CHIEF COMPLAINT: i have pain in my back and it goes to my neck

PRESENT ILLNESS: This 45 y/o white male presents to ER at [**Hospital1 22160**] transferred
from [**Hospital1 487**] ER for MRI.  Pt states he has LBP radiating to
neck
x 2-3 weeks with progressive weakness.  He went to PCP about [**Name Initial (PRE) **]
week ago for this pain/ although not as weak at that time/ and
was given antibiotics for a soft tissue mass at left clavicular
region.  He  is not sure what kind of abx.  He states the last
two days have been the worst with regards to pain and weakness.
Presented to outside ER via ambulance.  Pt states able to void
and move bowels / difficulty ambulating and moving around his
home.  He admits to fever, IVDA of coccaine that started 6months
ago and he stopped two weeks ago ("heavy use").  he admits to
6pack beer per day.  Denies trauma, sob, chest pain,
incontinence. Pt received antibiotics in ER

MEDICAL HISTORY: PMHx:denies

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM: on arrival
O: T:  101.3, 153/84, 84, 24 sat 99% O2Sat
Gen: WD/WN, appears stressed and uncomfortable
HEENT: Pupils:  errl       EOMs intact
Neck: Supple.
Lungs: scattered inspiratory wheeze and LLL decreased BS.
Cardiac: RRR. S1/S2.
Abd: Soft, + tender to RLQ - ? bladder distention BS+
Extrem: Warm and well-perfused. No C/C/E. + track marks noted to
B/l UE

FAMILY HISTORY: Family Hx:noncontrib

SOCIAL HISTORY: Social Hx: IVDA, ETOH
Methicillin susceptible Staphylococcus aureus septicemia,Intraspinal abscess,Acute gastric ulcer with hemorrhage, without mention of obstruction,Acute osteomyelitis, other specified sites,Cellulitis and abscess of trunk,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Unspecified pleural effusion,Cocaine abuse, unspecified,Alcohol withdrawal,Other and unspecified alcohol dependence, unspecified,Hyposmolality and/or hyponatremia,Vascular myelopathies,Other disorders of muscle, ligament, and fascia,Intervertebral disc disorder with myelopathy, cervical region,Other diseases of spleen,Acute esophagitis
Meth susc Staph aur sept,Intraspinal abscess,Ac stomach ulcer w hem,Ac osteomyelitis NEC,Cellulitis of trunk,Hpt B acte wo cm wo dlta,Pleural effusion NOS,Cocaine abuse-unspec,Alcohol withdrawal,Alcoh dep NEC/NOS-unspec,Hyposmolality,Vascular myelopathies,Muscle/ligament dis NEC,Cerv disc dis w myelopat,Spleen disease NEC,Acute esophagitis
Admission Date:  [**2184-9-27**]              Discharge Date:   [**2184-10-20**]

Date of Birth:  [**2138-10-13**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2724**]
Chief Complaint:
i have pain in my back and it goes to my neck

Major Surgical or Invasive Procedure:
drainage of epidural abcess in cervical spine x 2
Incision and drainage of abscess to left anterior chast wall
upper endoscopy
placement of [**Location (un) **] filter


History of Present Illness:
This 45 y/o white male presents to ER at [**Hospital1 22160**] transferred
from [**Hospital1 487**] ER for MRI.  Pt states he has LBP radiating to
neck
x 2-3 weeks with progressive weakness.  He went to PCP about [**Name Initial (PRE) **]
week ago for this pain/ although not as weak at that time/ and
was given antibiotics for a soft tissue mass at left clavicular
region.  He  is not sure what kind of abx.  He states the last
two days have been the worst with regards to pain and weakness.
Presented to outside ER via ambulance.  Pt states able to void
and move bowels / difficulty ambulating and moving around his
home.  He admits to fever, IVDA of coccaine that started 6months
ago and he stopped two weeks ago ("heavy use").  he admits to
6pack beer per day.  Denies trauma, sob, chest pain,
incontinence. Pt received antibiotics in ER


Past Medical History:
PMHx:denies


Social History:
Social Hx: IVDA, ETOH


Family History:
Family Hx:noncontrib


Physical Exam:
PHYSICAL EXAM: on arrival
O: T:  101.3, 153/84, 84, 24 sat 99% O2Sat
Gen: WD/WN, appears stressed and uncomfortable
HEENT: Pupils:  errl       EOMs intact
Neck: Supple.
Lungs: scattered inspiratory wheeze and LLL decreased BS.
Cardiac: RRR. S1/S2.
Abd: Soft, + tender to RLQ - ? bladder distention BS+
Extrem: Warm and well-perfused. No C/C/E. + track marks noted to
B/l UE

Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Motor: exam limited [**12-25**] pain.  Best effort elicits full strength
to LLE, RLE with 4+/5 throughout, RUE and LUE grip strength 3/5,
Biceps [**12-28**] 9internally rotates upper extremeties during bicep
testing), triceps [**2-25**], shoulder adduction [**2-25**], abduction 4-/5.


Sensation: Intact to light touch throughout however there is a
sensory level at the level of the umbilicus, distal to proximal
he perceives decreased sensation to legs compared with upper
torso.
Reflexes: slightly hyper-reflexive throughout, with 2 beat
clonus

Toes upgoing bilaterally
Rectal exam normal sphincter control for this examiner


Pertinent Results:
Date: [**2184-10-2**]
Signed by [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9479**], MD on [**2184-10-2**]  Affiliation: [**Hospital1 18**]

GI Staff EGD note

Uregent EGD showed severe ulcerative esophagitis which was
friable, but not actively bleeding.  In the antrum there was a
~1
cm ulcer with stigmata of recent hemorrhage (black spots) and
several tiny erosions (non bleeding).  There were several small
to 5 mm erosions in the fundus (non bleeding).  Duodenum was
normal.

We applied cautery to the antral ulcer in an attempt to reduce
his chances of rebleeding.

Suggest: transufse to keep Hct above 30%.  Continue with NG
suction, IV PPI, SICU hospitalization.  Call us for repeat EGD
if
he rebleeds or becomes hemodynamically unstable despite
transfusion.
MR L SPINE W/O CONTRAST  [**2184-10-16**] 1:21 AM

MR L SPINE W/O CONTRAST

Reason: please check progression
Contrast: MAGNEVIST

[**Hospital 93**] MEDICAL CONDITION:
46 year old man with L5S1 discitis/osteo
REASON FOR THIS EXAMINATION:
please check progression
EXAM: MRI of the lumbar spine.

CLINICAL INFORMATION: Patient with L5-S1 discitis and
osteomyelitis, for further evaluation and followup.

TECHNIQUE: T1, T2 and inversion recovery sagittal and T1 and T2
axial images were obtained before gadolinium. T1 sagittal and
axial images were obtained following gadolinium. Comparison was
made with the previous MRI of [**2184-10-7**].

FINDINGS: Again at L5-S1 level, abnormal signal is seen within
the left side of the disc with mild paraspinal soft tissue
changes. Soft tissue changes extend to the left neural foramen
with indentation and deformity of the exiting left L5 nerve
root. Since the previous study, the extent of T2 signal within
the disc has slightly decreased. In addition, the paraspinal
soft tissue changes also appear to be slightly less prominent. A
small focus of low signal within the enhancing soft tissues
indicates a tiny 5-mm paraspinal abscess which is also smaller
than before.

Again noted are small areas of T2 hyperintensities within the
posterior soft tissues bilaterally adjacent to the L4-5 facet
joints which are slightly decreased from previous MRI
examination but are still identified. There is no evidence of
significant epidural enhancement identified or evidence of
epidural abscess seen.

Mild multilevel degenerative changes are identified in the
lumbar region with mild bulging of disc at L4-5 level. There is
no evidence of high-grade spinal stenosis seen.

Note is made of significantly distended urinary bladder which is
a new finding since previous study.

IMPRESSION: Since the previous MRI examination, slight decrease
in degree of signal changes and enhancement is identified at
L5-S1 level. In addition, small posterior soft tissue abscesses
seen on the previous study have also slightly decreased in size.
These findings indicate overall improvement. A distended urinary
bladder is seen on the current study for which clinical
correlation is recommended. No significant new findings are
identified.

DR. [**First Name (STitle) 3905**] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 3906**]
CHEST (PORTABLE AP)  [**2184-10-11**] 7:38 AM

CHEST (PORTABLE AP)

Reason: R/O pneumonia

[**Hospital 93**] MEDICAL CONDITION:
45 year old man with cervial epidural abscess, s/p hardware
placement, now with fevers
REASON FOR THIS EXAMINATION:
R/O pneumonia
REASON FOR EXAMINATION: Fever.

Portable AP chest radiograph compared to [**2184-10-1**].

The patient is after cervical orthopedic surgery. The left PICC
line catheter terminates at the cavoatrial junction. The heart
size is normal. Mediastinum width, contour and position are
unremarkable. The lungs are clear. The pleural surfaces are
smooth with no pleural effusion.

IMPRESSION: No evidence of cardiopulmonary process.

CT CHEST W/CONTRAST  [**2184-10-11**] 5:47 PM

CT CHEST W/CONTRAST; CT ABDOMEN W/CONTRAST

Reason: please evaluate infectious process
Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
45 year old man with hx of IVDA, s/p epidural abscess drainange.
Now with neck abscess.
REASON FOR THIS EXAMINATION:
please evaluate infectious process
CONTRAINDICATIONS for IV CONTRAST: None.

INDICATION: History of IV drug abuse status post epidural
abscess drainage. Now with neck abscess.

COMPARISON: CT neck dated [**2184-10-10**] and CT abdomen and pelvis
dated [**2184-10-3**], and CT chest dated [**2184-10-2**].

TECHNIQUE: MDCT acquired images of the chest, abdomen and pelvis
were obtained after the administration of IV and oral contrast.

CT OF THE CHEST WITH IV CONTRAST: There is interval improvement
in the previously demonstrated left pleural/upper chest fluid
collection. Stranding in the anterior neck soft tissues with
multiple foci of air is demonstrated, consistent with the
patient's neck infection, that was more fully imaged on the neck
CT of one day prior.

There is a PICC catheter that terminates in the SVC. There are
coronary artery calcifications. There is a trace right-sided
pleural effusion, new compared to the previous exam.

The previously demonstrated left-sided effusion has resolved.
There are small areas of atelectasis in both lower lobes. Note
is made of a prominent left paratracheal node measuring 9 mm.
There are multiple other small mediastinal nodes that do not
meet CT criteria for pathologic enlargement. The airways appear
patent to the level of segmental bronchi bilaterally. There is
no pneumothorax.

CT OF THE ABDOMEN WITH IV CONTRAST: The previously demonstrated
region of hypoenhancement in the posterior portion of the spleen
is now less prominent, with two small residual round hypodense
foci. Splenomegaly is again noted. There are no focal liver
lesions. Gallbladder is decompressed. The adrenal glands and
kidneys are unremarkable. An infrarenal IVC filter is again
seen. Loops of small and large bowel are unremarkable. Appendix
is normal. There is trace ascites tracking along the right
pericolic gutter into the pelvis.

CT OF THE PELVIS WITH IV CONTRAST: There is a Foley catheter
within the bladder. Air within the bladder is presumably
secondary to the Foley catheter placement. The rectum and
sigmoid colon are unremarkable. There is small free fluid.

Bone windows demonstrate degenerative endplate changes at
multiple levels.

IMPRESSION:
1. Interval decrease in size and extent of previously
demonstrated left anterior chest wall fluid collection.
2. Soft tissue stranding and air in the anterior and right neck
is consistent with infection, incompletely imaged.
3. Previously demonstrated hypoenhancing peripheral focus in the
posterior spleen is now less prevalent compared to the previous
exam.
4. Emphysema.
5. Small ascites, predominantly located within the pelvis.
Reason: evaluate status of abscess
Contrast: MAGNEVIST

[**Hospital 93**] MEDICAL CONDITION:
45 year old man with epidural abscess s/p ACD C4-C5 and
evacuation of abscess.
REASON FOR THIS EXAMINATION:
evaluate status of abscess
EXAM: MRI of the cervical spine.

CLINICAL INFORMATION: Patient with cervical abscess, for further
evaluation.

TECHNIQUE: T1, T2 and inversion recovery sagittal and T1 and T2
axial images of the cervical spine were obtained before
gadolinium. T1 sagittal and axial images were obtained following
gadolinium. Comparison was made with the previous studies of
[**2184-9-27**] and [**2184-9-28**].

FINDINGS: There is evidence of increased signal seen within the
C4, C5, and C6 vertebral bodies. In addition, increased signal
is seen on inversion recovery and T2 images within the C4-5 and
C5-6 discs. Following gadolinium, enhancement is seen in the
epidural soft tissues with an area of which does not enhance,
extending on the posterior margin of C4 and C5 vertebral bodies
indicative of an epidural abscess. In addition, there is also a
fluid collection indicative of epidural abscess seen in the
prevertebral region extending from C4 to C6. The prevertebral
soft tissue thickness is also prominent indicating inflammatory
changes extending from C3 to C7. These findings indicate
reaccumulation of the epidural abscess with a new prevertebral
abscess. In addition, compared to the prior study, the signal
changes within the intervertebral disc and enhancement have also
increased. In addition, there is moderate- to-severe compression
of the spinal cord seen at C4 and C5 level with increased signal
within the spinal cord. This finding is more prominent since the
previous study of [**2184-9-28**].

A small fluid collection at the anterolateral right nect could
be post-operative fluid collection.

IMPRESSION: Since the previous MRI of [**2184-9-28**], there is now a
new epidural abscess identified at C4-5 level and a prevertebral
abscess seen from C4 to C6 with increased epidural and
prevertebral enhancement. There is also slight increase in
spinal cord compression and increased signal in the spinal cord
identified. Findings were discussed with the physician taking
care of the patient at the time of interpretation of the study
on [**2184-10-9**].
PATIENT/TEST INFORMATION:
Indication: Endocarditis.
Height: (in) 68
Weight (lb): 180
BSA (m2): 1.96 m2
BP (mm Hg): 111/71
HR (bpm): 70
Status: Inpatient
Date/Time: [**2184-10-5**] at 15:24
Test: TEE (Complete)
Doppler: Full Doppler and color Doppler
Contrast: None
Tape Number: 2006W000-0:00
Test Location: West Cath/EP Lab
Technical Quality: Adequate




REFERRING DOCTOR: DR. [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

INTERPRETATION:

Findings:

LEFT ATRIUM: Normal LA size.

RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size.

RIGHT VENTRICLE: Normal RV chamber size and free wall motion.

AORTA: Normal ascending, transverse and descending thoracic
aorta with no
atherosclerotic plaque.

AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. No
masses or
vegetations on aortic valve.

MITRAL VALVE: Normal mitral valve leaflets with trivial MR. [**Name13 (STitle) **]
mass or
vegetation on mitral valve.

TRICUSPID VALVE: Normal tricuspid valve leaflets with trivial
TR. No mass or
vegetation on tricuspid valve.

PULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflets
with
physiologic PR. No vegetation/mass on pulmonic valve.

PERICARDIUM: No pericardial effusion.

GENERAL COMMENTS: The patient was monitored by a nurse [**First Name (Titles) **] [**Last Name (Titles) 69920**]e
throughout the procedure. The posterior pharynx was anesthetized
with 2%
viscous lidocaine. No TEE related complications. 0.2 mg of IV
glycopyrrolate
was given as an antisialogogue prior to TEE probe insertion.

Conclusions:
The left atrium is normal in size. Right ventricular chamber
size and free
wall motion are normal. The ascending, transverse and descending
thoracic
aorta are normal in diameter and free of atherosclerotic plaque.
The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and
no aortic regurgitation. No masses or vegetations are seen on
the aortic
valve. The mitral valve appears structurally normal with trivial
mitral
regurgitation. No mass or vegetation is seen on the mitral
valve. No
vegetation/mass is seen on the pulmonic valve. There is no
pericardial
effusion.

IMPRESSION: No valvular vegetation or intracardiac mass seen.

Electronically signed by [**First Name11 (Name Pattern1) 449**] [**Last Name (NamePattern4) **], MD on [**2184-10-5**] 16:27.

[**Location (un) **] PHYSICIAN: [**Name10 (NameIs) **],[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 975**]

 BILAT LOWER EXT VEINS PORT  [**2184-10-4**] 3:39 PM

BILAT LOWER EXT VEINS PORT

Reason: eval for IVC filter placement

[**Hospital 93**] MEDICAL CONDITION:
45 year old man s/p anterior cervical discectomy for epidural
abscess with GI bleed
REASON FOR THIS EXAMINATION:
eval for IVC filter placement
LIMITED BILATERAL LOWER EXTREMITY VENOUS DOPPLER ULTRASOUND.

CLINICAL HISTORY: 45-year-old man status post anterior cervical
discectomy for epidural abscess, with GI bleed. Evaluate for IVC
filter placement.

No prior studies available for comparison.

FINDINGS: Limited Doppler ultrasound of the bilateral common
femoral veins was performed, as requested by the ordering
physician. [**Name10 (NameIs) **] bilateral common femoral veins are widely patent
and demonstrate normal compressibility, augmentation and phasic
flow. No evidence of intraluminal thrombus.

IMPRESSION: No evidence of deep venous thrombosis of bilateral
common femoral veins.

The study and the report were reviewed by the staff radiologist.
DR. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]
DR. [**First Name11 (Name Pattern1) 177**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Approved: TUE [**2184-10-5**] 9:33 AM





Brief Hospital Course:
Pt was admitted through the ED for c/o low back pain that
radiates to neck.  Pt taken to the OR emergently for drainage of
cervical epidural abscess.  Postopereatively the pts exam was
worse with diffuse weakness.  He remained intubated for 2 days
post op.  His cultures were positive for gram pos cocci in pairs
and clusters.  Antibiotics were started broad spectrum in OR. He
was seen and evaluated by ID and placed on Nafcillin to reach a
total course of 6weeks time.  A PICC line was placed. [**10-2**] he
had an episode of UGI bleeding and was scoped with cauterization
of a gastric ulcer.  He recieved 2 units of packed cells.  He
Had CT's of chest abd pelvis to eval for further abscess
formation.  There was note of ?splenic infarct vs. abscess.
This was followed by repeat CT and will be followed as an outpt
by ID>  It is not thought at this time to be an abscess.
He had a bedside I and D of the LEFT anterior chest wall abcess
x 2 by the surgical team.  [**10-6**] His Hct dropped again from 28
to 25.  He has remained stable - currently at 27.  He had LE
dopplers on the 13th which were negative
[**10-7**] MRI showed worsening discitis with increased fluid in
epidural space at C45 and new pre-vertebral abscess at C4-6. He
was transfused one unit pre-op and was taken back to the OR
[**10-10**] for 2 level corpectomy and discectomy / fusion as well as
evacutation of recurrent abscess.  He also had [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
filter placed that day.  His Na level has been fluctuatin
between 128 and 132 this hospitalization - he was on a fluid
restriction of 2000ml / day for a few days. His Na is stable at
132 as of [**10-17**].  He maintains a regular diet.
pneumovax was given .
[**10-15**] lumbar MRI has decreased abscesses and CRP now2.2 and ESR
57.
PPD negative this hospitalization and he did receive
pneumococcal vaccine.
cdiff from [**10-15**] is negative
His foley was d/c'd and he is being straight cath'd q 6 hours.
He was seen and evaluated by PT and OT. They are working with
him daily as his motor strength improves daily (LE strength >UE
strength).

Medications on Admission:
none

Discharge Medications:
1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
4. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  TID
(3 times a day) as needed.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
9. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed.
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
11. Lorazepam 0.5 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every 4
to 6 hours) as needed.
12. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
13. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**11-24**]
Drops Ophthalmic  PRN (as needed) as needed for dry eyes.
14. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed.
15. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO HS
(at bedtime) as needed.
16. Fentanyl 100 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
17. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
18. Nortriptyline 10 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
19. Dolasetron 12.5 mg/0.625 mL Solution Sig: One (1)
Intravenous  Q8H (every 8 hours) as needed for nausea.
20. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One
(1) ML Intravenous  DAILY (Daily) as needed.
21. Nafcillin 2 g Piggyback Sig: One (1)  Intravenous  every
four (4) hours: FOR A TOTAL OF 8 WEEKS - AS OF [**10-20**] PT IS DAY
#23 .


Discharge Disposition:
Extended Care

Facility:
[**Hospital **] Medical Center - [**Hospital1 3597**]

Discharge Diagnosis:
epidural abcess


Discharge Condition:
Stable/improved


Discharge Instructions:
Return to ED ASAP if any new weakness, numbness/ fever / wound
drainage
Please check blood test weekly for CBC,diff, BUN/Cr, LFT while
on antibiotics.
AND FAX TO [**Telephone/Fax (1) **]

Followup Instructions:
Dr [**Last Name (STitle) **] in 6 weeks at [**Telephone/Fax (1) **] with ap and lateral xrays
of c-spine.
You will need to follow up with the gastroenterology department
in [**2-26**] weeks with Dr. [**Last Name (STitle) **] - please call [**Telephone/Fax (1) **] for an
appointment
Infectious disease clinic follow up 12/19 11AM: check weekly,
CBC,diff, BUN/Cr, LFT.
NO SPECIFIC FOLLOW UP WITH THORACIC SURGERY NECESSARY PER
THORACIC TEAM, PLEASE OCNTINUE DRESSING CHANGES FOR LEFT
ANTERIOR CHEST WALL INCISION SITE AND CALL [**Telephone/Fax (1) **]



Completed by:[**2184-10-20**]
{'Methicillin susceptible Staphylococcus aureus septicemia,Intraspinal abscess,Acute gastric ulcer with hemorrhage, without mention of obstruction,Acute osteomyelitis, other specified sites,Cellulitis and abscess of trunk,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Unspecified pleural effusion,Cocaine abuse, unspecified,Alcohol withdrawal,Other and unspecified alcohol dependence, unspecified,Hyposmolality and/or hyponatremia,Vascular myelopathies,Other disorders of muscle, ligament, and fascia,Intervertebral disc disorder with myelopathy, cervical region,Other diseases of spleen,Acute esophagitis'}


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: i have pain in my back and it goes to my neck

PRESENT ILLNESS: This 45 y/o white male presents to ER at [**Hospital1 22160**] transferred
from [**Hospital1 487**] ER for MRI.  Pt states he has LBP radiating to
neck
x 2-3 weeks with progressive weakness.  He went to PCP about [**Name Initial (PRE) **]
week ago for this pain/ although not as weak at that time/ and
was given antibiotics for a soft tissue mass at left clavicular
region.  He  is not sure what kind of abx.  He states the last
two days have been the worst with regards to pain and weakness.
Presented to outside ER via ambulance.  Pt states able to void
and move bowels / difficulty ambulating and moving around his
home.  He admits to fever, IVDA of coccaine that started 6months
ago and he stopped two weeks ago ("heavy use").  he admits to
6pack beer per day.  Denies trauma, sob, chest pain,
incontinence. Pt received antibiotics in ER

MEDICAL HISTORY: PMHx:denies

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM: on arrival
O: T:  101.3, 153/84, 84, 24 sat 99% O2Sat
Gen: WD/WN, appears stressed and uncomfortable
HEENT: Pupils:  errl       EOMs intact
Neck: Supple.
Lungs: scattered inspiratory wheeze and LLL decreased BS.
Cardiac: RRR. S1/S2.
Abd: Soft, + tender to RLQ - ? bladder distention BS+
Extrem: Warm and well-perfused. No C/C/E. + track marks noted to
B/l UE

FAMILY HISTORY: Family Hx:noncontrib

SOCIAL HISTORY: Social Hx: IVDA, ETOH 

### Response:
{'Methicillin susceptible Staphylococcus aureus septicemia,Intraspinal abscess,Acute gastric ulcer with hemorrhage, without mention of obstruction,Acute osteomyelitis, other specified sites,Cellulitis and abscess of trunk,Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta,Unspecified pleural effusion,Cocaine abuse, unspecified,Alcohol withdrawal,Other and unspecified alcohol dependence, unspecified,Hyposmolality and/or hyponatremia,Vascular myelopathies,Other disorders of muscle, ligament, and fascia,Intervertebral disc disorder with myelopathy, cervical region,Other diseases of spleen,Acute esophagitis'}
