CHIEF COMPLAINT: Transfer from [**Hospital1 **] s/p MVA ? hemorrhage and cerebellar mass

PRESENT ILLNESS: Mr [**Known lastname **] is 66 y/o male with HTN, CAD and PAD. Was in his
normal state of health today, with the exception of feeling
exausted after being up for 72 hours trying to pump out his
basement. He remembers going to [**Company 7546**] and leaving the
parking lot that is the last thing he remembers. He awoke with
the arrival of the EMS, he was found in the parking lot the
details of what he hit are unavailable and there is discrepancy
about whether the air bag deployed. He was brought to [**Hospital **]
hospital and found to have ? cerebellar mass versus stroke and
right occiptal partieal focus of IPH. These appear to be more
concerning for masses than trauma. The patient only complains of
low back pain at this time.

MEDICAL HISTORY: CAD, PAD, has had right iliac artery stent and right coronary
artery stent

MEDICATION ON ADMISSION: ASA 325mg, Diova 160mg QD,
Lopressor 50mg [**Hospital1 **], Vitoran 1080 QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
BP:150/81  HR:80    R 18       O2Sats 98%
Gen: WD/WN c/o back pain
HEENT: Pupils: [**4-22**]        EOMs full;

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Former smoker 60 pack year hx stopped in [**2171**]. Drinks 3-4
glasses of wine per day. No illicit drug uses. Lives with wife,
works part time installing fire suppression systems.
Other isolated or specific phobias,Other convulsions,Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Other disorders of neurohypophysis,Pathologic fracture of vertebrae,Other malignant neoplasm without specification of site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Peripheral vascular disease, unspecified
Isolated/spec phobia NEC,Convulsions NEC,Sec mal neo brain/spine,Intracerebral hemorrhage,Neurohypophysis dis NEC,Path fx vertebrae,Malignant neoplasm NOS,Hypertension NOS,Crnry athrscl natve vssl,Status-post ptca,Periph vascular dis NOS
Admission Date:  [**2180-4-5**]              Discharge Date:   [**2180-4-17**]

Date of Birth:  [**2114-3-20**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3227**]
Chief Complaint:
Transfer from [**Hospital1 **] s/p MVA ? hemorrhage and cerebellar mass


Major Surgical or Invasive Procedure:
Intubation for MRI due to severe claustrophobia [**2180-4-6**]
R Suboccipital Crani for Mass Resection [**2180-4-14**]


History of Present Illness:
Mr [**Known lastname **] is 66 y/o male with HTN, CAD and PAD. Was in his
normal state of health today, with the exception of feeling
exausted after being up for 72 hours trying to pump out his
basement. He remembers going to [**Company 7546**] and leaving the
parking lot that is the last thing he remembers. He awoke with
the arrival of the EMS, he was found in the parking lot the
details of what he hit are unavailable and there is discrepancy
about whether the air bag deployed. He was brought to [**Hospital **]
hospital and found to have ? cerebellar mass versus stroke and
right occiptal partieal focus of IPH. These appear to be more
concerning for masses than trauma. The patient only complains of
low back pain at this time.


Past Medical History:
CAD, PAD, has had right iliac artery stent and right coronary
artery stent


Social History:
Former smoker 60 pack year hx stopped in [**2171**]. Drinks 3-4
glasses of wine per day. No illicit drug uses. Lives with wife,
works part time installing fire suppression systems.


Family History:
non-contributory

Physical Exam:
Upon admission:
BP:150/81  HR:80    R 18       O2Sats 98%
Gen: WD/WN c/o back pain
HEENT: Pupils: [**4-22**]        EOMs full;

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,4 to 3
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. No pronator drift

Motor:
      D    B     T    IP    Q  H     AT    [**Last Name (un) 938**]    G
R     5    5     5    3      5 5      5     5     5
L     5    5     5    3      5  5     5     5     5
Note IP most likely limited by pain

Sensation: Intact to light touch
Reflexes: B T Br Pa Ac
Right            2+
Left             2+

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, unable to test heel
to shin due to back pain.

Patient did not want me to turn him according to trauma there
was lumbar point tenderness. No bowel or bladder incontinence

Upon discharge:
SAME as above. Neurologically intact. Incision Clean, Dry, and
Intact


Pertinent Results:
CT Abdomen with contrast [**2180-4-5**]:
1. Age-indeterminate L3 and L4 compression fractures. Recommend
clinical
correlation. No evidence of acute visceral injury in the abdomen
or pelvis.
2. Esophageal wall thickening and regional gastrohepatic
lymphadenopathy.
Recommend endoscopy for further evaluation. Follow-up and
further evaluation for cause of lymaphdenopathy should be
obtained if endoscopy is negative and no other source
identified.
3. Right lower lobe pulmonary nodule measure up to 6-mm.
Recommend dedicated chest CT for further evaluation. Six-month
followup CT should also be performed to assess stability, given
patient's smoking history.
4. Hypodense hepatic lesion in segment IV. Recommend ultrasound
or MRI for
further characterization.

MRI Brain [**2180-4-6**]:
Numerous enhancing masses throughout the supra- and
infratentorial compartments, without subependymal or
leptomeningeal enhancement. The findings most likely represent
multiple metastatic lesions, likely mucinous adenocarcinoma from
a gastrointestinal primary site, given the MR [**First Name (Titles) **] [**Last Name (Titles) 34702**], as well as the findings on the body CT scan.

CT Chest with contrast [**2180-4-6**]:
1. Right middle lobe lung nodule. Followup in three months is
recommended.
2. Fatty liver with a focal lesion in the left lobe of the
liver. As
recommended in prior CT abdomen, MR could be performed.
3. Soft tissue asymmetry in the right side at the level of the
cricoid. This can be evaluated either with physical exam or
endoscopy.
4. Regional gastrohepatic lymphadenopathy associated with
esophageal wall
thickening as mentioned in prior CT should be evaluated.
5. Coronary calcifications.

Ultrasound of the liver [**2180-4-6**]:
1. No liver lesion to correlate with hypodensity seen on CT scan
identified.
No worrisome lesions identified.
2. Echogenic liver consistent with fatty infiltration. Other
forms of liver
disease and more advanced liver disease including significant
hepatic
fibrosis/cirrhosis cannot be excluded on this study.

MRI L-spine with and without contrast [**2180-4-6**]:
1. Multiple subacute compression fractures throughout the
visualized
thoracolumbar spine, corresponding to the findings on the
prompting CT scan. There is no associated soft tissue mass and
there is some normal residual bone marrow within each vertebral
body. Both the MR [**First Name (Titles) **] [**Last Name (Titles) **] appearance suggests that these are most
likely "benign" osteoporotic fractures, without features
suspicious for malignant involvement.

2. Chronic bilateral L5 spondylolysis with associated Grade I
anterolisthesis as detailed, and resultant foraminal narrowing,
more significant on the right.


MRI Brain [**4-14**]:
1. Multiple enhancing lesions, in the brain and the cerebral and
the
cerebellar hemispheres, redemonstrated for surgical planning;
the largest
lesion in the right cerebellar hemisphere measures 2.5 x 2.6 x
2.0 cm. There has been interval evolution of the lesions, with
increased necrosis and more conspicuous rim enhancement on the
present study compared to the prior study of [**4-6**], several new
lesions compared to the prior study of [**2180-4-6**]. This is a
limited study, performed for pre-surgical planning. Complete sMR
tudy is recommended to assess betetr the interval
change/progression.

LABS:
Amdission:
[**2180-4-5**] 01:41PM   WBC-13.6*# RBC-4.38* HGB-11.3* HCT-34.3*
MCV-78*# MCH-25.8*# MCHC-33.0 RDW-13.5
[**2180-4-5**] 01:41PM   PT-13.7* PTT-28.1 INR(PT)-1.2*
[**2180-4-5**] 01:41PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.0
LEUK-NEG
[**2180-4-5**] 03:00PM   GLUCOSE-135* UREA N-7 CREAT-0.7 SODIUM-123*
POTASSIUM-3.9 CHLORIDE-87* TOTAL CO2-29 ANION GAP-11

Discharge:
COMPLETE BLOOD COUNT   WBC  RBC   Hgb   Hct   MCV MCH   MCHC RDW
 Plt Ct
[**2180-4-17**] 05:50AM    10.5 4.23* 10.3* 32.9* 78* 24.4* 31.3
13.6 421
RENAL & GLUCOSE        Glucose UreaN Creat Na   K   Cl  HCO3
AnGap
[**2180-4-17**] 05:50AM    991     12    0.6   130* 4.8 94* 27   14


Brief Hospital Course:
The patient was transferred to [**Hospital1 18**] from an outside hospital
for evaluation of multiple intracranial massess after an episode
of LOC. Additional work up from the OSH included a CT of the
chest/abdomen that revealed a hypodensity in the liver and a
chronic L2 compression fractures. He was hyponatremic upon
admission and was admitted to the ICU for Q1 hour neuro checks
and q4 hr sodium checks. His neurologic examination was notable
only for mild dysmetria on his right upper extremity.

The patient was placed on hypertonic saline for the first night
and was switched to salt tablets on [**4-6**] when his Na was 130. A
brain MRI was required for the work up but the patient could not
tolerate the study due to severe claustrophobia.  Ultimately, he
required intubation for the study.  The MRI revealed multiple
brain lesions. MRI of the lumbar spine was negative for any
metastasis. Additionally, he had a liver ultrasound to further
evaluate a hypodensity seen on CT scan. The ultrasound was
negative for any concerning lesions.

The case was reviewed in the BTC. It was felt that the right
cerebellar lesion was of a sufficient size as to warrant
resection before whole brain radation can be safely
administered.  Since the patient had been on ASA, the plan was
to discharge the patient to have him return as an outpatient for
his surgery.  However, the patient failed PT eval, requiring
additional hospital stay.  Ultimately, the patient was taken to
the OR prior to discharge. On [**4-14**], the patient underwent a
right suboccipital craniotomy for tumor resection.  He tolerated
the procedure well. He was closely monitered in the ICU for the
following 36 hours and then transferred to to the floor.
Post-operatively, he remained neurologically unchanged relative
to his preoperative examination. He was OOB independently and
had very little post operative pain. He was seen by Physical
Therapy, who recommended that he was fine to return to home
without services.

He was discharged to home on [**4-17**]. Appointments were made for
the patient in terms of radiation therapy and GI endoscopy in
accordance to the patient's request.  He will follow up with Dr. [**Name (NI) 34703**] office in [**4-25**] weeks.  He will resume his ASA use 1 month
after surgery.


Medications on Admission:
ASA 325mg, Diova 160mg QD,
Lopressor 50mg [**Hospital1 **], Vitoran 1080 QD


Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
2. Levetiracetam 750 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*2*
3. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for headache.
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
6. Meds
Please continue to take your home medications Diovan and
Vytorin.


Discharge Disposition:
Home With Service

Facility:
VNA of the [**Location (un) 1121**]

Discharge Diagnosis:
Multiple brain lesions
Cerebellar mass - Metastesis of unknown origin
SIADH


Discharge Condition:
Neurologically stable


Discharge Instructions:
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.

??????	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.
??????	Your wound closure uses dissolvable sutures, you must keep
that area dry for 10 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. FOR ONE MONTH
??????	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:
You have an appointment in the Brain [**Hospital 341**] Clinic on [**5-1**] at
2:00pm.  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.

Be sure you notify your Primary care Doctor regarding the
pulmonary nodule that was found on your Chest CT.  You should
have a repeat CT of your lungs in 3 months.

Also, you should have a repeat check of your sodium level next
week with your PCP. [**Name10 (NameIs) **] should stay on a strict 1.2L fluid
restriction until you see him/her.



Completed by:[**2180-4-17**]
{'Other isolated or specific phobias,Other convulsions,Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Other disorders of neurohypophysis,Pathologic fracture of vertebrae,Other malignant neoplasm without specification of site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Peripheral vascular disease, unspecified'}


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: Transfer from [**Hospital1 **] s/p MVA ? hemorrhage and cerebellar mass

PRESENT ILLNESS: Mr [**Known lastname **] is 66 y/o male with HTN, CAD and PAD. Was in his
normal state of health today, with the exception of feeling
exausted after being up for 72 hours trying to pump out his
basement. He remembers going to [**Company 7546**] and leaving the
parking lot that is the last thing he remembers. He awoke with
the arrival of the EMS, he was found in the parking lot the
details of what he hit are unavailable and there is discrepancy
about whether the air bag deployed. He was brought to [**Hospital **]
hospital and found to have ? cerebellar mass versus stroke and
right occiptal partieal focus of IPH. These appear to be more
concerning for masses than trauma. The patient only complains of
low back pain at this time.

MEDICAL HISTORY: CAD, PAD, has had right iliac artery stent and right coronary
artery stent

MEDICATION ON ADMISSION: ASA 325mg, Diova 160mg QD,
Lopressor 50mg [**Hospital1 **], Vitoran 1080 QD

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Upon admission:
BP:150/81  HR:80    R 18       O2Sats 98%
Gen: WD/WN c/o back pain
HEENT: Pupils: [**4-22**]        EOMs full;

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Former smoker 60 pack year hx stopped in [**2171**]. Drinks 3-4
glasses of wine per day. No illicit drug uses. Lives with wife,
works part time installing fire suppression systems. 

### Response:
{'Other isolated or specific phobias,Other convulsions,Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Other disorders of neurohypophysis,Pathologic fracture of vertebrae,Other malignant neoplasm without specification of site,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Peripheral vascular disease, unspecified'}
