CHIEF COMPLAINT: Ataxia

PRESENT ILLNESS: The patient is a 64 y/o F with PMHx significant for diffuse
large B cell lymphoma, sarcoidosis, who was admitted earlier
today with ataxia and was transferred to the [**Hospital Unit Name 153**] after head CT
revealed cerebellar bleed. The patient began noting symptoms
approximately 1 week ago. At that time, she noted "heaviness" in
her legs that got progressively worse. She was evaluated by her
PCP 2 days prior to admission. Work-up at that time consisted of
a CXR as well as bloodwork. She was also referred for stress
testing. However, since then, she also began to experience
worsening ataxia. She was evaluated in the onc clinic this
afternoon and referred for admission.
.
On admission to the BMT service, the patient underwent head CT,
which showed a 1.3 cm hemorrhage in the left cerebellar
hemisphere. She was evaluated by neurosurgery, who felt that the
bleed likely occured several days ago. They recommended transfer
to the MICU for close neuro monitoring as well as brain MRI in
the AM.
.
On arrival to the [**Hospital Unit Name 153**], the patient's VS were 98.2 131/70 92 17
98%RA. She denied any complaints other than as above.
.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias. No focal
numbness/tingling. Denies lightheadedness or dizziness.

MEDICAL HISTORY: - History of diffuse large B-cell lymphoma with a MIB fraction
of approximately 100%, but no features of Burkitt's. Diagnosis
was made after biopsy of a large left adrenal mass. She also had
massive retroperitoneal and upper abdominal lymphadenopathy. She
received her first cycle of [**Hospital1 **] on [**2148-7-11**] and her first
dose of Rituxan on [**2148-7-25**]. At this point, she has completed six
cycles of therapy completing in 12/[**2147**].
- Sarcoidosis
- GERD

MEDICATION ON ADMISSION: OMEPRAZOLE - (OTC) - 20 mg Capsule

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple,
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused
Neuro: CN 2-12 grossly intact, 5/5 strength throughout,
sensation to light touch intact, biceps and patellar DTR's 2+
bilaterally, mild ataxia with FNF (L worse than right), mild
dysdiadochokinesia on [**Doctor First Name 6361**]

FAMILY HISTORY: Her father was a smoker and passed away from lung cancer at ~65
years of age. She has 3 children who have no known health
issues. She has 5 grandchildren, all of whom are healthy. There
is no history of sarcoidosis in her family as far as she knows.

SOCIAL HISTORY: She is married and lives with her husband. She is retired after
having worked in teleservices. She drinks a rare glass of wine,
~1-2 times a week. She denies ever having smoked. She denies any
illicits, including no heroin, cocaine, or methamphetamines. She
does not know of any exposures to tuberculosis or asbestos. She
has no pets.
Other malignant lymphomas, lymph nodes of multiple sites,Intracerebral hemorrhage,Lack of coordination,Sarcoidosis,Swelling, mass, or lump in head and neck,Lung involvement in other diseases classified elsewhere,Hypopotassemia,Esophageal reflux
Lymphomas NEC mult,Intracerebral hemorrhage,Lack of coordination,Sarcoidosis,Swelling in head & neck,Lung involv in oth dis,Hypopotassemia,Esophageal reflux
Admission Date:  [**2150-5-12**]              Discharge Date:   [**2150-5-20**]

Date of Birth:  [**2086-2-20**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 3913**]
Chief Complaint:
Ataxia

Major Surgical or Invasive Procedure:
MRI

History of Present Illness:
The patient is a 64 y/o F with PMHx significant for diffuse
large B cell lymphoma, sarcoidosis, who was admitted earlier
today with ataxia and was transferred to the [**Hospital Unit Name 153**] after head CT
revealed cerebellar bleed. The patient began noting symptoms
approximately 1 week ago. At that time, she noted "heaviness" in
her legs that got progressively worse. She was evaluated by her
PCP 2 days prior to admission. Work-up at that time consisted of
a CXR as well as bloodwork. She was also referred for stress
testing. However, since then, she also began to experience
worsening ataxia. She was evaluated in the onc clinic this
afternoon and referred for admission.
.
On admission to the BMT service, the patient underwent head CT,
which showed a 1.3 cm hemorrhage in the left cerebellar
hemisphere. She was evaluated by neurosurgery, who felt that the
bleed likely occured several days ago. They recommended transfer
to the MICU for close neuro monitoring as well as brain MRI in
the AM.
.
On arrival to the [**Hospital Unit Name 153**], the patient's VS were 98.2 131/70 92 17
98%RA. She denied any complaints other than as above.
.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias. No focal
numbness/tingling. Denies lightheadedness or dizziness.


Past Medical History:
- History of diffuse large B-cell lymphoma with a MIB fraction
of approximately 100%, but no features of Burkitt's. Diagnosis
was made after biopsy of a large left adrenal mass. She also had
massive retroperitoneal and upper abdominal lymphadenopathy. She
received her first cycle of [**Hospital1 **] on [**2148-7-11**] and her first
dose of Rituxan on [**2148-7-25**]. At this point, she has completed six
cycles of therapy completing in 12/[**2147**].
- Sarcoidosis
- GERD

Social History:
She is married and lives with her husband. She is retired after
having worked in teleservices. She drinks a rare glass of wine,
~1-2 times a week. She denies ever having smoked. She denies any
illicits, including no heroin, cocaine, or methamphetamines. She
does not know of any exposures to tuberculosis or asbestos. She
has no pets.

Family History:
Her father was a smoker and passed away from lung cancer at ~65
years of age. She has 3 children who have no known health
issues. She has 5 grandchildren, all of whom are healthy. There
is no history of sarcoidosis in her family as far as she knows.


Physical Exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple,
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused
Neuro: CN 2-12 grossly intact, 5/5 strength throughout,
sensation to light touch intact, biceps and patellar DTR's 2+
bilaterally, mild ataxia with FNF (L worse than right), mild
dysdiadochokinesia on [**Doctor First Name 6361**]


Pertinent Results:
Admission labs:
===============
[**2150-5-12**] 01:25PM BLOOD WBC-5.1 RBC-4.53 Hgb-15.4 Hct-43.7 MCV-97
MCH-34.1* MCHC-35.3* RDW-12.8 Plt Ct-180
[**2150-5-13**] 05:59AM BLOOD WBC-3.8* RBC-4.32 Hgb-14.4 Hct-42.9
MCV-99* MCH-33.3* MCHC-33.5 RDW-13.0 Plt Ct-174
[**2150-5-12**] 01:25PM BLOOD Neuts-68.2 Lymphs-23.1 Monos-6.1 Eos-1.9
Baso-0.7
[**2150-5-12**] 01:25PM BLOOD Plt Ct-180
[**2150-5-12**] 07:44PM BLOOD PT-12.4 PTT-20.7* INR(PT)-1.0
[**2150-5-12**] 01:25PM BLOOD UreaN-20 Creat-0.6 Na-142 K-4.5 Cl-106
HCO3-28 AnGap-13
[**2150-5-13**] 05:59AM BLOOD Glucose-104* UreaN-18 Creat-0.6 Na-142
K-4.0 Cl-107 HCO3-27 AnGap-12
[**2150-5-12**] 01:25PM BLOOD ALT-52* AST-42* LD(LDH)-190 AlkPhos-74
TotBili-0.8
[**2150-5-12**] 01:25PM BLOOD Calcium-10.2 Phos-3.0 Mg-2.0
[**2150-5-13**] 05:59AM BLOOD Calcium-9.4 Phos-3.5 Mg-2.0
.
Discharge labs:
===============
[**2150-5-20**] 06:02AM BLOOD WBC-2.7* RBC-3.67* Hgb-12.7 Hct-35.2*
MCV-96 MCH-34.6* MCHC-36.1* RDW-12.2 Plt Ct-149*
[**2150-5-20**] 06:02AM BLOOD Neuts-59.7 Lymphs-32.6 Monos-1.9*
Eos-5.6* Baso-0.2
[**2150-5-20**] 06:02AM BLOOD Glucose-109* UreaN-10 Creat-0.6 Na-141
K-3.8 Cl-104 HCO3-32 AnGap-9
[**2150-5-20**] 06:02AM BLOOD ALT-70* AST-52* LD(LDH)-192 AlkPhos-51
TotBili-1.2
[**2150-5-20**] 06:02AM BLOOD Calcium-9.1 Phos-3.5 Mg-2.0
[**2150-5-19**] 08:57AM BLOOD mthotrx-0.04
.
CSF studies:
============
[**2150-5-15**] 03:44PM CEREBROSPINAL FLUID (CSF) WBC-950 RBC-290*
Polys-0 Lymphs-12 Monos-0 Other-88
[**2150-5-15**] 03:44PM CEREBROSPINAL FLUID (CSF) WBC-810 RBC-50*
Polys-0 Lymphs-8 Monos-0 Other-92
[**2150-5-15**] 03:44PM CEREBROSPINAL FLUID (CSF) TotProt-327*
Glucose-3 LD(LDH)-302
[**2150-5-15**] 03:44PM CEREBROSPINAL FLUID (CSF) CSF-PEP-NO OLIGOCL
[**2150-5-15**] 03:44PM CEREBROSPINAL FLUID (CSF) ANGIOTENSIN 1
CONVERTING ENZYME-negative
.
Imaging:
========
CT HEAD [**2150-5-12**]: New parenchymal hematoma in the left cerebellar
hemisphere, with minimal surrounding edema and minimal mass
effect on the fourth ventricle.
.
CXR [**5-20**]:  No previous images. Port-A-Cath extends to the lower
portion of the SVC or upper portion of the right atrium. Lungs
are essentially clear and there is no vascular congestion or
pleural effusion.
.
MR head [**5-14**]: Solitary enhancing mass within the left cerebellar
hemisphere, corresponding to the hyperdensity seen on CT. The
findings may reflect a hypercellular tumor, or a mass containing
hemorrhagic components. The differential diagnosis includes
lymphoma or a solitary hemorrhagic metastasis.
.
CT abd/pelvis [**5-14**]:
1. Stable small gastrohepatic, celiac and retroperitoneal lymph
nodes are not enlarged by CT size criteria. No new significant
adenopathy is seen in the chest, abdomen or pelvis.
2. Stable small hiatal hernia. Mildly dilated esophagus with
oral contrast may be due to reflux. Correlate clinically.
3. Scattered biapical ground-glass opacities and centrilobular
pulmonary nodules with calcified mediastinal lymph nodes are
consistent with known history of sarcoidosis and are stable.
4. Diverticulosis without diverticulitis.
.


Brief Hospital Course:
64 y/o F with PMHx significant for diffuse large B cell
lymphoma, sarcoidosis, who was admitted earlier today with
ataxia and was transferred to the [**Hospital Unit Name 153**] after head CT revealed
cerebellar bleed.
.
# Cerbellar Mass: When she first presented head CT revealed a
left cereballr bleed. Subsequent MRI revealed an underlying
mass. She had an LP with the CSF showing many white blood cells
many of which appeared malignant and flow cytometry revealed
B-cell origin cells with CD20 expression, suggesting CNS
involvement of her lymphoma She was started on high dose
methotrexate on [**5-16**] and tolerated this well. Her ataxia and
left side dysmetria improved. PT evaluated her and provided her
with a walker for discharge. She will follow up in 2 days for
countcheck and see Dr. [**Last Name (STitle) 724**] next week to schedule next cycle of
HD-MTX and possibly repeat an LP prior to this to evaluate for
cell counts. She had a portacath placed prior to discharge. Will
finish 1 more day of leucovorin (MTX levels at time of discharge
<0.04) and start acyclovir for prophylaxis.
.
# DLBCL: She has a history of DLBCL which she was treated for
with [**Hospital1 **]. Her last treatment was in 12/[**2147**]. As above, had CNS
involvement and L cerebellar mass. Treated with first cycle of
HD-MTX. She had a portacath placed prior to discharge for
further therapy. As above, was discharged on 1 more day of
leucovorin and acyclovir prophylaxis.
.

Medications on Admission:
OMEPRAZOLE - (OTC) - 20 mg Capsule

Discharge Medications:
1. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
2. leucovorin calcium 25 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours).
3. acyclovir 400 mg Tablet Sig: One (1) Tablet PO three times a
day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Diffuse large B cell lymphoma
Left cerebellar mass

Secondary:
Sarcoid


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:
Dear Ms. [**Known lastname 2412**],

You were admitted because you were having difficulty walking. We
found that you had a mass in your cerebellum on the left side.
Based on the results of a spinal fluid analysis this is likely
due to your lymphoma. You received treatment with methotrexate
and your balance improved slightly. You had a port-a-cath placed
for your future chemo. You will need ongoing treatment with
methotrexate and will follow up with Dr. [**Last Name (STitle) 724**] at the date/time
below. You will likely need a repeat LP at that time. You will
also be coming back on Friday to have your counts checked, at
the date/time below.

Please call the hospital and have the BMT fellow paged if you
develop a fever >100.4, worsening balance or any other
concerning symptoms.

We have made the following changes to your medications:
- START leucovorin 25mg every 6 hours
- START acyclovir 400mg three times daily

Followup Instructions:

Department: HEMATOLOGY/BMT
When: FRIDAY [**2150-5-22**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9574**], NP [**Telephone/Fax (1) 3241**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: NEUROLOGY
When: MONDAY [**2150-5-25**] at 9:30 AM
With: [**First Name11 (Name Pattern1) 640**] [**Last Name (NamePattern4) 4861**], MD [**Telephone/Fax (1) 1844**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage



Completed by:[**2150-5-21**]
{'Other malignant lymphomas, lymph nodes of multiple sites,Intracerebral hemorrhage,Lack of coordination,Sarcoidosis,Swelling, mass, or lump in head and neck,Lung involvement in other diseases classified elsewhere,Hypopotassemia,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: Ataxia

PRESENT ILLNESS: The patient is a 64 y/o F with PMHx significant for diffuse
large B cell lymphoma, sarcoidosis, who was admitted earlier
today with ataxia and was transferred to the [**Hospital Unit Name 153**] after head CT
revealed cerebellar bleed. The patient began noting symptoms
approximately 1 week ago. At that time, she noted "heaviness" in
her legs that got progressively worse. She was evaluated by her
PCP 2 days prior to admission. Work-up at that time consisted of
a CXR as well as bloodwork. She was also referred for stress
testing. However, since then, she also began to experience
worsening ataxia. She was evaluated in the onc clinic this
afternoon and referred for admission.
.
On admission to the BMT service, the patient underwent head CT,
which showed a 1.3 cm hemorrhage in the left cerebellar
hemisphere. She was evaluated by neurosurgery, who felt that the
bleed likely occured several days ago. They recommended transfer
to the MICU for close neuro monitoring as well as brain MRI in
the AM.
.
On arrival to the [**Hospital Unit Name 153**], the patient's VS were 98.2 131/70 92 17
98%RA. She denied any complaints other than as above.
.
.
Review of sytems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denied cough. Denied chest pain or tightness,
palpitations. Denied nausea, vomiting, diarrhea, constipation or
abdominal pain. No recent change in bowel or bladder habits. No
dysuria. Denied arthralgias or myalgias. No focal
numbness/tingling. Denies lightheadedness or dizziness.

MEDICAL HISTORY: - History of diffuse large B-cell lymphoma with a MIB fraction
of approximately 100%, but no features of Burkitt's. Diagnosis
was made after biopsy of a large left adrenal mass. She also had
massive retroperitoneal and upper abdominal lymphadenopathy. She
received her first cycle of [**Hospital1 **] on [**2148-7-11**] and her first
dose of Rituxan on [**2148-7-25**]. At this point, she has completed six
cycles of therapy completing in 12/[**2147**].
- Sarcoidosis
- GERD

MEDICATION ON ADMISSION: OMEPRAZOLE - (OTC) - 20 mg Capsule

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple,
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
rhonchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused
Neuro: CN 2-12 grossly intact, 5/5 strength throughout,
sensation to light touch intact, biceps and patellar DTR's 2+
bilaterally, mild ataxia with FNF (L worse than right), mild
dysdiadochokinesia on [**Doctor First Name 6361**]

FAMILY HISTORY: Her father was a smoker and passed away from lung cancer at ~65
years of age. She has 3 children who have no known health
issues. She has 5 grandchildren, all of whom are healthy. There
is no history of sarcoidosis in her family as far as she knows.

SOCIAL HISTORY: She is married and lives with her husband. She is retired after
having worked in teleservices. She drinks a rare glass of wine,
~1-2 times a week. She denies ever having smoked. She denies any
illicits, including no heroin, cocaine, or methamphetamines. She
does not know of any exposures to tuberculosis or asbestos. She
has no pets. 

### Response:
{'Other malignant lymphomas, lymph nodes of multiple sites,Intracerebral hemorrhage,Lack of coordination,Sarcoidosis,Swelling, mass, or lump in head and neck,Lung involvement in other diseases classified elsewhere,Hypopotassemia,Esophageal reflux'}
