CHIEF COMPLAINT: Acute mental status change

PRESENT ILLNESS: 48 yo woman who has hx oligodendroglioma, thyroid dz, GERD, HTN,
depression, urinary incontinence, who initially presented to the
ED with altered mental status on [**5-2**].  Per ONC H and P, patient
had  had worsening new tremor for the past few weeks along with
weakness in her legs. MRI of head done day of admission showed
multiple intraparencymal masses in the right frontal/temporal
lobes with vasculogenic edema, increased in size compared to
[**4-10**]; with increased mass effect and shift; new hydrocephalus.
There was also findings of leptomeningeal spread and new
enchancing tumor in the (R) hypothalamus.
.
She was admitted to the ONC service where she was started on
Decadron.  An EEG was also obtained (per notes, negative).
Neurosurgery saw the patient and recommended not attempting
further debulking given advanced disease.  Neurology also saw
patient, agreed with poor prognosis, and concurred that the
hydrocephalus was from the tumor entering the ventricles. They
also noted (B) mild papilledema. On [**5-6**] the patient and VP
shunt placed to palliate increased ICP.  On [**5-7**] had 2 Head CTs;
the second showed a 4.1 x 3.3 cm right frontal intraparenchymal
hemorrhage with associated slight worsening in regional mass
effect with shift of the falx approximately 6 mm to the left and
effacement of the adjacent portion of the suprasellar cistern.
This was thought to represent bleeding into the tumor.  Later in
the day, the Moonlighter was called for ?aniscicora.  Neuro-ONC
attending called, who recommended continuing with DMS and giving
hydral for MAP of 123.
.
Had urgent repeat Head CT [**5-8**] showed large right frontal
intraparenchymal hemorrhage measuring approximately 3.8 x 3.2
cm,  unchanged in size compared to [**2197-5-7**]; however, the
overall density of this region has increased suggesting ongoing
hemorrhage.  The amount of intraventricular blood in the right
lateral
ventricle has increased.  Dilatation of the supratentorial
ventricular system has increased.  She was thus transferred to
the [**Hospital Unit Name 153**] for frequent Neuro checks, mannitol, and close
monitoring of her MAPs (goal 100-120). Of note, Nsurg saw
patient this morning, tapped VP shunt, opening pressure 7-8 cm,
"probably functioning well".
.
Currently the patient denies HA, N, V, or blurry vision but
intermittently non-sensical speech.

MEDICAL HISTORY: -Brain tumor:
Tumor hx: briefly, Ms. [**Known lastname **] had presented in 6/98 with
seizure (GTC) and was found on MRI to have R frontotemporal
lesion; she underwent R temporal lobectomy in 7/98 and pathology
revealed glioma. She underwent radiation in [**9-1**]. In
[**2193**], she had apparent right hemifacial spasm that was improved
with keppra, suggestive of seizure. She had new edema at that
point in the right frontotemporal area and area of new
enhancement ant/sup temporal lobe, R frontal. This was followed
by MRI. In [**8-23**] she had re-biopsy of temporal lobe (incr
swelling) and path revealed grade II oligodendroglioma; she
received temodar in [**2195**], underwent resection again in [**12-26**], and
has had several more courses of radiation. Most recently, she
had been on PCV chemo and underwent more radiation in [**2-23**]. Her
last brain MRI was [**2197-4-10**].
-Hypothyroid
-GERD
-HTN
-Depression
-Chronic urinary incontinence
-G2P2

MEDICATION ON ADMISSION: [**Doctor First Name **] 180 mg
Ditropan 5 mg
Decadron prn with chemo only (none recently)
Exelon - pt reports that she stopped taking this months ago
Prilosec 40 mg [**Hospital1 **]
Felodipine 5 mg [**Hospital1 **]
Synthroid 150/137 alternating qod
Lamictal 250 mg [**Hospital1 **]
Keppra 1500 mg [**Hospital1 **]
Trileptal 300 mg [**Hospital1 **]
Finished Zithromax for bronchitis in [**Month (only) 116**]
Compazine PRN
.
Transfer MEDS
DMS 8 mg IV q 8
[**Doctor First Name **] 60 mg [**Hospital1 **]
Hydral prn
SSI
Lamotrigine 250 mg po bid
T4 137 alt 150 qd
Keppra 1500 mg po bid
Mannitol 25 mg IV q 6
Oxybutynin 5 mg PO TID
Oxcarbazepine 300 mg PO BID
Percocet prn
Pantoprazole 40 mg IV Q12
Felodipine 7.5 mg qd
MS Contin 15 mg po bid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.4 HR 78 BP 143/84 RR21 93-95 RA
General: laying in bed, (B) upper extremity tremor, confused
HEENT: pupils equal in size but pt will not cooperate with
penlight exam, EOM grossly intact
Heart: RRR s MRG
Lungs: CTAB
Abdomen: 3-4 cm well-healed scar in RUQ; soft, NABS, NT/ND
Ext: no edema
Neuro: CN as above, Motor strength grossly intact, Alert to
person, place (knows its [**Hospital1 18**]), year??, month = [**Month (only) 547**],
President is [**Hospital1 1806**]

FAMILY HISTORY: n/c

SOCIAL HISTORY: She does smoke 1 to 1-1/2 pack of cigarettes per day.  She does
not drink.
Unspecified intracranial hemorrhage,Obstructive hydrocephalus,Malignant neoplasm of other parts of brain,Other convulsions,Candidiasis of mouth,Unspecified essential hypertension,Unspecified acquired hypothyroidism
Intracranial hemorr NOS,Obstructiv hydrocephalus,Malig neo brain NEC,Convulsions NEC,Thrush,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2197-5-2**]              Discharge Date:   [**2197-5-12**]

Date of Birth:  [**2148-7-18**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
Acute mental status change

Major Surgical or Invasive Procedure:
VP shunt placement


History of Present Illness:
48 yo woman who has hx oligodendroglioma, thyroid dz, GERD, HTN,
depression, urinary incontinence, who initially presented to the
ED with altered mental status on [**5-2**].  Per ONC H and P, patient
had  had worsening new tremor for the past few weeks along with
weakness in her legs. MRI of head done day of admission showed
multiple intraparencymal masses in the right frontal/temporal
lobes with vasculogenic edema, increased in size compared to
[**4-10**]; with increased mass effect and shift; new hydrocephalus.
There was also findings of leptomeningeal spread and new
enchancing tumor in the (R) hypothalamus.
.
She was admitted to the ONC service where she was started on
Decadron.  An EEG was also obtained (per notes, negative).
Neurosurgery saw the patient and recommended not attempting
further debulking given advanced disease.  Neurology also saw
patient, agreed with poor prognosis, and concurred that the
hydrocephalus was from the tumor entering the ventricles. They
also noted (B) mild papilledema. On [**5-6**] the patient and VP
shunt placed to palliate increased ICP.  On [**5-7**] had 2 Head CTs;
the second showed a 4.1 x 3.3 cm right frontal intraparenchymal
hemorrhage with associated slight worsening in regional mass
effect with shift of the falx approximately 6 mm to the left and
effacement of the adjacent portion of the suprasellar cistern.
This was thought to represent bleeding into the tumor.  Later in
the day, the Moonlighter was called for ?aniscicora.  Neuro-ONC
attending called, who recommended continuing with DMS and giving
hydral for MAP of 123.
.
Had urgent repeat Head CT [**5-8**] showed large right frontal
intraparenchymal hemorrhage measuring approximately 3.8 x 3.2
cm,  unchanged in size compared to [**2197-5-7**]; however, the
overall density of this region has increased suggesting ongoing
hemorrhage.  The amount of intraventricular blood in the right
lateral
ventricle has increased.  Dilatation of the supratentorial
ventricular system has increased.  She was thus transferred to
the [**Hospital Unit Name 153**] for frequent Neuro checks, mannitol, and close
monitoring of her MAPs (goal 100-120). Of note, Nsurg saw
patient this morning, tapped VP shunt, opening pressure 7-8 cm,
"probably functioning well".
.
Currently the patient denies HA, N, V, or blurry vision but
intermittently non-sensical speech.

Past Medical History:
-Brain tumor:
Tumor hx: briefly, Ms. [**Known lastname **] had presented in 6/98 with
seizure (GTC) and was found on MRI to have R frontotemporal
lesion; she underwent R temporal lobectomy in 7/98 and pathology
revealed glioma. She underwent radiation in [**9-1**]. In
[**2193**], she had apparent right hemifacial spasm that was improved
with keppra, suggestive of seizure. She had new edema at that
point in the right frontotemporal area and area of new
enhancement ant/sup temporal lobe, R frontal. This was followed
by MRI. In [**8-23**] she had re-biopsy of temporal lobe (incr
swelling) and path revealed grade II oligodendroglioma; she
received temodar in [**2195**], underwent resection again in [**12-26**], and
has had several more courses of radiation. Most recently, she
had been on PCV chemo and underwent more radiation in [**2-23**]. Her
last brain MRI was [**2197-4-10**].
-Hypothyroid
-GERD
-HTN
-Depression
-Chronic urinary incontinence
-G2P2


Social History:
She does smoke 1 to 1-1/2 pack of cigarettes per day.  She does
not drink.


Family History:
n/c

Physical Exam:
T 98.4 HR 78 BP 143/84 RR21 93-95 RA
General: laying in bed, (B) upper extremity tremor, confused
HEENT: pupils equal in size but pt will not cooperate with
penlight exam, EOM grossly intact
Heart: RRR s MRG
Lungs: CTAB
Abdomen: 3-4 cm well-healed scar in RUQ; soft, NABS, NT/ND
Ext: no edema
Neuro: CN as above, Motor strength grossly intact, Alert to
person, place (knows its [**Hospital1 18**]), year??, month = [**Month (only) 547**],
President is [**Hospital1 1806**]

Pertinent Results:
brain MRI [**5-2**]: 1. Multiple intraparenchymal masses in right
frontal and temporal lobes with vasculogenic edema, overall
increased in size compared to the prior study, with increased
mass effect and shift of normally midline structures. Increased
size of ventricle, representing developing hydrocephalus, which
may contribute to the patient's symptoms. Increased enhancement
along the leptomeninges
surrounding the brainstem, interpeduncular cistern and left
temporal lobe, representing leptomeningeal spread. New enhancing
tumor in the right hypothalamus.
2. MR angiography: No flow limiting stenosis.
.
CXR [**5-2**]: Lungs are low in volume, exaggerating heart size,
which is probably top normal. Retrocardiac opacity seen on the
lateral view is probably hiatus hernia. Lungs are otherwise
clear. No pleural effusion or evidence of central adenopathy.
.
CT Head [**5-2**]: Overall, stable appearance of the tumor and edema
in the right frontal lobe as compared to [**2197-4-10**]. Small
amount of mass effect on the suprasellar cistern is also
unchanged.
.
EEG [**5-2**]: no report in computer but per ONC notes, (-)
.
Head CT [**5-7**]: Interval placement of a VP shunt through a new
craniotomy in the right frontal skull with tip terminating in
the anterior [**Doctor Last Name 534**] of the left lateral ventricle. Otherwise, no
significant change compared to prior study. Again seen are some
foci of hyperdensity in the inferior aspect of right frontal
lobe, possibly representing hemorrhage.
.
Head CT [**5-7**]: 4.1 x 3.3 cm right frontal intraparenchymal
hemorrhage with associated slight worsening in regional mass
effect with shift of the falx approximately 6 mm to the left and
effacement of the adjacent portion of the suprasellar cistern.
.
KUB [**5-7**]: Supine frontal views of the chest and abdomen and
lateral view of the abdomen are submitted. Intact shunt catheter
traverses the chest and upper abdomen ending anteriorly above
the level of the umbilicus. There is no evidence of intestinal
obstruction or mass effect.
.
Head CT [**5-8**]:  Increased dilatation of the supratentorial
ventricular system and increased intraventricular blood compared
to [**2197-5-7**].  The overall size and configuration of a right
frontal intraparenchymal hemorrhage associated mass
effect are unchanged; however, the increased density of this
right frontal hematoma suggests continued hemorrhage.

Brief Hospital Course:
#ICH/dilation of Ventricular system:  Patient was transferred to
the [**Hospital Unit Name 153**] for close monitoring.  She was continued on Mannitol,
anti-seizure prophylaxis with lamictal, keppra, trileptal, and
Decadron.  She received Q2H neurochecks and she remained stable.
 She was followed by her neurooncologist, Dr. [**Last Name (STitle) 4253**].  Due to
her poor prognosis, she was made comfort measures only (CMO)
after a family meeting with her, her HCP, and her entire family
on [**2197-5-2**].  A PICC line was placed by Interventional
radiology because patient has very difficult access and requires
multiple IV medications for her comfort.  She was left on her
antiseizure medications and Decadron per the family's request to
prevent ongoing seizures, but otherwise all other medications
except those intended to maximize the patient's comfort were
discontinued.  She was sent to a hospice facility on [**2197-5-12**] under the care of Dr. [**Last Name (STitle) **].
.
# Comm: [**Name (NI) **], HCP: [**Telephone/Fax (1) 56708**] (cel), [**Telephone/Fax (1) 56709**]


Medications on Admission:
[**Doctor First Name **] 180 mg
Ditropan 5 mg
Decadron prn with chemo only (none recently)
Exelon - pt reports that she stopped taking this months ago
Prilosec 40 mg [**Hospital1 **]
Felodipine 5 mg [**Hospital1 **]
Synthroid 150/137 alternating qod
Lamictal 250 mg [**Hospital1 **]
Keppra 1500 mg [**Hospital1 **]
Trileptal 300 mg [**Hospital1 **]
Finished Zithromax for bronchitis in [**Month (only) 116**]
Compazine PRN
.
Transfer MEDS
DMS 8 mg IV q 8
[**Doctor First Name **] 60 mg [**Hospital1 **]
Hydral prn
SSI
Lamotrigine 250 mg po bid
T4 137 alt 150 qd
Keppra 1500 mg po bid
Mannitol 25 mg IV q 6
Oxybutynin 5 mg PO TID
Oxcarbazepine 300 mg PO BID
Percocet prn
Pantoprazole 40 mg IV Q12
Felodipine 7.5 mg qd
MS Contin 15 mg po bid


Discharge Medications:
1. Dexamethasone Acetate 8 mg/mL Suspension Sig: Eight (8) mg
Injection every eight (8) hours.
2. Morphine 10 mg/mL Solution Sig: 1-5 mg Intravenous  every
four (4) hours as needed for pain: Please administer as needed
for comfort.
3. Phenytoin Sodium 50 mg/mL Solution Sig: 100mg  Intravenous
Q8H (every 8 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 35813**] Center - [**Location (un) 37361**], RI

Discharge Diagnosis:
Oligodendroglioma complicated by intracranial hemorrhage


Discharge Condition:
stable to be discharged to hospice


Discharge Instructions:
Please administer medications as below for comfort.


Followup Instructions:
Please contact facility doctor as needed


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Unspecified intracranial hemorrhage,Obstructive hydrocephalus,Malignant neoplasm of other parts of brain,Other convulsions,Candidiasis of mouth,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: Acute mental status change

PRESENT ILLNESS: 48 yo woman who has hx oligodendroglioma, thyroid dz, GERD, HTN,
depression, urinary incontinence, who initially presented to the
ED with altered mental status on [**5-2**].  Per ONC H and P, patient
had  had worsening new tremor for the past few weeks along with
weakness in her legs. MRI of head done day of admission showed
multiple intraparencymal masses in the right frontal/temporal
lobes with vasculogenic edema, increased in size compared to
[**4-10**]; with increased mass effect and shift; new hydrocephalus.
There was also findings of leptomeningeal spread and new
enchancing tumor in the (R) hypothalamus.
.
She was admitted to the ONC service where she was started on
Decadron.  An EEG was also obtained (per notes, negative).
Neurosurgery saw the patient and recommended not attempting
further debulking given advanced disease.  Neurology also saw
patient, agreed with poor prognosis, and concurred that the
hydrocephalus was from the tumor entering the ventricles. They
also noted (B) mild papilledema. On [**5-6**] the patient and VP
shunt placed to palliate increased ICP.  On [**5-7**] had 2 Head CTs;
the second showed a 4.1 x 3.3 cm right frontal intraparenchymal
hemorrhage with associated slight worsening in regional mass
effect with shift of the falx approximately 6 mm to the left and
effacement of the adjacent portion of the suprasellar cistern.
This was thought to represent bleeding into the tumor.  Later in
the day, the Moonlighter was called for ?aniscicora.  Neuro-ONC
attending called, who recommended continuing with DMS and giving
hydral for MAP of 123.
.
Had urgent repeat Head CT [**5-8**] showed large right frontal
intraparenchymal hemorrhage measuring approximately 3.8 x 3.2
cm,  unchanged in size compared to [**2197-5-7**]; however, the
overall density of this region has increased suggesting ongoing
hemorrhage.  The amount of intraventricular blood in the right
lateral
ventricle has increased.  Dilatation of the supratentorial
ventricular system has increased.  She was thus transferred to
the [**Hospital Unit Name 153**] for frequent Neuro checks, mannitol, and close
monitoring of her MAPs (goal 100-120). Of note, Nsurg saw
patient this morning, tapped VP shunt, opening pressure 7-8 cm,
"probably functioning well".
.
Currently the patient denies HA, N, V, or blurry vision but
intermittently non-sensical speech.

MEDICAL HISTORY: -Brain tumor:
Tumor hx: briefly, Ms. [**Known lastname **] had presented in 6/98 with
seizure (GTC) and was found on MRI to have R frontotemporal
lesion; she underwent R temporal lobectomy in 7/98 and pathology
revealed glioma. She underwent radiation in [**9-1**]. In
[**2193**], she had apparent right hemifacial spasm that was improved
with keppra, suggestive of seizure. She had new edema at that
point in the right frontotemporal area and area of new
enhancement ant/sup temporal lobe, R frontal. This was followed
by MRI. In [**8-23**] she had re-biopsy of temporal lobe (incr
swelling) and path revealed grade II oligodendroglioma; she
received temodar in [**2195**], underwent resection again in [**12-26**], and
has had several more courses of radiation. Most recently, she
had been on PCV chemo and underwent more radiation in [**2-23**]. Her
last brain MRI was [**2197-4-10**].
-Hypothyroid
-GERD
-HTN
-Depression
-Chronic urinary incontinence
-G2P2

MEDICATION ON ADMISSION: [**Doctor First Name **] 180 mg
Ditropan 5 mg
Decadron prn with chemo only (none recently)
Exelon - pt reports that she stopped taking this months ago
Prilosec 40 mg [**Hospital1 **]
Felodipine 5 mg [**Hospital1 **]
Synthroid 150/137 alternating qod
Lamictal 250 mg [**Hospital1 **]
Keppra 1500 mg [**Hospital1 **]
Trileptal 300 mg [**Hospital1 **]
Finished Zithromax for bronchitis in [**Month (only) 116**]
Compazine PRN
.
Transfer MEDS
DMS 8 mg IV q 8
[**Doctor First Name **] 60 mg [**Hospital1 **]
Hydral prn
SSI
Lamotrigine 250 mg po bid
T4 137 alt 150 qd
Keppra 1500 mg po bid
Mannitol 25 mg IV q 6
Oxybutynin 5 mg PO TID
Oxcarbazepine 300 mg PO BID
Percocet prn
Pantoprazole 40 mg IV Q12
Felodipine 7.5 mg qd
MS Contin 15 mg po bid

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T 98.4 HR 78 BP 143/84 RR21 93-95 RA
General: laying in bed, (B) upper extremity tremor, confused
HEENT: pupils equal in size but pt will not cooperate with
penlight exam, EOM grossly intact
Heart: RRR s MRG
Lungs: CTAB
Abdomen: 3-4 cm well-healed scar in RUQ; soft, NABS, NT/ND
Ext: no edema
Neuro: CN as above, Motor strength grossly intact, Alert to
person, place (knows its [**Hospital1 18**]), year??, month = [**Month (only) 547**],
President is [**Hospital1 1806**]

FAMILY HISTORY: n/c

SOCIAL HISTORY: She does smoke 1 to 1-1/2 pack of cigarettes per day.  She does
not drink. 

### Response:
{'Unspecified intracranial hemorrhage,Obstructive hydrocephalus,Malignant neoplasm of other parts of brain,Other convulsions,Candidiasis of mouth,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
