CHIEF COMPLAINT: seizure

PRESENT ILLNESS: The pt is a 25 year-old male with a past medical history
significant for a seizure disorder and by report on phenytoin
and
has issues with medication compliance presents with an episode
of
status while at work.

MEDICAL HISTORY: -GTC since age 18, treated with dilantin monotherapy and briefly
with Lamictal as well, likely noncompliant. Apparently he saw
his
Neurologist (Dr. [**Last Name (STitle) 74474**] at [**Location (un) 12021**]) on [**2-14**] and his
dilantin dose was decreased from 400mg PO BID to 300mg PO BID.
-GERD

MEDICATION ON ADMISSION: Dilantin 100 mg q AM/ 200 mg PO q PM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Intubated and sedated, will follow some commands when
off propofol
HEENT: Intubated, appears to have small tongue laceration not
actively bleeding
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Coarse mechanical breath sounds bilaterally
Cardiac: RRR, nl. S1S2
Abdomen: soft, NT/ND, normoactive bowel sounds
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.

FAMILY HISTORY: 

SOCIAL HISTORY: -Unemployed, lives with his girlfriend
-[**Name (NI) 1139**]: 2ppd
-Etoh: girlfriend denies use
-Drugs: intermittent Marijuana use, also has been taking unknown
doses of ativan in unknown frequencies which he does not obtain
from his physician
Epilepsy, unspecified, without mention of intractable epilepsy
Epilep NOS w/o intr epil
Admission Date:  [**2119-1-10**]              Discharge Date:   [**2119-1-11**]

Date of Birth:  [**2092-10-17**]             Sex:   M

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
seizure

Major Surgical or Invasive Procedure:
none

History of Present Illness:
The pt is a 25 year-old male with a past medical history
significant for a seizure disorder and by report on phenytoin
and
has issues with medication compliance presents with an episode
of
status while at work.

The history is obtained solely from the outside records.  There
was  number for the patient's family however there is currently
no answer.

The patient was apparently at work this morning when he had a
seizure.  He has a history of seizures and is on PHT by report.
The [**Location (un) 8641**] notes stated that he has frequent admissions for
seizures and he is apparently not very compliant with his
medications.  Today after his seizure he was post ictal and then
had another seizure.  By report he had a number of seizures and
did not clearly return to baseline between them.  EMS was called
and he was transferred to [**Hospital 8641**] hospital.

At [**Location (un) 8641**] he was still noted to be seizing.  He was given a
total
of 8mg of Ativan (although the last 1-2mg appears to be for
agitation).  His PHT level was checked and noted to be
sub-therapeutic 6.3.  He was given a load of 750mg.  There was
concern that the patient was still seizing (although unclear if
it was before or after the load) and he was intubated and
sedated.  A head CT was obtained which was normal.  He was noted
to have a low grade temp of 100.1 and was started on
ceftriaxone.
His last recorded seizure was about 11am.  It was decided to
send
the patient to [**Hospital1 18**] for further evaluation.

Here the patient had an LP, and neurology was called for further
evaluation.

On neuro ROS and GROS are currently unavailable


Past Medical History:
-GTC since age 18, treated with dilantin monotherapy and briefly
with Lamictal as well, likely noncompliant. Apparently he saw
his
Neurologist (Dr. [**Last Name (STitle) 74474**] at [**Location (un) 12021**]) on [**2-14**] and his
dilantin dose was decreased from 400mg PO BID to 300mg PO BID.
-GERD


Social History:
-Unemployed, lives with his girlfriend
-[**Name (NI) 1139**]: 2ppd
-Etoh: girlfriend denies use
-Drugs: intermittent Marijuana use, also has been taking unknown
doses of ativan in unknown frequencies which he does not obtain
from his physician


Physical Exam:
General: Intubated and sedated, will follow some commands when
off propofol
HEENT: Intubated, appears to have small tongue laceration not
actively bleeding
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Coarse mechanical breath sounds bilaterally
Cardiac: RRR, nl. S1S2
Abdomen: soft, NT/ND, normoactive bowel sounds
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.

Neurologic:
-Mental Status: Intubated and sedated.  When off propofol for
about 10-15 minutes will open eyes to noxious stimulation and
look around the room, will maintain wakefulness.  Follow axial
commands and would intermittently follow appendicular commands.
Squeezed and released left hand and showed 2 fingers on right
hand.  He would then buck vent and become agitated and required
re-sedation.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VFF to threat
III, [**Known lastname **], VI: EOMI without nystagmus.
V, VII: corneal reflexes intact bilaterally
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Gag and cough present

-Motor: Normal bulk, tone throughout.  As he comes off sedation
he spontaneously moves all four extremities with equal and
likely
full strength.  Movements are purposeful.

-Sensory: Withdraws to stimulation at all 4 ext

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  2  2    2    1   1
R  2  2    2    1   1
Plantar briskly withdrew both feet, unclear direction of toe


Pertinent Results:
[**2119-1-10**] 03:39PM   TYPE-ART TIDAL VOL-500 PEEP-5 PO2-102 PCO2-43
PH-7.39 TOTAL CO2-27 BASE XS-0 -ASSIST/CON INTUBATED-INTUBATED
[**2119-1-10**] 03:25PM URINE  HOURS-RANDOM
[**2119-1-10**] 03:25PM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2119-1-10**] 03:25PM URINE  COLOR-Yellow APPEAR-Cloudy SP [**Last Name (un) 155**]-1.012
[**2119-1-10**] 03:25PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-25
GLUCOSE-100 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2119-1-10**] 03:25PM URINE  RBC->50 WBC-[**7-21**]* BACTERIA-MANY
YEAST-NONE EPI-0-2
[**2119-1-10**] 03:00PM CEREBROSPINAL FLUID (CSF)  PROTEIN-56*
GLUCOSE-102
[**2119-1-10**] 03:00PM CEREBROSPINAL FLUID (CSF)  WBC-1 RBC-0 POLYS-0
LYMPHS-86 MONOS-14
[**2119-1-10**] 02:39PM   COMMENTS-GREEN TOP
[**2119-1-10**] 02:39PM   GLUCOSE-80 LACTATE-1.4 NA+-143 K+-3.8 CL--103
TCO2-27
[**2119-1-10**] 02:35PM   UREA N-8 CREAT-1.0
[**2119-1-10**] 02:35PM   estGFR-Using this
[**2119-1-10**] 02:35PM   CK(CPK)-190
[**2119-1-10**] 02:35PM   LIPASE-18
[**2119-1-10**] 02:35PM   PHENYTOIN-14.6
[**2119-1-10**] 02:35PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2119-1-10**] 02:35PM   WBC-14.3* RBC-4.84 HGB-14.6 HCT-40.9 MCV-85
MCH-30.1 MCHC-35.6* RDW-14.3
[**2119-1-10**] 02:35PM   PT-12.6 PTT-23.2 INR(PT)-1.1
[**2119-1-10**] 02:35PM   PLT COUNT-318
[**2119-1-10**] 02:35PM   FIBRINOGE-186

Brief Hospital Course:
The pt is a 25 year-old male with a past medical history
significant for a seizure disorder and by report on phenytoin
and has issues with medication compliance presents with an
episode of status while at work.  He had witnessed seizure at
work and then was post ictal and had a number of seizures
without full returning to baseline.  This continued for
approximately 90 minutes.  He was taken by EMS to [**Hospital 8641**]
hospital where he was still noted to be seizing.  He was noted
to have a
sub-therapeutic Dilantin level of 6.3, and a low grade temp of
100.1.  He was given a total of 8mg of Ativan and loaded with
750mg of PHT.  He had a head CT which was normal.  During this
time he was intubated and sedated and transferred to [**Hospital1 18**].

HOSPITAL COURSE:
His last seizure noted from the records was at 11am on the day
that he was transferred to [**Hospital1 18**].  Here he had an LP which was
normal and did not show any signs of an infection. He was
initially sedated and intubated. He was admitted to the ICU
overnight, self extubated and was breathing well on room air.
In the morning patinet was doing well. His neuro exam was
completely normal and nonfocal. He had a normal mental status
exam, although he was someone irritated and angry that he was
transferred to [**Location (un) 86**] and demanded that he would be discharged
asap.  He was afebrile.  His neurologist was contact[**Name (NI) **] ([**Name (NI) 6692**],
[**Name8 (MD) **] MD) at [**Telephone/Fax (1) 76650**] to discuss his previous treatment plan
and the plan that we were going to put in place considering his
discharge.  The Dilantin level was therapeutic at 20.

Patient was found to have a history of GTC epilepsy.  Patient
was found to be on a dilantin [**Doctor Last Name 2949**].  Initially on 400 mg [**Hospital1 **] X
14 days.  On [**12-13**] take 300 [**Hospital1 **] X 7 days, then 200 [**Hospital1 **] X 7 days,
then 100 [**Hospital1 **] X 7 days, then 1 daily X 7 days.  Patient was also
started on Keppra XR 1500 nightly.  Patient was feeling well and
was requesting to go home and follow up with his neurologist.
Patient was currently taking 100 in the morning and 200 mg in
the evening of the dilantin prior to admission.

It is unclear the exact cause of his seizure.  However, it may
relate to his tapering of dilantin.  Patient was to be d/c on
Dilantin 100 mg PO TID and Keppra 1500 mg PO qHS.  He was
strongly encouraged to follow up with his Neurologist within the
next 7-10 days. His PCP and his Neurologist were informed about
his status and that he was discharged from our hospital.


Medications on Admission:
Dilantin 100 mg q AM/ 200 mg PO q PM

Discharge Medications:
1. phenytoin 50 mg Tablet, Chewable Sig: Two (2) Tablet,
Chewable PO three times a day.
Disp:*180 Tablet, Chewable(s)* Refills:*3*
2. Keppra XR 750 mg Tablet Sustained Release 24 hr Sig: Two (2)
Tablet Sustained Release 24 hr PO at bedtime.
Disp:*60 Tablet Sustained Release 24 hr(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Seizures


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


Discharge Instructions:
You were admitted after being found to have a set of seizures
lasting around 90 minutes. You were initially taken by EMS to
[**Hospital 8641**] hospital where you were noted to still be seizing. You
were found to have a low dilantin level of 6.3, and a low grade
temp of 100.1.  You had a head CT which was normal.  Your
neurologist was contact[**Name (NI) **] ([**Name (NI) 6692**], [**Name8 (MD) **] MD) at [**Telephone/Fax (1) 76650**].
Dilantin was therapeutic at 20 in the morning.

You were found to be in the course of a Dilantin taper which had
initially started at 400 mg [**Hospital1 **], but you were currently taking
100 mg in the morning and 200 mg at night.  You were also to be
taking Keppra XR 1500 mg daily.

With a therapeutic level of dilantin. You requested to go home,
and therefore we sent you home on Dilantin 100 mg three times
daily, and your keppra XR 1500 mg nightly.  You are to follow up
within the week to your Neurologist




It is unclear the exact cause of his seizure.  However, it may


relate to his tapering of dilantin.  Patient was to be d/c on


Dilantin 100 mg PO TID and Keppra 1500 mg PO qHS.  He should


follow up with his Neurologist within the next 7-10 days.



Followup Instructions:
[**Last Name (LF) 6692**], [**Name8 (MD) **] MD - Within the week
Phone number [**Telephone/Fax (1) 76650**]
[**Apartment Address(1) 76651**]
[**Location (un) 8641**], [**Numeric Identifier 59342**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2119-1-11**]
{'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: seizure

PRESENT ILLNESS: The pt is a 25 year-old male with a past medical history
significant for a seizure disorder and by report on phenytoin
and
has issues with medication compliance presents with an episode
of
status while at work.

MEDICAL HISTORY: -GTC since age 18, treated with dilantin monotherapy and briefly
with Lamictal as well, likely noncompliant. Apparently he saw
his
Neurologist (Dr. [**Last Name (STitle) 74474**] at [**Location (un) 12021**]) on [**2-14**] and his
dilantin dose was decreased from 400mg PO BID to 300mg PO BID.
-GERD

MEDICATION ON ADMISSION: Dilantin 100 mg q AM/ 200 mg PO q PM

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: General: Intubated and sedated, will follow some commands when
off propofol
HEENT: Intubated, appears to have small tongue laceration not
actively bleeding
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
Pulmonary: Coarse mechanical breath sounds bilaterally
Cardiac: RRR, nl. S1S2
Abdomen: soft, NT/ND, normoactive bowel sounds
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.

FAMILY HISTORY: 

SOCIAL HISTORY: -Unemployed, lives with his girlfriend
-[**Name (NI) 1139**]: 2ppd
-Etoh: girlfriend denies use
-Drugs: intermittent Marijuana use, also has been taking unknown
doses of ativan in unknown frequencies which he does not obtain
from his physician 

### Response:
{'Epilepsy, unspecified, without mention of intractable epilepsy'}
