CHIEF COMPLAINT: Facial Numbness

PRESENT ILLNESS: Ms. [**Known lastname 3444**] is a 40 yo woman with metastatic breast CA to bone
direct admitted to the floor for metastasis of the sphenoid
encoroaching on the posterior wall of the L orbit & mandibular
mets causing orbital pain, periorbital and mental numbness. She
has noted these symptoms since about [**12-16**] and they have
progressed from tingling to numbness. She is also seeing black
spots on her vision. She also notes for the past 2 weeks she has
had weakness &numbness of her LLE, for the past 1 week she has
been unable to flex her hip, extend her knee, or dorsiflex her
foot. She also complains of low back pain. This morning she had
difficulty holding her urine to make it to the bath room. Denies
any peri-anal numbness.
.
She presented to the ED on [**12-19**] with a few days of numbness in L
side of face, down her body, etc. CT scan was non-diagnostic and
she left AMA. Open MRI (see below) showed bony disease of the
greater wings of sphenoid, extending into the optic canal, and
bony involvement of the mandible approaching the inferior
alveolar nerve canal.

MEDICAL HISTORY: Metastatic breast cancer with verterbral metastasis s/p XRT to
thoracic spine & chemotherapy
HTN
Morbid Obesity
Depression
Anemia
Post partum cardiomyopathy- EF now improved to 45-50%
h/o peritonsillar abscess [**2101**] s/p I&D
?transfusion reaction recently
?anxiety

MEDICATION ON ADMISSION: albuterol prn
flexeril 5-10mg po q 6 H prn
hctz 25mg po daily
lisinopril 30mg po daily
Toprol XL 100mg po daily
oxycontin 20mg po bid
percocet 1-2 tabs po q 4-6 hrs prn
zometa q month
MVI

ALLERGIES: Iodine; Iodine Containing / Morphine / Oxycontin

PHYSICAL EXAM: T 97.5 HR 95 BP 130/95 RR 16 100%RA
GENERAL: NAD, AOX3, Speaking in full sentences
HEENT: PEERLA, No scleral icterus.
CV: S1 S2 No M/R/G
PULM: Clear to ausculation bilaterally
ABDOMEN: Morbid Obesity, soft, Non-Tender, Non-Distended, BS+
EXTREMITY: No cyanosis, clubbing or edema
NEURO: Alert and Oriented x3. Pt unable to move L eye up and
lateral without discomfort. Left sided V1-V3 lacking sensation.
Bilateral mental area lacking sensation. Mild left facial droop.
Right V1-V2 WNL. 5/5 Strength and Sensation in Upper Extremities
Bilaterally. 5/5 Strength and sensation R LE. 1/5 Strength in
LLE extensors. No sensation on mid and anterior thigh. Sacral
area with normal sensation bilaterally. Anal wink intact.
Equivocal 1+ reflexes due to pt's habitus. Equivocal babinski
signs bilaterally.

FAMILY HISTORY: Aunt with [**Name2 (NI) 499**] cancer at 46. Grandmother had leukemia. Mother:
diabetes. [**Hospital 5772**] medical history unknown to patient.

SOCIAL HISTORY: Lives at home with husband and children. smoking [**1-17**] cigarettes
per day
Secondary malignant neoplasm of bone and bone marrow,Peripartum cardiomyopathy, postpartum condition or complication,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Other facial nerve disorders,Other disorders of optic nerve,Urinary incontinence, unspecified,Malignant neoplasm of other specified sites of female breast,Estrogen receptor positive status [ER+],Other specified visual disturbances,Anemia in neoplastic disease,Morbid obesity,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Depressive disorder, not elsewhere classified,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health
Secondary malig neo bone,Peripartum card-postpart,Mal neo lymph-axilla/arm,Facial nerve dis NEC,Optic nerve disorder NEC,Urinary incontinence NOS,Malign neopl breast NEC,Estrogen recep pstv stat,Visual disturbances NEC,Anemia in neoplastic dis,Morbid obesity,Hypertension NOS,Anxiety state NOS,Tobacco use disorder,Depressive disorder NEC,Hx antineoplastic chemo,Hx of irradiation
Admission Date:  [**2103-12-21**]              Discharge Date:   [**2103-12-23**]

Date of Birth:  [**2063-8-23**]             Sex:   F

Service: MEDICINE

Allergies:
Iodine; Iodine Containing / Morphine / Oxycontin

Attending:[**First Name3 (LF) 477**]
Chief Complaint:
Facial Numbness

Major Surgical or Invasive Procedure:
Mechanical Ventilation


History of Present Illness:
Ms. [**Known lastname 3444**] is a 40 yo woman with metastatic breast CA to bone
direct admitted to the floor for metastasis of the sphenoid
encoroaching on the posterior wall of the L orbit & mandibular
mets causing orbital pain, periorbital and mental numbness. She
has noted these symptoms since about [**12-16**] and they have
progressed from tingling to numbness. She is also seeing black
spots on her vision. She also notes for the past 2 weeks she has
had weakness &numbness of her LLE, for the past 1 week she has
been unable to flex her hip, extend her knee, or dorsiflex her
foot. She also complains of low back pain. This morning she had
difficulty holding her urine to make it to the bath room. Denies
any peri-anal numbness.
.
She presented to the ED on [**12-19**] with a few days of numbness in L
side of face, down her body, etc. CT scan was non-diagnostic and
she left AMA. Open MRI (see below) showed bony disease of the
greater wings of sphenoid, extending into the optic canal, and
bony involvement of the mandible approaching the inferior
alveolar nerve canal.


Past Medical History:
Metastatic breast cancer with verterbral metastasis s/p XRT to
thoracic spine & chemotherapy
HTN
Morbid Obesity
Depression
Anemia
Post partum cardiomyopathy- EF now improved to 45-50%
h/o peritonsillar abscess [**2101**] s/p I&D
?transfusion reaction recently
?anxiety


Social History:
Lives at home with husband and children. smoking [**1-17**] cigarettes
per day


Family History:
Aunt with [**Name2 (NI) 499**] cancer at 46. Grandmother had leukemia. Mother:
diabetes. [**Hospital 5772**] medical history unknown to patient.


Physical Exam:
T 97.5 HR 95 BP 130/95 RR 16 100%RA
GENERAL: NAD, AOX3, Speaking in full sentences
HEENT: PEERLA, No scleral icterus.
CV: S1 S2 No M/R/G
PULM: Clear to ausculation bilaterally
ABDOMEN: Morbid Obesity, soft, Non-Tender, Non-Distended, BS+
EXTREMITY: No cyanosis, clubbing or edema
NEURO: Alert and Oriented x3. Pt unable to move L eye up and
lateral without discomfort. Left sided V1-V3 lacking sensation.
Bilateral mental area lacking sensation. Mild left facial droop.
Right V1-V2 WNL. 5/5 Strength and Sensation in Upper Extremities
Bilaterally. 5/5 Strength and sensation R LE. 1/5 Strength in
LLE extensors. No sensation on mid and anterior thigh. Sacral
area with normal sensation bilaterally. Anal wink intact.
Equivocal 1+ reflexes due to pt's habitus. Equivocal babinski
signs bilaterally.


Pertinent Results:
Admission Labs:
[**2103-12-20**] 10:22AM   WBC-4.9 RBC-3.01* HGB-8.7* HCT-26.0* MCV-86
MCH-29.0 MCHC-33.6 RDW-19.5*
[**2103-12-20**] 10:22AM   PLT COUNT-245
[**2103-12-20**] 10:22AM   GRAN CT-3332
[**2103-12-20**] 10:22AM   CEA-100* CA27.29-3139*
[**2103-12-20**] 10:22AM   ALBUMIN-3.8 CALCIUM-9.7 PHOSPHATE-4.9*
MAGNESIUM-1.8
[**2103-12-20**] 10:22AM   ALT(SGPT)-36 AST(SGOT)-94* LD(LDH)-608* ALK
PHOS-108 TOT BILI-0.6
[**2103-12-20**] 10:22AM   UREA N-9 CREAT-0.8 SODIUM-143 POTASSIUM-4.3
CHLORIDE-105 TOTAL CO2-28 ANION GAP-14
[**2103-12-20**] 12:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5
LEUK-NEG
.
EXAM: MRI of the cervical, thoracic, and lumbar spine.
CLINICAL INFORMATION: Patient with left lower extremity weakness
and urinaryincontinence, rule out cord compression.

CERVICAL SPINE:

TECHNIQUE: T1, T2 and inversion recovery sagittal and
gradient-echo axial
images of cervical spine were acquired.

FINDINGS: Diffuse metastatic lesions are identified in the
cervical vertebral
bodies on the partially visualized upper thoracic region. Mild
compression of
the inferior endplate of C7 vertebra and mild anterior wedging
of T4 vertebra
are identified. There is no cord compression seen or epidural
mass. The
post-gadolinium cervical images are somewhat limited by motion.
There is no
abnormal signal seen within the spinal cord. Endotracheal tube
is visualized
with retained secretions in the nasopharynx.

IMPRESSION: Diffuse bony metastatic disease. No cord compression
seen.

THORACIC SPINE:

TECHNIQUE: T1, T2 and inversion recovery sagittal and T2 axial
images were
obtained before gadolinium. T1 sagittal and axial images were
obtained
following the administration of gadolinium.

FINDINGS: Diffuse bony metastatic lesions are identified in the
thoracic
region. No evidence of epidural mass or spinal cord compression
seen. Mild
wedging of the T4, T6, T10, and T12 vertebral bodies noted.
There is no
evidence of intrinsic spinal cord signal abnormalities
identified. No acute
compression fracture seen. Diffuse metastatic lesions are
identified in the
liver and also an area of atelectasis seen in the left lower
lung.

IMPRESSION: Diffuse bony metastasis. No abnormal intraspinal
enhancement. No
cord compression.

LUMBAR SPINE:

TECHNIQUE: T1, T2 and inversion recovery sagittal and T2 axial
images were
obtained before gadolinium. T1 sagittal and axial images were
obtained
following the administration of gadolinium.

FINDINGS: Diffuse bony metastasis is identified in the lumbar
region and in
the visualized sacrum. There is no evidence of high-grade thecal
sac
compression identified. No epidural mass is seen.

At L4-5, there is diffuse disc bulge identified indenting the
thecal sac with
mild left-sided and moderate right-sided foraminal narrowing.
The disc
bulging and a small protrusion is in contact with exiting right
[**Name (NI) 5774**] nerve root
at this level.

At L5-S1 level, mild disc bulging identified.

IMPRESSION: Diffuse bony metastatic disease. No evidence of
epidural mass or
high-grade thecal sac compression. Degenerative changes in the
lower lumbar
region as described above.

COMMENT: Compared to the previous MRI of [**2102-7-5**], there appears
to be some
progression of bony metastatic lesions in the spine. No epidural
mass is
seen. The degenerative changes in the lumbar region appear
stable.
.
Pertinent Labs:
[**2103-12-22**] 05:14AM BLOOD calTIBC-298 VitB12-> [**2094**] Folate-8.4
Ferritn-> [**2094**] TRF-229
[**2103-12-22**] 05:14AM BLOOD Calcium-9.8 Phos-5.9* Mg-1.6 Iron-245*

Brief Hospital Course:
40F with metastatic breast CA to bone presenting with facial
numbness and leg weakness and urinary incontinence.
.
# Mental Numbness: The patient presented with left sided facial
weakness and bilateral mental numbness. This was thought to be
secondary to metastic disease. The patient was given decadron
10mg IV x 1, and then 4mg po q6hrs. The patient underwent a
single cranial XRT treatment and subsequently her left sided
facial weakness and numbness resolved. Neuro-Onc was consulted
and stated "This is most likely localized in the jaw
but not in the principal or spinal gnaglia of V." The patient
stated her mental numbess was much improved at the time of
discharge.
.
# Left Sided Visual Changes: The patient reported black spots in
her vision upon presentation. This was thought to be second to
optic nerve compression secondary to tumor. Neuro was consulted
and stated "The
tumor to the optical canal explains the eyes symptoms."
Following dexamthasone and XRT the patients symptoms resolved.
.
# Leg Weakness and r/o Cord Comprssion: The patient reported 5
to 7 day history of left lower extremity and numbness prior to
admission. In addition she had noted urinary incontinence. The
initial differential included deficits to cord compression vs a
central process. It thought to be unlikely a central process due
to sparing her arms. The patient was seen by neurology,
neuro-onc and rad-onc. The patient underwent a MRI spine
(requiring subsequent intubation and transfer to the unit for
extubation, details of which are above), that did not reveal
evidence of cord compression. The patient continued to receive
PO dexamethasone and subsequently her leg weakness and numbness
completely at the time of discharge.
.
# Anemia of Chronic Disease: The patient presented with a Hct of
26. Iron studies that were sent that were consistent with anemia
of chronic disease. The patient's Hct at discharge was 24.5. The
patient did not receive transfusions during her hospital course.
The patient should have her hematocrit checked this week.

Medications on Admission:
albuterol prn
flexeril 5-10mg po q 6 H prn
hctz 25mg po daily
lisinopril 30mg po daily
Toprol XL 100mg po daily
oxycontin 20mg po bid
percocet 1-2 tabs po q 4-6 hrs prn
zometa q month
MVI


Discharge Medications:
1. Metoprolol Succinate 100 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO at bedtime.
2. Lisinopril 10 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).
3. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed.
4. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1)
Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
5. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: One (1) Tablet
PO Q4H (every 4 hours) as needed.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO
DAILY (Daily).
9. Flexeril 10 mg Tablet Sig: One (1) Tablet PO four times a
day.
10. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO three times
a day.
Disp:*21 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis
- Metstatic Breast CA
- Mental Neuropathy
- r/o Cord Compression
- r/o Left Optic Nerve Compression


Discharge Condition:
Good. Patients left lower extremity weakness completly resolved.
Left lower extremity numbness completely resolved. Left visual
changes completely resolved. Left facial numbess resolved with
exception to mild numbess on the patients chin. Patient
ambulating and at her mental and physical baseline.


Discharge Instructions:
You were admitted to hosptial with facial numbness, blurred
vision in your left eye and left leg weakness and numbness. You
were intubated and underwent an MRI. You received one dose of
radiation.
.
Please continue to take all of your medications as listed below.
.
Please keep all of your appointments.
.
Please return to hospital if you experience worsening back pain,
loss of urine or stool, numbess in your lower extremities,
fevers, chills, shortness of breath, worsening visual changes.
Please stop smoking. Information was given to you on admission
regarding smoking cessation.

Followup Instructions:
Please follow-up with your PCP [**Name Initial (PRE) 176**] 1-2 weeks of discharge.
.
Please call Dr. [**First Name4 (NamePattern1) 1356**] [**Last Name (NamePattern1) 5775**] office tomorrow for follow-up.
.
Radiation Oncology plans to call you on Monday morning to
schedule follow-up.


                             [**Name6 (MD) **] [**Name8 (MD) 490**] MD, [**MD Number(3) 491**]
{'Secondary malignant neoplasm of bone and bone marrow,Peripartum cardiomyopathy, postpartum condition or complication,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Other facial nerve disorders,Other disorders of optic nerve,Urinary incontinence, unspecified,Malignant neoplasm of other specified sites of female breast,Estrogen receptor positive status [ER+],Other specified visual disturbances,Anemia in neoplastic disease,Morbid obesity,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Depressive disorder, not elsewhere classified,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}


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: Facial Numbness

PRESENT ILLNESS: Ms. [**Known lastname 3444**] is a 40 yo woman with metastatic breast CA to bone
direct admitted to the floor for metastasis of the sphenoid
encoroaching on the posterior wall of the L orbit & mandibular
mets causing orbital pain, periorbital and mental numbness. She
has noted these symptoms since about [**12-16**] and they have
progressed from tingling to numbness. She is also seeing black
spots on her vision. She also notes for the past 2 weeks she has
had weakness &numbness of her LLE, for the past 1 week she has
been unable to flex her hip, extend her knee, or dorsiflex her
foot. She also complains of low back pain. This morning she had
difficulty holding her urine to make it to the bath room. Denies
any peri-anal numbness.
.
She presented to the ED on [**12-19**] with a few days of numbness in L
side of face, down her body, etc. CT scan was non-diagnostic and
she left AMA. Open MRI (see below) showed bony disease of the
greater wings of sphenoid, extending into the optic canal, and
bony involvement of the mandible approaching the inferior
alveolar nerve canal.

MEDICAL HISTORY: Metastatic breast cancer with verterbral metastasis s/p XRT to
thoracic spine & chemotherapy
HTN
Morbid Obesity
Depression
Anemia
Post partum cardiomyopathy- EF now improved to 45-50%
h/o peritonsillar abscess [**2101**] s/p I&D
?transfusion reaction recently
?anxiety

MEDICATION ON ADMISSION: albuterol prn
flexeril 5-10mg po q 6 H prn
hctz 25mg po daily
lisinopril 30mg po daily
Toprol XL 100mg po daily
oxycontin 20mg po bid
percocet 1-2 tabs po q 4-6 hrs prn
zometa q month
MVI

ALLERGIES: Iodine; Iodine Containing / Morphine / Oxycontin

PHYSICAL EXAM: T 97.5 HR 95 BP 130/95 RR 16 100%RA
GENERAL: NAD, AOX3, Speaking in full sentences
HEENT: PEERLA, No scleral icterus.
CV: S1 S2 No M/R/G
PULM: Clear to ausculation bilaterally
ABDOMEN: Morbid Obesity, soft, Non-Tender, Non-Distended, BS+
EXTREMITY: No cyanosis, clubbing or edema
NEURO: Alert and Oriented x3. Pt unable to move L eye up and
lateral without discomfort. Left sided V1-V3 lacking sensation.
Bilateral mental area lacking sensation. Mild left facial droop.
Right V1-V2 WNL. 5/5 Strength and Sensation in Upper Extremities
Bilaterally. 5/5 Strength and sensation R LE. 1/5 Strength in
LLE extensors. No sensation on mid and anterior thigh. Sacral
area with normal sensation bilaterally. Anal wink intact.
Equivocal 1+ reflexes due to pt's habitus. Equivocal babinski
signs bilaterally.

FAMILY HISTORY: Aunt with [**Name2 (NI) 499**] cancer at 46. Grandmother had leukemia. Mother:
diabetes. [**Hospital 5772**] medical history unknown to patient.

SOCIAL HISTORY: Lives at home with husband and children. smoking [**1-17**] cigarettes
per day 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Peripartum cardiomyopathy, postpartum condition or complication,Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb,Other facial nerve disorders,Other disorders of optic nerve,Urinary incontinence, unspecified,Malignant neoplasm of other specified sites of female breast,Estrogen receptor positive status [ER+],Other specified visual disturbances,Anemia in neoplastic disease,Morbid obesity,Unspecified essential hypertension,Anxiety state, unspecified,Tobacco use disorder,Depressive disorder, not elsewhere classified,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}
