CHIEF COMPLAINT: Seizures, Multiple parietal and occipital brain lesions on the
right side that have grown on sequential imaging.

PRESENT ILLNESS: This is a 44 year old female who is known to Dr. [**Last Name (STitle) **] and
followed in the Brain tumor clinic  since [**2169**] by Dr.[**Last Name (STitle) 4253**]
for the multiple recurrent intracranial meningiomas.
     She underwent Cyberknife therapy  in [**7-9**] for the rt
frontal-lateral dural-based meningiomas.  On [**9-8**]  she had
cyberknife therapy to the Right IV tumor. The wound was slow
healing. In [**7-/2172**] New brain MRI showed increased edema around
the Rt IV tumor. PET scan was neg at that time. However, she
underwent a ventriculocisternostomy for an entrapped rt temporal
[**Doctor Last Name 534**].  She was weaned off steroid therapy and post op MRI showed
decreased edema. She did well following the
ventriculocisternostomy, to the point of near complete symptom
resolutiion and returned back into the workforce.

MEDICAL HISTORY: Recurrent intracranial Meningiomas
Seizure Disorder
h/o facial reconstruction following an MVA

MEDICATION ON ADMISSION: Baclofen 40mg qhs, Dilantin 100mg Qam and 250mg qpm.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission: taken from PAT interview dated [**2173-5-24**].  VSS:
112/68-71-16. O2Sat 100%.  Pleasant, Alert and oriented.
Cardiac: RRR. Lungs are clear to ascultation throughout. Abdomen
is soft, nontender. There is no dependent edema.
Pt is noted to wear a left leg brace for ambulation.  Immediate
post op evaluation [**2173-5-26**] pt remained neurologically stable.
98-115/62-89-17 with O2Sat of 99% on R/A.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Married, Nonsmoker. Occasional ETOH use
Benign neoplasm of cerebral meninges,Epilepsy, unspecified, without mention of intractable epilepsy
Ben neo cerebr meninges,Epilep NOS w/o intr epil
Admission Date:  [**2173-5-26**]              Discharge Date:   [**2173-5-28**]

Date of Birth:  [**2129-3-1**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Seizures, Multiple parietal and occipital brain lesions on the
right side that have grown on sequential imaging.

Major Surgical or Invasive Procedure:
[**2173-5-27**] Right Parieto-occipital Craniotomy for tumor
resection bu Dr. [**Last Name (STitle) 14354**] [**Name (STitle) **]


History of Present Illness:
     This is a 44 year old female who is known to Dr. [**Last Name (STitle) **] and
followed in the Brain tumor clinic  since [**2169**] by Dr.[**Last Name (STitle) 4253**]
for the multiple recurrent intracranial meningiomas.
     She underwent Cyberknife therapy  in [**7-9**] for the rt
frontal-lateral dural-based meningiomas.  On [**9-8**]  she had
cyberknife therapy to the Right IV tumor. The wound was slow
healing. In [**7-/2172**] New brain MRI showed increased edema around
the Rt IV tumor. PET scan was neg at that time. However, she
underwent a ventriculocisternostomy for an entrapped rt temporal
[**Doctor Last Name 534**].  She was weaned off steroid therapy and post op MRI showed
decreased edema. She did well following the
ventriculocisternostomy, to the point of near complete symptom
resolutiion and returned back into the workforce.

Past Medical History:
Recurrent intracranial Meningiomas
Seizure Disorder
h/o facial reconstruction following an MVA

Social History:
Married, Nonsmoker. Occasional ETOH use

Family History:
N/C

Physical Exam:
On admission: taken from PAT interview dated [**2173-5-24**].  VSS:
112/68-71-16. O2Sat 100%.  Pleasant, Alert and oriented.
Cardiac: RRR. Lungs are clear to ascultation throughout. Abdomen
is soft, nontender. There is no dependent edema.
Pt is noted to wear a left leg brace for ambulation.  Immediate
post op evaluation [**2173-5-26**] pt remained neurologically stable.
98-115/62-89-17 with O2Sat of 99% on R/A.

On discharge:

Pertinent Results:
[**2173-5-26**] 02:39PM   GLUCOSE-159* UREA N-11 CREAT-0.7 SODIUM-138
POTASSIUM-3.7 CHLORIDE-107 TOTAL CO2-21* ANION GAP-14, CA-8.8
PHOS-3.4 MG-1.9,WBC-8.7# RBC-4.35 HGB-13.9 HCT-39.8 MCV-91
MCH-31.9 MCHC-34.9 RDW-12.6, PLT COUNT-287, PT-12.9 PTT-20.5*
INR(PT)-1.1, GLUCOSE-101 LACTATE-0.8 NA+-126* K+-3.3* CL--99*
HGB-13.3 calcHCT-40

[**5-26**] MRI brain- Compared with 3/30 study: Interval enlargement
of the right occipital parafalcine meningioma. Multiple other
meningiomas appear either stable or increased by 1 mm, which
could be related to technical differences. No new masses
identified.
[**5-26**] CT brain-FINDINGS: The patient is status post right
occipital craniotomy. Prior rt frontal and temporal craniotomy
sites are noted.

Since the previous MRI, the patient has had resections of the rt
occipital
parafalcine meningioma and the meningioma adjacent to the rt
falx near the
apex. Sm. foci of air are noted at these sites in addition to
around the
rt frontal lobe consistent with post-surgical changes. There is
min.
shift of midline structures to the lt of 3 mm, which is not sig.
changed since the previous study. A sm. amount of hemorrhage is
seen
surrounding the right occipital resection site. A rt
ventriculostomy
catheter is seen terminating in the suprasellar cistern,
unchanged. A rt
ventricular mass is seen in the atrium measuring up to 8 mm with
peripheral calcification, stable. Visualized paranasal sinuses
and mastoid air cells are clear.

IMPRESSION: Expected postoperative changes. Sm amount of
hemorrhage
surrounding the post-surgical site along the rit occipital lobe.
Leftward
shift of midline structures of 3 mm, not signifantly changed.

The study and the report were reviewed by the staff radiologist.



Brief Hospital Course:
Pt underwent a right parietal occipital craniotomy for tumor
resection on [**2173-5-26**] by Dr. [**Last Name (STitle) 14354**] [**Name (STitle) **] as scheduled. There
were no perioperative complications to report. Post operative CT
imaging was obtained and revealed the expected postoperative
changes. Neurologic exam remained stable. A+O x3. PERRLA 5mm to
4mm. The pts prior left sided weakness persists and is
unchanged. She transferred to the floor on [**2173-5-27**].  Physical
therapy recommended outpatient neuro rehab for which she was
given a prescription. On discharge she was eating and drinking
without difficulty.

Medications on Admission:
Baclofen 40mg qhs, Dilantin 100mg Qam and 250mg qpm.

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule
PO DAILY (Daily).
3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain: do not drive while you are on this
medication .
Disp:*40 Tablet(s)* Refills:*0*
4. Dilantin Infatabs 50 mg Tablet, Chewable Sig: Five (5)
Tablet, Chewable PO q hs.
5. Out Patient Neuro Rehab
Treat and eval for severe left sided weakness


Discharge Disposition:
Home

Discharge Diagnosis:
Recurrent Atypical Meningioma


Discharge Condition:
Neurologically stable


Discharge Instructions:
General Instructions

??????	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.
??????	You may wash your hair only after sutures and/or staples have
been removed. If 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.
??????	If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you haven been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	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, unless you have been instructed not to.

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: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.

Follow-Up Appointment Instructions

??????	Please return to the office in two weeks for removal of your
staples or sutures.
??????	Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in two weeks.
??????	You will not need a CT scan of the brain with / without
contrast.

General Instructions

??????	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.
??????	You may wash your hair only after sutures and/or staples have
been removed. If 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.
??????	If you have been prescribed Dilantin (Phenytoin) for
anti-seizure medicine, take it as prescribed and follow up with
laboratory blood drawing in one week.  This can be drawn at your
PCP??????s office, but please have the results faxed to [**Telephone/Fax (1) 87**].
If you haven been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	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, unless you have been instructed not to.

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: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.

Follow-Up Appointment Instructions

??????	Please return to the office in two weeks for removal of your
staples or sutures.
??????	Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in two weeks.
??????	You will not need a CT scan of the brain with / without
contrast.


Followup Instructions:
You will need to follow up in two weeks with Dr. [**Last Name (STitle) **]. You
will  also need to have the surgical staples/sutures removed at
this time. Please call [**Telephone/Fax (1) 1669**] for an appointment.



Completed by:[**2173-5-28**]
{'Benign neoplasm of cerebral meninges,Epilepsy, unspecified, without mention of intractable epilepsy'}


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: Seizures, Multiple parietal and occipital brain lesions on the
right side that have grown on sequential imaging.

PRESENT ILLNESS: This is a 44 year old female who is known to Dr. [**Last Name (STitle) **] and
followed in the Brain tumor clinic  since [**2169**] by Dr.[**Last Name (STitle) 4253**]
for the multiple recurrent intracranial meningiomas.
     She underwent Cyberknife therapy  in [**7-9**] for the rt
frontal-lateral dural-based meningiomas.  On [**9-8**]  she had
cyberknife therapy to the Right IV tumor. The wound was slow
healing. In [**7-/2172**] New brain MRI showed increased edema around
the Rt IV tumor. PET scan was neg at that time. However, she
underwent a ventriculocisternostomy for an entrapped rt temporal
[**Doctor Last Name 534**].  She was weaned off steroid therapy and post op MRI showed
decreased edema. She did well following the
ventriculocisternostomy, to the point of near complete symptom
resolutiion and returned back into the workforce.

MEDICAL HISTORY: Recurrent intracranial Meningiomas
Seizure Disorder
h/o facial reconstruction following an MVA

MEDICATION ON ADMISSION: Baclofen 40mg qhs, Dilantin 100mg Qam and 250mg qpm.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On admission: taken from PAT interview dated [**2173-5-24**].  VSS:
112/68-71-16. O2Sat 100%.  Pleasant, Alert and oriented.
Cardiac: RRR. Lungs are clear to ascultation throughout. Abdomen
is soft, nontender. There is no dependent edema.
Pt is noted to wear a left leg brace for ambulation.  Immediate
post op evaluation [**2173-5-26**] pt remained neurologically stable.
98-115/62-89-17 with O2Sat of 99% on R/A.

FAMILY HISTORY: N/C

SOCIAL HISTORY: Married, Nonsmoker. Occasional ETOH use 

### Response:
{'Benign neoplasm of cerebral meninges,Epilepsy, unspecified, without mention of intractable epilepsy'}
