CHIEF COMPLAINT: Left leg weakness and focal left leg seizures

PRESENT ILLNESS: 68 y/o right handed male with history of prostate CA diagnosed
three years ago presents today to [**Hospital1 18**] after several episodes
of
uncontrolled left leg shaking.

MEDICAL HISTORY: Prostate CA treated with seeds
HTN
MI in [**2123**]
Defibirlator and pacemaker placement [**2124**]

MEDICATION ON ADMISSION: ASA, Plavix, Coreg, Lisinopril, Protonix, Lipitor

ALLERGIES: Codeine

PHYSICAL EXAM: O: T:96.5  BP:140 /68         HR:56    R   16    O2Sats 100%

FAMILY HISTORY: NC

SOCIAL HISTORY: Quit smoking '[**92**]
No ETOH
Retired, but works part time at [**Location (un) 86**] Sports club
Secondary malignant neoplasm of brain and spinal cord,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Malignant neoplasm of other parts of bronchus or lung,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of prostate,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of tobacco use,Other specified cardiac dysrhythmias,Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus] and influenza
Sec mal neo brain/spine,Part epil w/o intr epil,Mal neo bronch/lung NEC,Other lung disease NEC,Hx-prostatic malignancy,Old myocardial infarct,Status autm crd dfbrltr,Hypertension NOS,Crnry athrscl natve vssl,History of tobacco use,Cardiac dysrhythmias NEC,Nd vac strp pnumn/inflnz
Admission Date:  [**2126-1-15**]              Discharge Date:   [**2126-1-25**]

Date of Birth:  [**2057-5-15**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Left leg weakness and focal left leg seizures

Major Surgical or Invasive Procedure:
Brain biopsy


History of Present Illness:
68 y/o right handed male with history of prostate CA diagnosed
three years ago presents today to [**Hospital1 18**] after several episodes
of
uncontrolled left leg shaking.

Patient provides history of approx 4 weeks ago when sitting on
the couch uncontrollable left leg shaking that last aprox 15
seconds. He again experienced this same shaking this past sunday
but multiple times in a row.  He has also started to notice
heavyness in his left leg with some difficulty completing a heal
to toe step motion.


Past Medical History:
Prostate CA treated with seeds
HTN
MI in [**2123**]
Defibirlator and pacemaker placement [**2124**]


Social History:
Quit smoking '[**92**]
No ETOH
Retired, but works part time at [**Location (un) 86**] Sports club


Family History:
NC

Physical Exam:
O: T:96.5  BP:140 /68         HR:56    R   16    O2Sats 100%

Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 5 to 3 b        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: [**1-31**] 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, to
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 [**4-4**] throughout, except left [**Last Name (un) 938**]
[**3-5**].
No pronator drift

unable to balance of toes or heals.

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

Reflexes: Hyper reflix throuhout 2+

Toes mute

Coordination: normal on finger-nose-finger

Exam on Discharge:
Neurologically intact with exception of slight left facialy


Pertinent Results:
CT torso
1) 3-mm pulmonary nodule within the left upper lobe and 1-mm
pulmonary nodule within the right middle lobe. Given the
patient's history of previous malignancy, followup chest CT is
recommended in 12 months.
2) Diverticulosis without diverticulitis.
3) Area of faint patchy sclerosis of the right seventh rib (3:49
and 400a:11)which could represent metastatic focus in patient
with history of prostate cancer. Please correlate with PSA
levels.

ECHO:
The left atrium is markedly dilated. The estimated right atrial
pressure is 0-5 mmHg. Left ventricular wall thicknesses are
normal. The left ventricular cavity is moderately dilated. There
is mild regional left ventricular systolic dysfunction with
severe hypokinesis of the distal lateral, distal septal, and
apical segments. There is mild hypokinesis of the remaining
segments (LVEF = 40 %). The estimated cardiac index is normal
(>=2.5L/min/m2). Right ventricular chamber size and free wall
motion are normal. The ascending aorta is mildly dilated. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. There is no aortic valve stenosis. Mild
(1+) aortic regurgitation is seen. The mitral valve leaflets are
structurally normal. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. There is borderline pulmonary
artery systolic hypertension. There is no pericardial effusion.

IMPRESSION: Left ventricular cavity enlargement with regional
and global systolic dysfunction c/w diffuse process (multivessel
CAD, toxin, metabolic, etc.) Mild aortic regurgitatio.


Brief Hospital Course:
Patient was admitted to [**Hospital1 18**] after presenting to the ER with
cheif complaint of left [**Last Name (un) **] shaking and heaviness felt to be
secondary to seizure activity.  head Ct showed mutlipel
intracranial lesions and he was admitted for workup.  He had a
CT torso which showed two lung lesions as well as a questionable
rib lesion.  An MRi was not obtained secondary to the patients
Pacemaker.  on [**1-17**] he was transferred from the ICU to the floor
while awaiting further treatment decisions. A conversation was
had with a colleague of his cardiologist who felt it was
appropriate to hold his Aspirin and Plavix for a biopsy of his
brain lesion early next week.

On the evening on [**1-19**] he had asymtomatic bradycardia to 38.
Telemetry was added. An EKG showed NSR at 45 bpm. External
reports in OMR allowed us to see his [**Hospital3 **] records from
placement of [**Company 1543**] pacer in [**12-10**] and last interrogation in
[**11-9**]. The low rate was 35 bpm. EP fellow was paged.

As a preoperative w/o patient had an ECHO performed that showed
mild left ventricular dilatation and an EF of 40 %. He underwent
a stereotactic brain biopsy on [**1-23**] without complications.

He will be discharged home w/o services and follow up in Brain
tumor clinic.

Medications on Admission:
ASA, Plavix, Coreg, Lisinopril, Protonix, Lipitor

Discharge Medications:
1. carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
2. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours):
Please stay on this medication while on steroids.
Disp:*40 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
5. levetiracetam 750 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
9. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*30 Tablet(s)* Refills:*0*
10. dexamethasone 2 mg Tablet Sig: One (1) Tablet PO As
directed: Take one pill TID s3 days, then 2 [**Hospital1 **] .
Disp:*60 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
multiple brain lesions


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. You may put a dressing on your wound if it
continues to ooz, when that stops you can leave it open to air.
??????	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.
 If you have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	If you are being sent home on steroid medication, make sure
you are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	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.
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: increasing redness,
increased swelling, increased tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
??????Please return to the office in [**6-9**] 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.
??????You have an appointment in the Brain [**Hospital 341**] Clinic on XXXXXXX.
The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 516**] of [**Hospital1 18**],
in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone number is
[**Telephone/Fax (1) 1844**]. Please call if you need to change your
appointment, or require additional directions. You should
recieve a call from them with an appointment time with in the
week, if you don't, please contact them.



Completed by:[**2126-1-25**]
{'Secondary malignant neoplasm of brain and spinal cord,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Malignant neoplasm of other parts of bronchus or lung,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of prostate,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of tobacco use,Other specified cardiac dysrhythmias,Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus] and influenza'}


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: Left leg weakness and focal left leg seizures

PRESENT ILLNESS: 68 y/o right handed male with history of prostate CA diagnosed
three years ago presents today to [**Hospital1 18**] after several episodes
of
uncontrolled left leg shaking.

MEDICAL HISTORY: Prostate CA treated with seeds
HTN
MI in [**2123**]
Defibirlator and pacemaker placement [**2124**]

MEDICATION ON ADMISSION: ASA, Plavix, Coreg, Lisinopril, Protonix, Lipitor

ALLERGIES: Codeine

PHYSICAL EXAM: O: T:96.5  BP:140 /68         HR:56    R   16    O2Sats 100%

FAMILY HISTORY: NC

SOCIAL HISTORY: Quit smoking '[**92**]
No ETOH
Retired, but works part time at [**Location (un) 86**] Sports club 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy,Malignant neoplasm of other parts of bronchus or lung,Other diseases of lung, not elsewhere classified,Personal history of malignant neoplasm of prostate,Old myocardial infarction,Automatic implantable cardiac defibrillator in situ,Unspecified essential hypertension,Coronary atherosclerosis of native coronary artery,Personal history of tobacco use,Other specified cardiac dysrhythmias,Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus] and influenza'}
