CHIEF COMPLAINT: 

PRESENT ILLNESS: This 60-year-old female with
past medical history of breast cancer status post a radical
mastectomy with known lumbar metastasis and pelvic metastasis
status post radiation therapy.  The patient developed severe
headache three days prior to admission with nausea and
vomiting x2.  The patient was seen at [**Hospital **] Hospital for
possible metastasis to the brain.  CT was negative for
metastasis, however, a carotid aneurysm was noted on verbal
report from outside hospital.  Films were not provided at the
time of admission.

MEDICAL HISTORY: As above.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Cerebral aneurysm, nonruptured,Urinary tract infection, site not specified,Secondary malignant neoplasm of bone and bone marrow,Unspecified essential hypertension,Personal history of malignant neoplasm of breast
Nonrupt cerebral aneurym,Urin tract infection NOS,Secondary malig neo bone,Hypertension NOS,Hx of breast malignancy
Admission Date:  [**2129-11-13**]     Discharge Date:  [**2129-11-19**]

Date of Birth:   [**2069-1-30**]     Sex:  F

Service: Neurosurgery

HISTORY OF PRESENT ILLNESS:  This 60-year-old female with
past medical history of breast cancer status post a radical
mastectomy with known lumbar metastasis and pelvic metastasis
status post radiation therapy.  The patient developed severe
headache three days prior to admission with nausea and
vomiting x2.  The patient was seen at [**Hospital **] Hospital for
possible metastasis to the brain.  CT was negative for
metastasis, however, a carotid aneurysm was noted on verbal
report from outside hospital.  Films were not provided at the
time of admission.

CTA and MRA was done at [**Hospital **] Hospital, which showed a 9 mm
left carotid anterior aneurysm, an ICA aneurysm at the circle
of [**Location (un) 431**].  Patient denies blurred vision, weakness of
extremities, but does note an episode of left tongue
heaviness, difficulty with speech a few days ago lasting for
seconds, possibly resolving spontaneously.

PAST MEDICAL HISTORY:  As above.

PAST SURGICAL HISTORY:  Status post radical mastectomy.

ADMISSION MEDICATIONS:
1. Aspirin 81 mg q.d.
2. Metoprolol q.d.
3. Ativan prn.
4. Narcotic and pain medication prn.

Patient was admitted to the ICU under Dr.[**Name (NI) 9224**] service
with q.1h. neuro checks.  A LP was done to rule out
subarachnoid hemorrhage.  CT/MRA was done at outside
hospital.  NPO patient was made possible for angiogram.
Blood pressure was kept between 130-190 and amlodipine 60 mg
p.o. q.4h.  Patient had an arterial line and a right IJ
placed.

On first hospital day, the patient was prepped for an
angiogram.  No meningeal signs were noted.  No diplopia.
Face was symmetric.  There was no drift.  Pupils were equal
and reactive.

On the 9th, the patient did have a cerebral angiogram done,
which showed a left supraclioid aneurysm, wide neck
unsuitable for coiling.  Patient was not considered to be a
candidate for coiling also because of HITS. Postoperatively,
angiogram, there was no issues other than her blood pressure was
slightly elevated, and she was started on Nipride.

On the [**11-14**], the patient remained neurologically
stable.  However, overnight on the 10th, she did develop a
fever up to 102.  She was seen by her oncologist, Dr. [**Last Name (STitle) **]
recommended the usual workup of chest x-ray, blood cultures,
urine cultures, and was typed and crossed for 2 units.

Of note, patient has had three hospitalizations in the past
for fevers of unknown origin.  Her last chemotherapy was
approximately two weeks prior to this spike in fever.
Patient was planned to go to the operating room on the 12th
to have her aneurysm clipped.  However, given the fevers up
to 103.1, the surgery was held off.  Her laboratories on the
12th:  White count was 5.3, hematocrit 31.1, and platelets
116, polys were 63, she had 9 bands, and lymphocytes were 14.
Her cultures thus far were negative.

Also on the 12th, the patient continued to have fevers up to
104.  She was seen by both Dr. [**Last Name (STitle) **] and [**Doctor Last Name 1132**], who did give
her the option of possibly having the surgery versus not
having the surgery.  Patient's long prognosis of her breast
cancer is 6-24 months and she has also had a HIT syndrome in
the past.

On the [**11-17**], patient had a positive urine culture
as treated with Levaquin for that.  Also Dr. [**Last Name (STitle) 1132**] met with
the patient on the 13th and discussed the options with the
patient and her husband, given her cancer prognosis and also
given that she had a negative CT for subarachnoid hemorrhage
and the history of HIT in the past that he recommended and
the patient agreed to medical management with close followup
of her symptoms.  She will be following up with Dr. [**Last Name (STitle) 1132**] in
one week post discharge.

The patient was discharged on [**2129-11-19**].  We did ask her to
stay one more day, however, patient insisted on being
discharged.  Her fever overnight was up to 102.  She remained
neurologically intact.  No complaints of headaches.  Our
recommendations are to followup with her primary care
physician to follow her cultures.  She should take Levaquin
as prescribed and follow up with Dr. [**Last Name (STitle) 1132**] in one week also.

DISCHARGE MEDICATIONS:
1. Trazodone 50 mg 1.5 tablets p.o. q.h.s. as needed.
2. Citalopram hydrobromide one p.o. q.d.
3. Levofloxacin 500 mg one p.o. q.24h. for the next four
days.



                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1133**]

Dictated By:[**Last Name (NamePattern4) 26792**]

MEDQUIST36

D:  [**2129-11-19**]  10:26
T:  [**2129-11-21**]  08:27
JOB#:  [**Job Number 54027**]
{'Cerebral aneurysm, nonruptured,Urinary tract infection, site not specified,Secondary malignant neoplasm of bone and bone marrow,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}


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: 

PRESENT ILLNESS: This 60-year-old female with
past medical history of breast cancer status post a radical
mastectomy with known lumbar metastasis and pelvic metastasis
status post radiation therapy.  The patient developed severe
headache three days prior to admission with nausea and
vomiting x2.  The patient was seen at [**Hospital **] Hospital for
possible metastasis to the brain.  CT was negative for
metastasis, however, a carotid aneurysm was noted on verbal
report from outside hospital.  Films were not provided at the
time of admission.

MEDICAL HISTORY: As above.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Cerebral aneurysm, nonruptured,Urinary tract infection, site not specified,Secondary malignant neoplasm of bone and bone marrow,Unspecified essential hypertension,Personal history of malignant neoplasm of breast'}
