial to the
tumor. The predominant blood supply is from the right internal
carotid artery, ophthalmic artery and cavernous branches.

CT HEAD WITHOUT CONTRAST [**2149-7-29**]:
Small focus of intraparenchymal hemorrhage in the region of
right temporal meningioma resection, with expected
post-operative changes, and no  difference in mass effect from
the pre-operative exam.

PATHOLOGY [**2149-7-29**]:  **pending**

MR HEAD W/ AND W/O CONTRAST [**2149-7-30**]:
Post-operative changes with findings suggesting residual
neoplasm medially.  There is stable uncal herniation with  mass
effect on the right cerebral peduncle and abnormal signal.
Restricted diffusion in the right temporal lobe could represent
acute ischemia or post operative cytotoxic edema.

Brief Hospital Course:
59 y/o F presents with headache worsening over the past 24hrs
presents with new R temporal hemorrhagic lesion on head CT. She
was trasnferred to [**Hospital1 18**] for further neurosurgical intervention.
Once at [**Hospital1 18**], she was admitted to neurosurgery and placed in
the ICU for close monitoring. She was started on dexamethasone
and MRI head was ordered. Over the day she became increasingly
more lethargic. She was placed on 25g Q4H of mannitol and 3% NS
for edema. On [**7-28**], her exam was improved and her mannitol was
decreased to 12.5g Q6H. She was taken to angiogram for
evaluation of vasculature. She was pre-oped for OR on [**7-29**] for R
craniotomy for resection of lesion.

Patient underwent right craniotomy with mass excision on [**7-29**].
The procedure was uncomplicated; a JP drain was left in place.
Upon completion of the case, the patient was extubated and
transferred in stable condition to the PACU.  After a recovery
period, the patient was transferred back to the neuro-ICU.
Post-operative head CT demonstrated small focus of
intraparenchymal hemorrhage in the region of right temporal
meningioma resection, with expected post-operative changes.

On [**2149-7-30**], POD #1, patient's examination improved significantly.
 She was AOx3, no pronator drift, full strength, and pulses
intact.  Post-op head MRI revealed post-operative changes with
findings suggesting residual neoplasm medially, stable uncal
herniation with  mass effect on the right cerebral peduncle, and
restricted diffusion in the right temporal lobe could represent
acute ischemia or post operative cytotoxic edema.

The neurosurgical team advanced the patient's diet, discontinued
her foley, discontinued her A-line, and transfered the patient
to the floor in good condition.  On [**7-31**], the patient's JP drain
was removed. She worked with PT/OT and her decadron was weaned.
Patient was discharged to rehab on [**8-1**].


Medications on Admission:
Fiorinal PRN, Vicodin PRN, Zoloft


Discharge Medications:
1. Acetaminophen-Caff-Butalbital [**1-27**] TAB PO Q6H:PRN headache
RX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg [**1-27**]
Capsule(s) by mouth every six (6) hours Disp #*60 Tablet
Refills:*0
2. LeVETiracetam 750 mg PO BID
RX *Keppra 750 mg 1 Tablet(s) by mouth twice a day Disp #*60
Tablet Refills:*2
3. Sertraline 200 mg PO DAILY
4. OxycoDONE (Immediate Release)  5-10 mg PO Q4H:PRN Pain
RX *oxycodone 5 mg [**1-27**] Capsule(s) by mouth every four (4) hours
Disp #*60 Tablet Refills:*0
5. Dexamethasone 2 mg PO REFER TO ADDITIONAL INSTRUCTIONS
Please take 3mg (1.5 tab) Q8H x 1 day, then 2mg (1 tab) Q8H x 1
day, then 2mg (1 tab) [**Hospital1 **]
Tapered dose - DOWN
RX *dexamethasone 2 mg 1 Tablet(s) by mouth refer to additional
instructions Disp #*90 Tablet Refills:*1
6. Docusate Sodium 100 mg PO BID
RX *Colace 100 mg 1 Capsule(s) by mouth twice a day Disp #*60
Tablet Refills:*2


Discharge Disposition:
Home With Service

Facility:
Caregroup Home Care

Discharge Diagnosis:
R temporal hemmorhagic mass
Vasogenic edema


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.

Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
??????	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.
??????	**Your wound was closed with staples then you must wait until
after they are removed to wash your hair. 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 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**].

??????	**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 101.5?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

 ??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**2149-8-11**]
@ 10:30AM.  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.



Completed by:[**2149-8-7**]
{'Benign neoplasm of cerebral meninges,Unspecified intracranial hemorrhage,Dysthymic disorder,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Esophageal reflux'}


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: 59 yo F hx migraines presents with worsening HA over the past 24
hrs.  Husband brought pt to ED today with worst HA of her life.
On arrival at OSH pt had an episode of syncope, after which
episode she was neuro intact.  CT head revealed hemorrhagic
right sided mass with significant edema and MLS.  Pt given
Dexamethasone 10mg IV and Keppra 500mg IV and was transferred to
[**Hospital1 18**] for further care.  C/o Headache that is [**9-5**].  Denies
weakness, numbness tingling, blurred vision, double vision,
nausea or vomiting.

MEDICAL HISTORY: Migraines, carpal tunnel syndrome s/p repair, s/p hysterectomy,
anxiety/depression

MEDICATION ON ADMISSION: Fiorinal PRN, Vicodin PRN, Zoloft

ALLERGIES: Augmentin / Sulfa(Sulfonamide Antibiotics)

PHYSICAL EXAM: O: T:  97.4  HR: 66  BP: 131/76  RR: 16  Sat: 99% ra
Gen:  WD/WN, comfortable, NAD.
HEENT: normocephalic, atraumatic
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Slightly sleepy but participates fully in exam.
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.

FAMILY HISTORY: unknown

SOCIAL HISTORY: denies illicit drugs 

### Response:
{'Benign neoplasm of cerebral meninges,Unspecified intracranial hemorrhage,Dysthymic disorder,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Esophageal reflux'}
