CHIEF COMPLAINT: headache

PRESENT ILLNESS: Mr. [**Known lastname **] is a 23 y/o male in previously good health who was
moving boxes on [**2129-8-18**] when he noted gradual onset headaches
which were localized mostly to the left frontal portion of his
head.  He took analgesics and noted some relief.  He denies head
trauma, loss of consciousness, or other associated neurological
symptoms.  After the pain improved, headache returned today
stronger than previously noted.  He presented to OSH where head
CT revealed left parieto-occipital hyperdensity consistent with
acute hemorrhage.  He was transferred to [**Hospital1 18**] ED for
neurosurgical evaluation.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM upon admission:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**3-20**] bilaterally  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-21**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives in apartment; denies tobacco or IVDU; social EtOH use
Benign neoplasm of cerebral meninges,Intracerebral hemorrhage,Other acute postoperative pain
Ben neo cerebr meninges,Intracerebral hemorrhage,Acute postop pain NEC
Admission Date:  [**2129-8-20**]              Discharge Date:   [**2129-8-28**]

Date of Birth:  [**2105-9-24**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
headache

Major Surgical or Invasive Procedure:
right craniotomy for tumor resection


History of Present Illness:
Mr. [**Known lastname **] is a 23 y/o male in previously good health who was
moving boxes on [**2129-8-18**] when he noted gradual onset headaches
which were localized mostly to the left frontal portion of his
head.  He took analgesics and noted some relief.  He denies head
trauma, loss of consciousness, or other associated neurological
symptoms.  After the pain improved, headache returned today
stronger than previously noted.  He presented to OSH where head
CT revealed left parieto-occipital hyperdensity consistent with
acute hemorrhage.  He was transferred to [**Hospital1 18**] ED for
neurosurgical evaluation.

Past Medical History:
none

Social History:
lives in apartment; denies tobacco or IVDU; social EtOH use


Family History:
non-contributory

Physical Exam:
PHYSICAL EXAM upon admission:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**3-20**] bilaterally  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-21**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 3 to 2 mm
bilaterally.
Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. No abnormal movements,
tremors. Strength full power [**5-23**] throughout. No pronator drift

Sensation: Intact to light touch, propioception, pinprick and
vibration bilaterally.

Toes downgoing bilaterally

Coordination: normal on finger-nose-finger, rapid alternating
movements, heel to shin

On Discharge:
Neurological examination was non-focal. AOX3, EOMI, no pronator
drift. Full motor strength and sensation throughout upper and
lower extremities.  Surgical incision was clean dry and intact.


Pertinent Results:
CT head [**2129-8-25**]:
FINDINGS: The patient is post left occipital craniotomy and
excision of the left posterior temporal occipital meningioma,
with expected degree of
pneumocephalus. There are tiny foci of high attenuation in the
postoperative bed, which may reflect presence of hemorrhage.
There is no hydrocephalus, shift of normally midline structures.
There is no mass effect or edema.

Left occipital craniotomy changes are evident on the bone
windows. Imaged
paranasal sinuses are pneumatized and well aerated.

IMPRESSION: Status post excision of left temporoparietal
meningioma, with
small foci of hemorrhage and expected postoperative changes.


[**2129-8-27**] 06:55AM BLOOD WBC-11.7* RBC-4.70 Hgb-14.1 Hct-39.8*
MCV-85 MCH-30.0 MCHC-35.4* RDW-12.4 Plt Ct-356
[**2129-8-27**] 06:55AM BLOOD Glucose-104 UreaN-7 Creat-0.6 Na-139
K-4.4 Cl-100 HCO3-27 AnGap-16
[**2129-8-27**] 06:55AM BLOOD Calcium-9.4 Phos-3.2 Mg-2.1

Brief Hospital Course:
 Mr. [**Known lastname **] is a 23 y/o male in previously good health who was
moving boxes on [**2129-8-18**] when he noted gradual onset headaches
which were localized mostly to the left frontal portion of his
head.  He took analgesics and noted some relief. After the pain
improved, headache returned the following day with stronger
intensity, prompting his going to the ED for evaluation.

By CT an area of questionable mass was identified in the occiput
and further work-up was done and inclusive of MRI, CTA/V.  An
angiogram was desired, however this was refused by the patient,
as he "didn't feel good about it".  He went to the OR for
resection of this mass via a posteriorly placed incision, and
tolerated the procedure well. He was maintained in the ICU
overnight for monitoring, and transferred to [**Hospital Ward Name **] 11 floor
status to following day.  He was evaluated by PT on POD#2, and
determined to be appropriate for home discharge, however the
patient continued to be hospitalized secondary to pain
Management issues.  Narcotic agents were changed, and an
anti-spasmodic was added, which made a marked difference in pain
relief.  On [**8-28**], he was discharged to home without further
physical therapy needs, and instructions to follow up as noted
previously in this document.

Medications on Admission:
None

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours) for
5 days.
Disp:*5 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
2. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed.
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. Phenytoin Sodium Extended 200 mg Capsule Sig: One (1) Capsule
PO BID (2 times a day).
Disp:*60 Capsule(s)* Refills:*2*
5. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) for 3 doses.
Disp:*3 Tablet(s)* Refills:*0*
6. Dexamethasone 0.5 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day) for 3 doses.
Disp:*6 Tablet(s)* Refills:*0*
7. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours
as needed.
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
left parieto-occipital meningioma


Discharge Condition:
neurologically stable


Discharge Instructions:
DISCHARGE INSTRUCTIONS FOR CRANIOTOMY/HEAD INJURY

??????Have a 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,
excessive bending
??????You may wash your hair only after sutures have been removed
??????You may shower before this time with assistance and use of a
shower cap
??????Increase your intake of fluids and fiber as pain medicine
(narcotics) can cause constipation
??????Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, aspirin, Advil,
Ibuprofen etc.
??????If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing as
ordered
??????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, drainage
??????Fever greater than or equal to 101?????? F


Followup Instructions:
Follow-up in Brain [**Hospital 341**] Clinic on the [**Location (un) 858**] of the [**Hospital Ward Name 5074**].
The appointment will be with [**Name6 (MD) 5005**] [**Last Name (NamePattern4) 5342**], MD
Phone:[**Telephone/Fax (1) 44**] Date/Time:[**2129-9-5**] 4:00pm.

You will have your sutures removed at that time as well.



Completed by:[**2129-8-28**]
{'Benign neoplasm of cerebral meninges,Intracerebral hemorrhage,Other acute postoperative pain'}


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: headache

PRESENT ILLNESS: Mr. [**Known lastname **] is a 23 y/o male in previously good health who was
moving boxes on [**2129-8-18**] when he noted gradual onset headaches
which were localized mostly to the left frontal portion of his
head.  He took analgesics and noted some relief.  He denies head
trauma, loss of consciousness, or other associated neurological
symptoms.  After the pain improved, headache returned today
stronger than previously noted.  He presented to OSH where head
CT revealed left parieto-occipital hyperdensity consistent with
acute hemorrhage.  He was transferred to [**Hospital1 18**] ED for
neurosurgical evaluation.

MEDICAL HISTORY: none

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PHYSICAL EXAM upon admission:
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: [**3-20**] bilaterally  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**3-21**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives in apartment; denies tobacco or IVDU; social EtOH use 

### Response:
{'Benign neoplasm of cerebral meninges,Intracerebral hemorrhage,Other acute postoperative pain'}
