CHIEF COMPLAINT: headaches

PRESENT ILLNESS: Mr. [**Known lastname 32661**] is a 55-year-old male with a history of headaches
and a family history of three members who died from subarachnoid
hemorrhage.  He underwent routine screening MRA and was found to
have a right middle cerebral artery aneurysm.  He had a cererbal
angiogram bu tthe aneursym was not able to be successfully
coiled. He presented electively for a open craniotomy/clipping

MEDICAL HISTORY: HTN, arthritis, cocaine use, appendectomy

MEDICATION ON ADMISSION: AMLODIPINE - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day
HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth
once a day
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
PRAVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth once a day
SELENIUM SULFIDE - 2.25 % Shampoo - lather, apply to skin,
shower
off 10 minutes later q d x 1 week, then biweekly - No
Substitution
SILDENAFIL [VIAGRA] - 50 mg Tablet - 1 Tablet(s) by mouth 1 hour

ALLERGIES: OxyContin

PHYSICAL EXAM: On Discharge: intact

FAMILY HISTORY: three members who died from subarachnoid hemorrhage.

SOCIAL HISTORY: +tobacco, +cocaine use
Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Tobacco use disorder,Family history of other condition
Nonrupt cerebral aneurym,Hypertension NOS,Hyperlipidemia NEC/NOS,Tobacco use disorder,Family hx-condition NEC
Name:  [**Known lastname 12030**],[**Known firstname 63**]                   Unit No:   [**Numeric Identifier 12031**]

Admission Date:  [**2184-5-12**]              Discharge Date:   [**2184-5-15**]

Date of Birth:  [**2129-3-17**]             Sex:   M

Service: NEUROSURGERY

Allergies:
OxyContin

Attending:[**First Name3 (LF) 40**]
Addendum:
updated discharge instructions as below

Discharge Disposition:
Home

Discharge 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 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.
?????? Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.



Medications:
?????? Continue all other medications you were taking before surgery,
unless otherwise directed
?????? You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.



What activities you can and cannot do:

?????? When you go home, you may walk and go up and down stairs.
?????? You may shower (let the soapy water run over groin incision,
rinse and pat dry)
?????? Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
?????? No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
?????? After 1 week, you may resume sexual activity.
?????? After 1 week, gradually increase your activities and distance
walked as you can tolerate.
?????? No driving until you are no longer taking pain medications



What to report to office:

?????? Changes in vision (loss of vision, blurring, double vision,
half vision)
?????? Slurring of speech or difficulty finding correct words to use
?????? Severe headache or worsening headache not controlled by pain
medication
?????? A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
?????? Trouble swallowing, breathing, or talking
?????? Numbness, coldness or pain in lower extremities
?????? Temperature greater than 101.5F for 24 hours
?????? New or increased drainage from incision or white, yellow or
green drainage from incisions
?????? Bleeding from groin puncture site
?????? 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

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 43**] MD [**MD Number(2) 44**]

Completed by:[**2184-5-15**]

Admission Date:  [**2184-5-12**]              Discharge Date:   [**2184-5-15**]

Date of Birth:  [**2129-3-17**]             Sex:   M

Service: NEUROSURGERY

Allergies:
OxyContin

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
headaches

Major Surgical or Invasive Procedure:
[**2184-5-13**]: R MCA aneurysm open clipping, cerebral Angiogram


History of Present Illness:
Mr. [**Known lastname 32661**] is a 55-year-old male with a history of headaches
and a family history of three members who died from subarachnoid
hemorrhage.  He underwent routine screening MRA and was found to
have a right middle cerebral artery aneurysm.  He had a cererbal
angiogram bu tthe aneursym was not able to be successfully
coiled. He presented electively for a open craniotomy/clipping

Past Medical History:
HTN, arthritis, cocaine use, appendectomy

Social History:
+tobacco, +cocaine use

Family History:
three members who died from subarachnoid hemorrhage.

Physical Exam:
On Discharge: intact

Pertinent Results:
Angiogram [**2184-5-12**]: IMPRESSION:
Successful clipping of the right middle cerebral artery
bifurcation aneurysm with no residual filling. Minimal spasm
noted in the adjacent vessels.

CT head [**2184-5-13**]: IMPRESSION: Status post right MCA aneurysm
clipping. No large intracranial hemorrhage or mass effect.
Expected post-surgical changes of mild frontoparietal sulcal
effacement and small pneumocephalus.


Brief Hospital Course:
This is a 55 year old man with history of R MCA aneurysm
presents for open clipping. He was taken to the OR on [**2184-5-12**].
OR course was uncomplicated and JP drain was placed. Patient was
transferred from OR to the angio suite for angiogram to evaluate
clipping. This was uneventful and he was transfered to the ICU
and extubated. On [**5-13**] he was neurologically intact with some
right retro-orbital headache. CT head was done and this showed
no hemorrhage. His Foley was removed and his diet was advanced.
On [**5-14**] he was neurologically stable. His JP drain was removed
and he was cleared for transfer to the floor. PT was consulted
for assistance with discharge planning and they found him stable
and suitable for discharge to home.

Medications on Admission:
AMLODIPINE - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day
HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth
once a day
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
PRAVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth once a day
SELENIUM SULFIDE - 2.25 % Shampoo - lather, apply to skin,
shower
off 10 minutes later q d x 1 week, then biweekly - No
Substitution
SILDENAFIL [VIAGRA] - 50 mg Tablet - 1 Tablet(s) by mouth 1 hour

prior to intercourse
ASPIRIN [ASPIR-81] - 81 mg Tablet, Delayed Release (E.C.) - 1
Tablet(s) by mouth once a day
CAMPHOR-MENTHOL [DERMASARRA] - 0.5 %-0.5 % Lotion - affected
area
twice a day


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain/temp/HA.
2. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): take while on pain medication.
Disp:*60 Capsule(s)* Refills:*0*
5. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
7. hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
R MCA aneurysm


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge 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 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.
??????	If you were on a medication such as Coumadin (Warfarin), or
Plavix (clopidogrel), or Aspirin, prior to your injury, you may
safely resume taking this on XXXXXXXXXXX.
??????	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 have 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.

Medications:
??????	Take Aspirin 325mg (enteric coated) once daily.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site
??????	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:
Follow-Up Appointment Instructions

??????Please return to the office in [**8-10**] days(from your date of
surgery) for removal of your staples/sutures and/or a wound
check. This appointment can be made with the Nurse Practitioner.
 Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you
live quite a distance from our office, please make arrangements
for the same, with your PCP.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.



Completed by:[**2184-5-15**]
{'Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Tobacco use disorder,Family history of other condition'}


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: headaches

PRESENT ILLNESS: Mr. [**Known lastname 32661**] is a 55-year-old male with a history of headaches
and a family history of three members who died from subarachnoid
hemorrhage.  He underwent routine screening MRA and was found to
have a right middle cerebral artery aneurysm.  He had a cererbal
angiogram bu tthe aneursym was not able to be successfully
coiled. He presented electively for a open craniotomy/clipping

MEDICAL HISTORY: HTN, arthritis, cocaine use, appendectomy

MEDICATION ON ADMISSION: AMLODIPINE - 2.5 mg Tablet - 1 Tablet(s) by mouth once a day
HYDROCHLOROTHIAZIDE - 12.5 mg Capsule - 1 Capsule(s) by mouth
once a day
LISINOPRIL - 40 mg Tablet - 1 Tablet(s) by mouth once a day
PRAVASTATIN - 40 mg Tablet - 1 Tablet(s) by mouth once a day
SELENIUM SULFIDE - 2.25 % Shampoo - lather, apply to skin,
shower
off 10 minutes later q d x 1 week, then biweekly - No
Substitution
SILDENAFIL [VIAGRA] - 50 mg Tablet - 1 Tablet(s) by mouth 1 hour

ALLERGIES: OxyContin

PHYSICAL EXAM: On Discharge: intact

FAMILY HISTORY: three members who died from subarachnoid hemorrhage.

SOCIAL HISTORY: +tobacco, +cocaine use 

### Response:
{'Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Tobacco use disorder,Family history of other condition'}
