CHIEF COMPLAINT: Headache

PRESENT ILLNESS: 47 year old male presented to [**Hospital6 1597**] after having a
new headache that was unlike any headaches he's had in the past.
He has no dizziness, no N/V, no visual changes,gait changes or
any other symptoms. The patient had a head CT at the OSH which
showed a 6 cm left frontal mass. He was sent to [**Hospital1 18**] for a
neurosurgical evaluation.

MEDICAL HISTORY: HTN thought to be related to pain that resolved with no
medication

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:99.4  BP:178/124    HR:96    RR:14       O2Sats:97% RA
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.
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.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: The patient is Armenian. He is an investment consultant and
lives with his wife, 2 children, and his father.
[**Name (NI) **] smoked 1 ppd x 15 years. No ETOH.
Benign neoplasm of cerebral meninges,Pneumonia, organism unspecified,Unspecified transient mental disorder in conditions classified elsewhere,Unspecified essential hypertension
Ben neo cerebr meninges,Pneumonia, organism NOS,Transient mental dis NOS,Hypertension NOS
Admission Date:  [**2115-12-31**]              Discharge Date:   [**2116-1-10**]

Date of Birth:  [**2068-7-20**]             Sex:   M

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:
Left frontal craniotomy


History of Present Illness:
47 year old male presented to [**Hospital6 1597**] after having a
new headache that was unlike any headaches he's had in the past.
He has no dizziness, no N/V, no visual changes,gait changes or
any other symptoms. The patient had a head CT at the OSH which
showed a 6 cm left frontal mass. He was sent to [**Hospital1 18**] for a
neurosurgical evaluation.


Past Medical History:
HTN thought to be related to pain that resolved with no
medication


Social History:
The patient is Armenian. He is an investment consultant and
lives with his wife, 2 children, and his father.
[**Name (NI) **] smoked 1 ppd x 15 years. No ETOH.


Family History:
non-contributory


Physical Exam:
T:99.4  BP:178/124    HR:96    RR:14       O2Sats:97% RA
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.
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, 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 [**5-4**] throughout. No pronator drift.

Sensation: Intact to light touch bilaterally.

Toes downgoing bilaterally


Pertinent Results:
[**2115-12-31**] 05:51AM   GLUCOSE-182* UREA N-18 SODIUM-142
POTASSIUM-4.0 CHLORIDE-108 TOTAL CO2-25 ANION GAP-13
[**2115-12-31**] 05:51AM   PHENYTOIN-14.4
[**2115-12-31**] 05:51AM   WBC-9.7 RBC-4.73 HGB-14.5 HCT-42.0 MCV-89
MCH-30.6 MCHC-34.5 RDW-13.6
[**2115-12-31**] 05:51AM   PT-12.5 PTT-25.9 INR(PT)-1.1
[**2115-12-31**] 01:30AM   GLUCOSE-129* UREA N-16 CREAT-1.1 SODIUM-143
POTASSIUM-4.0 CHLORIDE-107 TOTAL CO2-26 ANION GAP-14
[**2115-12-31**] 01:30AM   WBC-10.0 RBC-4.70 HGB-14.5 HCT-40.1 MCV-85
MCH-30.9 MCHC-36.2* RDW-13.4
[**2115-12-31**] 01:30AM   NEUTS-69.9 LYMPHS-24.1 MONOS-3.3 EOS-2.0
BASOS-0.8
[**2115-12-31**] 01:30AM   PT-12.2 PTT-25.6 INR(PT)-1.0

MRI [**2115-12-31**]: Left frontal extra-axial mass most likely a
meningioma.

CT HEAD W/O CONTRAST  [**2116-1-3**] 9:20 AM
IMPRESSION: Expected postoperative changes without acute
hemorrhage, edema or infarction.

EEG Study Date of [**2116-1-6**]
IMPRESSION: This is a normal portable EEG in the waking and
drowsy
states. There were no areas of prominent focal slowing. There
were no
epileptiform features. No electrographic seizures were recorded.
Of
note, the faster beta frequency rhythms are likely related to
medication
effects from benzodiazepine administration.


Brief Hospital Course:
Pt started initially on decadron with surrounding edema around
mass.  Mass resected via Left sided frontotemporal craniotomy on
[**2116-1-1**], which patient tolerated well.  However, on POD1, pt
noted to be significantly agitated/striking at staff.  As a
result, pt was sedated and intubated.  He continued to be
significantly agitated/not responsive to commands on POD2-3.  On
POD3, he was noted to have PNA, likely aspiration related, for
which he was started on vancomycin/zosyn for coverage.
Psychiatry was consulted as well and recommended haldol PRN,
which he started with improvement in agitation.

He was able to follow simple commands with decreased agitation.
however, on POD5, he was noted to have 5 second episode of R eye
turn/head turn with bilateral UE shaking.  Dilantin level 10.1
(corrected) at that time.  Neurology consulted and recommend
goal level 15-20.  pt was given 500 mg x 1. EEG demonstrated
normal results.

Pt was extubated on POD 5 which the patient tolerated well.
with seizure activity, psychiatry was contact[**Name (NI) **] with haldol's
lowering of seizure threshold.  Psychiatry recommended change to
Ativan. In addition his Dilantin was changed to Keppra.
On [**2116-1-7**] he was transfered to stepdown unit, and speech therapy
was ordered, and recommended treatment between 5 - 7 weeks. On
[**2116-1-8**] and [**2116-1-9**] his speech has greatly improved, he did not
have any word finding difficulties, and his speech was fluent
without dysarthria.

Pt discharged on [**2115-1-10**] to home with 24 hours supervision per
PT recommendations.

Medications on Admission:
none

Discharge Medications:
1. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day): take while on steroid.
Disp:*14 Tablet(s)* Refills:*0*
4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day:
take while on narcotic.
Disp:*60 Capsule(s)* Refills:*0*
5. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
Disp:*3 Tablet(s)* Refills:*0*
6. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
7. Dexamethasone 2 mg Tablet Sig: 1.5 Tablets PO Q12H (every 12
hours) for 2 days.
Disp:*6 Tablet(s)* Refills:*0*
8. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours) for 2 days.
Disp:*4 Tablet(s)* Refills:*0*
9. Dexamethasone 2 mg Tablet Sig: 0.5 Tablet PO Q12H (every 12
hours) for 2 days.
Disp:*2 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**] and Hospice

Discharge Diagnosis:
Left frontal 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:
Follow up with Dr. [**Last Name (STitle) **] in 4 weeks [**Telephone/Fax (1) 58980**].  Pt will need
repeat CT head with visit.
Have staples removed next week. please call above number to
schedule appointment.



Completed by:[**2116-1-10**]
{'Benign neoplasm of cerebral meninges,Pneumonia, organism unspecified,Unspecified transient mental disorder in conditions classified elsewhere,Unspecified essential hypertension'}


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: 47 year old male presented to [**Hospital6 1597**] after having a
new headache that was unlike any headaches he's had in the past.
He has no dizziness, no N/V, no visual changes,gait changes or
any other symptoms. The patient had a head CT at the OSH which
showed a 6 cm left frontal mass. He was sent to [**Hospital1 18**] for a
neurosurgical evaluation.

MEDICAL HISTORY: HTN thought to be related to pain that resolved with no
medication

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T:99.4  BP:178/124    HR:96    RR:14       O2Sats:97% RA
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.
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.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: The patient is Armenian. He is an investment consultant and
lives with his wife, 2 children, and his father.
[**Name (NI) **] smoked 1 ppd x 15 years. No ETOH. 

### Response:
{'Benign neoplasm of cerebral meninges,Pneumonia, organism unspecified,Unspecified transient mental disorder in conditions classified elsewhere,Unspecified essential hypertension'}
