CHIEF COMPLAINT: Skull defect

PRESENT ILLNESS: 44 yo female with a h/o left frontal AVM in the supplementary
motor area. The AVM was treated with stereotactic radiosurgery
(Gamma Knife)in [**2114**]. In [**2116**], the patient developed a seizure
disorder. [**2118-5-27**] she developed
headaches and after an MRI and a digital angiogram showed no
residual pathological vessels, a contrast enhancing lesion
with massive focal residual edema was diagnosed- very
likely represents radionecrosis. The patient had midline
shift and mass effect. On [**2118-8-10**] she had a left craniotomy for
resection of the radionecrosis. She then presented to the office
in [**2118-8-27**] with increased left facial swelling and incision
drainage, she was taken to the OR for a wound washout and
craniectomy. She now returns for a cranioplasty after a long
course of outpatient IV antibiotic therapy.

MEDICAL HISTORY: seizures,h/o radio therapy for avm has resid edema causing
seizures; Dysrhythmia (palps w/ panic attacks), Recent Upper
Respiratory Infection
Palpitations with panic attacks
Panic, anxiety
Depression
h/o nephrolithiasis (at 20yrs old)
TB as a child (treated)

MEDICATION ON ADMISSION: FLUTICASONE [FLONASE] -  (Prescribed by Other Provider) - 50 mcg
Spray, Suspension - 2 sprays(s) each nostril daily as needed for
nasal congestion
LEVETIRACETAM [KEPPRA] - 1,000 mg Tablet - 1 Tablet(s) by mouth
twice a day - No Substitution
LEVETIRACETAM [KEPPRA] - 500 mg Tablet - 1 Tablet(s) by mouth at
bedtime - No Substitution
LEVETIRACETAM [KEPPRA] - 250 mg Tablet - 1 Tablet(s) by mouth
four times a day - No Substitution
OSELTAMIVIR [TAMIFLU] - 75 mg Capsule - one Capsule(s) by mouth
twice a day x 5 days
VENLAFAXINE - 50 mg Tablet - One Tablet(s) by mouth twice a day
ACETAMINOPHEN [TYLENOL] -  (OTC) - Dosage uncertain
IBUPROFEN [ADVIL MIGRAINE] -  (OTC) - 200 mg Capsule - 1
Capsule(s) by mouth once a day as needed for headache

ALLERGIES: Codeine

PHYSICAL EXAM: On admission:
AOx3, PERRL, Face symm, tongue midline. EOM intact w/o
nystagmus. Speech clear and fluent. Comprehension intact.
Follows commands. No pronator. MAE [**5-31**]

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married. Lives with husband.
Other specified acquired deformity of head,Cerebral edema,Epilepsy, unspecified, without mention of intractable epilepsy,Esophageal reflux,Obesity, unspecified,Panic disorder without agoraphobia,Late effect of radiation,Other ill-defined cerebrovascular disease
Oth spcf deformity head,Cerebral edema,Epilep NOS w/o intr epil,Esophageal reflux,Obesity NOS,Panic dis w/o agorphobia,Late effect of radiation,Cerebrovasc disease NEC
Admission Date:  [**2118-12-7**]              Discharge Date:   [**2118-12-9**]

Date of Birth:  [**2073-12-25**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
Skull defect

Major Surgical or Invasive Procedure:
s/p cranioplasty on [**2118-12-7**]


History of Present Illness:
44 yo female with a h/o left frontal AVM in the supplementary
motor area. The AVM was treated with stereotactic radiosurgery
(Gamma Knife)in [**2114**]. In [**2116**], the patient developed a seizure
disorder. [**2118-5-27**] she developed
headaches and after an MRI and a digital angiogram showed no
residual pathological vessels, a contrast enhancing lesion
with massive focal residual edema was diagnosed- very
likely represents radionecrosis. The patient had midline
shift and mass effect. On [**2118-8-10**] she had a left craniotomy for
resection of the radionecrosis. She then presented to the office
in [**2118-8-27**] with increased left facial swelling and incision
drainage, she was taken to the OR for a wound washout and
craniectomy. She now returns for a cranioplasty after a long
course of outpatient IV antibiotic therapy.


Past Medical History:
seizures,h/o radio therapy for avm has resid edema causing
seizures; Dysrhythmia (palps w/ panic attacks), Recent Upper
Respiratory Infection
Palpitations with panic attacks
Panic, anxiety
Depression
h/o nephrolithiasis (at 20yrs old)
TB as a child (treated)


Social History:
Married. Lives with husband.

Family History:
Non-contributory

Physical Exam:
On admission:
AOx3, PERRL, Face symm, tongue midline. EOM intact w/o
nystagmus. Speech clear and fluent. Comprehension intact.
Follows commands. No pronator. MAE [**5-31**]

Upon discharge:
AOx3. Neuro intact. MAE [**5-31**]. Incision C/D/I. Ambulating,
tolerating POs

Pertinent Results:
CT Head [**2118-12-7**]: (Post-Op)
Patient is status post left frontal cranioplasty. Persistent
vasogenic edema in the left frontal lobe, unchanged. No shift of
normally
midline structures or acute hemorrhage identified.

*******************

[**2118-12-7**] 03:13PM   WBC-13.8*# RBC-4.76 HGB-12.8 HCT-37.6 MCV-79*
MCH-27.0 MCHC-34.2 RDW-14.4
[**2118-12-7**] 03:13PM   PLT COUNT-555*
[**2118-12-7**] 03:13PM   CALCIUM-9.2 PHOSPHATE-3.4 MAGNESIUM-2.3
[**2118-12-7**] 03:13PM   estGFR-Using this
[**2118-12-7**] 03:13PM   GLUCOSE-128* CREAT-0.9 SODIUM-141
POTASSIUM-4.1 CHLORIDE-102 TOTAL CO2-30 ANION GAP-13

Brief Hospital Course:
44 yo female who was electively admitted for a cranioplasty with
Dr. [**Last Name (STitle) **]. Immediately post-op she remained in the PACU
overnight. Overnight she voided 4L and received 1L NS bolus. POD
1 she was transferred to the floor. Prior to transfer she was
noted to have increase HR, low BP, and low urine output thus
received 1L of NS. On the floor, she was OOB to chair,
tolerating a regular diet. She was neurologically intact and
cleared for discharge on [**2118-12-9**].

Medications on Admission:
FLUTICASONE [FLONASE] -  (Prescribed by Other Provider) - 50 mcg
Spray, Suspension - 2 sprays(s) each nostril daily as needed for
nasal congestion
LEVETIRACETAM [KEPPRA] - 1,000 mg Tablet - 1 Tablet(s) by mouth
twice a day - No Substitution
LEVETIRACETAM [KEPPRA] - 500 mg Tablet - 1 Tablet(s) by mouth at
bedtime - No Substitution
LEVETIRACETAM [KEPPRA] - 250 mg Tablet - 1 Tablet(s) by mouth
four times a day - No Substitution
OSELTAMIVIR [TAMIFLU] - 75 mg Capsule - one Capsule(s) by mouth
twice a day x 5 days
VENLAFAXINE - 50 mg Tablet - One Tablet(s) by mouth twice a day
ACETAMINOPHEN [TYLENOL] -  (OTC) - Dosage uncertain
IBUPROFEN [ADVIL MIGRAINE] -  (OTC) - 200 mg Capsule - 1
Capsule(s) by mouth once a day as needed for headache


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain/t>100/HA.
2. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
5. Venlafaxine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
6. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2)
Spray Nasal DAILY (Daily) as needed for nasal congestion.
7. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) for 6 days: Take 2mg Q6hrs [**Date range (1) 1855**], take 2mg Q12
[**Date range (1) 1856**], Take 2mg Q24 [**12-14**], then stop.
Disp:*16 Tablet(s)* Refills:*0*
8. Levetiracetam 500 mg Tablet Sig: 2.5 Tablets PO BID (2 times
a day).


Discharge Disposition:
Home

Discharge Diagnosis:
Skull defect
s/p cranioplasty


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.
??????	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.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

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.


Followup Instructions:
You will need to see the nurse practitioner 14 days
post-operatively for suture removal. Please call [**Telephone/Fax (1) 1669**]
for the appointment.
You will need to follow up with Dr. [**Last Name (STitle) **] in 4 weeks with a
Head CT of the brain.



Completed by:[**2118-12-9**]
{'Other specified acquired deformity of head,Cerebral edema,Epilepsy, unspecified, without mention of intractable epilepsy,Esophageal reflux,Obesity, unspecified,Panic disorder without agoraphobia,Late effect of radiation,Other ill-defined cerebrovascular disease'}


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: Skull defect

PRESENT ILLNESS: 44 yo female with a h/o left frontal AVM in the supplementary
motor area. The AVM was treated with stereotactic radiosurgery
(Gamma Knife)in [**2114**]. In [**2116**], the patient developed a seizure
disorder. [**2118-5-27**] she developed
headaches and after an MRI and a digital angiogram showed no
residual pathological vessels, a contrast enhancing lesion
with massive focal residual edema was diagnosed- very
likely represents radionecrosis. The patient had midline
shift and mass effect. On [**2118-8-10**] she had a left craniotomy for
resection of the radionecrosis. She then presented to the office
in [**2118-8-27**] with increased left facial swelling and incision
drainage, she was taken to the OR for a wound washout and
craniectomy. She now returns for a cranioplasty after a long
course of outpatient IV antibiotic therapy.

MEDICAL HISTORY: seizures,h/o radio therapy for avm has resid edema causing
seizures; Dysrhythmia (palps w/ panic attacks), Recent Upper
Respiratory Infection
Palpitations with panic attacks
Panic, anxiety
Depression
h/o nephrolithiasis (at 20yrs old)
TB as a child (treated)

MEDICATION ON ADMISSION: FLUTICASONE [FLONASE] -  (Prescribed by Other Provider) - 50 mcg
Spray, Suspension - 2 sprays(s) each nostril daily as needed for
nasal congestion
LEVETIRACETAM [KEPPRA] - 1,000 mg Tablet - 1 Tablet(s) by mouth
twice a day - No Substitution
LEVETIRACETAM [KEPPRA] - 500 mg Tablet - 1 Tablet(s) by mouth at
bedtime - No Substitution
LEVETIRACETAM [KEPPRA] - 250 mg Tablet - 1 Tablet(s) by mouth
four times a day - No Substitution
OSELTAMIVIR [TAMIFLU] - 75 mg Capsule - one Capsule(s) by mouth
twice a day x 5 days
VENLAFAXINE - 50 mg Tablet - One Tablet(s) by mouth twice a day
ACETAMINOPHEN [TYLENOL] -  (OTC) - Dosage uncertain
IBUPROFEN [ADVIL MIGRAINE] -  (OTC) - 200 mg Capsule - 1
Capsule(s) by mouth once a day as needed for headache

ALLERGIES: Codeine

PHYSICAL EXAM: On admission:
AOx3, PERRL, Face symm, tongue midline. EOM intact w/o
nystagmus. Speech clear and fluent. Comprehension intact.
Follows commands. No pronator. MAE [**5-31**]

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Married. Lives with husband. 

### Response:
{'Other specified acquired deformity of head,Cerebral edema,Epilepsy, unspecified, without mention of intractable epilepsy,Esophageal reflux,Obesity, unspecified,Panic disorder without agoraphobia,Late effect of radiation,Other ill-defined cerebrovascular disease'}
