CHIEF COMPLAINT: seizures

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old woman with a recent
cardiopulmonary arrest of unknown etiology and seizures who has
been transferred from [**Hospital1 **] [**Location (un) 620**] for further management of
suspected status epilepticus. This history was obtained from
discussion with her son [**Name (NI) 333**] and from review of the medical
record. On [**2108-2-18**] she was found down at her residence and was
noted to be bradycardic, hypotensive, hypothermic, and
lethargic.
She was transported to an ED at Upstate [**Location (un) **] Hospital in
NY
where she had a cardiopulmonary arrest and was intubated and
resuscitated. The intubation was difficult and she was found to
have a mediastinal mass (multinodular goiter with papillary
microcarcinoma, which was removed). She had a complicated
hospital course with hospital-associated pneumonia, lung
collapse
s/p bronchoscopy, sepsis, corneal abrasion/chemosis,
perioperative anemia from blood loss, and then confusion. She
was
started on quetiapine initially for suspected ICU-related
delirium. However, she started showing clinical signs of
seizures
(sudden behavioral arrest, blank stare, eye deviation to the
left
and down) which resolved with low dose of lorazepam. Despite
reportedly unremarkable head imaging, she was thought to
potentially has PRES (unclear what the blood pressure
measurements were at the time). She was started on Levetiracetam
750 mg [**Hospital1 **] for seizure prevention. An EEG done at that time
reportedly suggested potential epileptiform foci but no seizures
were seen. She was discharged to a rehab but per her family did
not return to her prior highly functional baseline mental
status.
On [**2108-3-21**], she was even more lethargic than usual and did not
respond promptly to sternal rub. She was observed as having
right
face and right shoulder twitches with associated bowel/bladder
incontinence which ceased with diazepam 2.5 mg given twice. She
had a normal blood sugar of 81 at that time and otherwise normal
vital signs after the episode. She was transferred to
[**Hospital1 **]
for further management where she was given two loading doses of
Fosphenytoin 500 mg with some improvement in the focal motor
activity. Neurology was consulted there and recommended
increasing Levetiracetam to 1000 mg [**Hospital1 **] and continuing
Phenytoin.
She had an unremarkable NCHCT. She was found to have a UTI and
was started on Ceftriaxone on [**3-21**]. She was thought to
potentially have pneumonia as well, but chest imaging did not
reveal an infiltrate so this was stopped. An EEG was obtained
which potentially showed frequent left parasagittal epileptiform
discharges, so she was transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: [] Neurologic - Seizures (s/p cardiac arrest, ? hypoxic brain
injury), Recent ? Posterior Reversible Leukoencephalopathy
Syndrome (clinical diagnosis at onset of seizures)
[] MSK - Left hip fracture (s/p ORIF)
[] Cardiovascular - Recent cardiac arrest, HTN, HL, reportedly
CAD
[] Pulmonary - Recent hypoxic respiratory failure
[] Endocrine - Multinodular goiter with papillary carcinoma (s/p
resection, discovered during difficult intubation)
[] Ophthalmologic - Corneal abrasion/chemosis

MEDICATION ON ADMISSION: Transfer Medications:
LEV 1000 [**Hospital1 **]
NovoLog sliding scale
Lovenox 40 SC
Mag PRN
PHT 100 q8h
CTX 1g daily,
ASA 325
Nexium 20 [**Hospital1 **]
APAP 650 q6h prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General: NAD, lying in bed comfortably.
Head: NC/AT, no conjunctival icterus, no oropharyngeal lesions
Neck: Supple, no nuchal rigidity, no meningismus
Cardiovascular: RRR, no M/R/G
Pulmonary: Equal air entry bilaterally, no crackles or wheezes
Abdomen: Soft, NT, ND, no guarding
Extremities: Warm, no edema, palpable radial/dorsalis pedis
pulses
Skin: No rashes or lesions

FAMILY HISTORY: Ovarian cancer (mother)

SOCIAL HISTORY: Until recently living independently, driving. Now
at [**Hospital3 4103**] on the [**Doctor Last Name **]. No tobacco, ETOH, or illicit drug
use.
Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy,Other encephalopathy,Urinary tract infection, site not specified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of sudden cardiac arrest,Personal history of traumatic fracture,Personal history of malignant neoplasm of thyroid
Epilep NEC w/o intr epil,Encephalopathy NEC,Urin tract infection NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Hx sudden cardiac arrest,Hx traumatic fracture,Hx of thyroid malignancy
Admission Date:  [**2108-3-22**]              Discharge Date:   [**2108-4-3**]


Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 17813**]
Chief Complaint:
seizures


Major Surgical or Invasive Procedure:
None

History of Present Illness:
The patient is a [**Age over 90 **] year old woman with a recent
cardiopulmonary arrest of unknown etiology and seizures who has
been transferred from [**Hospital1 **] [**Location (un) 620**] for further management of
suspected status epilepticus. This history was obtained from
discussion with her son [**Name (NI) 333**] and from review of the medical
record. On [**2108-2-18**] she was found down at her residence and was
noted to be bradycardic, hypotensive, hypothermic, and
lethargic.
She was transported to an ED at Upstate [**Location (un) **] Hospital in
NY
where she had a cardiopulmonary arrest and was intubated and
resuscitated. The intubation was difficult and she was found to
have a mediastinal mass (multinodular goiter with papillary
microcarcinoma, which was removed). She had a complicated
hospital course with hospital-associated pneumonia, lung
collapse
s/p bronchoscopy, sepsis, corneal abrasion/chemosis,
perioperative anemia from blood loss, and then confusion. She
was
started on quetiapine initially for suspected ICU-related
delirium. However, she started showing clinical signs of
seizures
(sudden behavioral arrest, blank stare, eye deviation to the
left
and down) which resolved with low dose of lorazepam. Despite
reportedly unremarkable head imaging, she was thought to
potentially has PRES (unclear what the blood pressure
measurements were at the time). She was started on Levetiracetam
750 mg [**Hospital1 **] for seizure prevention. An EEG done at that time
reportedly suggested potential epileptiform foci but no seizures
were seen. She was discharged to a rehab but per her family did
not return to her prior highly functional baseline mental
status.
On [**2108-3-21**], she was even more lethargic than usual and did not
respond promptly to sternal rub. She was observed as having
right
face and right shoulder twitches with associated bowel/bladder
incontinence which ceased with diazepam 2.5 mg given twice. She
had a normal blood sugar of 81 at that time and otherwise normal
vital signs after the episode. She was transferred to
[**Hospital1 **]
for further management where she was given two loading doses of
Fosphenytoin 500 mg with some improvement in the focal motor
activity. Neurology was consulted there and recommended
increasing Levetiracetam to 1000 mg [**Hospital1 **] and continuing
Phenytoin.
She had an unremarkable NCHCT. She was found to have a UTI and
was started on Ceftriaxone on [**3-21**]. She was thought to
potentially have pneumonia as well, but chest imaging did not
reveal an infiltrate so this was stopped. An EEG was obtained
which potentially showed frequent left parasagittal epileptiform
discharges, so she was transferred to [**Hospital1 18**] for further care.

Prior to transfer per her son, he [**Name2 (NI) 15598**]'t notice any more motor
activity but she was not very arousable (she would only briefly
open her eyes to voice).


Past Medical History:
[] Neurologic - Seizures (s/p cardiac arrest, ? hypoxic brain
injury), Recent ? Posterior Reversible Leukoencephalopathy
Syndrome (clinical diagnosis at onset of seizures)
[] MSK - Left hip fracture (s/p ORIF)
[] Cardiovascular - Recent cardiac arrest, HTN, HL, reportedly
CAD
[] Pulmonary - Recent hypoxic respiratory failure
[] Endocrine - Multinodular goiter with papillary carcinoma (s/p
resection, discovered during difficult intubation)
[] Ophthalmologic - Corneal abrasion/chemosis


Social History:
Until recently living independently, driving. Now
at [**Hospital3 4103**] on the [**Doctor Last Name **]. No tobacco, ETOH, or illicit drug
use.


Family History:
Ovarian cancer (mother)

Physical Exam:
General: NAD, lying in bed comfortably.
Head: NC/AT, no conjunctival icterus, no oropharyngeal lesions
Neck: Supple, no nuchal rigidity, no meningismus
Cardiovascular: RRR, no M/R/G
Pulmonary: Equal air entry bilaterally, no crackles or wheezes
Abdomen: Soft, NT, ND, no guarding
Extremities: Warm, no edema, palpable radial/dorsalis pedis
pulses
Skin: No rashes or lesions

Neurologic Examination:

- Mental Status - Alert, Oriented to self and year, but no year
or city. She follows commands.
- Cranial Nerves - [II] PERRL 3->2 brisk. VF full to threat.
[III, IV, VI] Tracks to the left but has difficult crossing
midline to the right. [V] Corneals present bilaterally. [VII] No
facial asymmetry at rest. [XII] Tongue midline.

- Motor - No tremor or asterixis or myoclonus currently. She has
full strength on the left side of her body, with decreased
strengh on the right, but moving at least against gravity.
- Sensory - Response to noxious all four extremities.

- Reflexes
=[Bic] [Tri] [[**Last Name (un) 1035**]] [Quad] [Gastroc]
L 2      2      2      2        2
R 2      2      2      2        1
Plantar response extensor bilaterally.

- Gait - Unable to assess.


Brief Hospital Course:
Neuro:

Mrs. [**Known lastname 110651**] was very sleepy while in the ICU, and her EEG was
showing PLEDs. She was started on keppra and dilantin. Her PLEDs
improved, and her mental status continued to slowly improved.
Upon transfer to the floor, she had no further clinical
seizures. Her mental status was improving daily, and she was
back to having full conversations on the day of her discharge.
we stopped her dilantin and increased the keppra in order to
create a balance between her level of drowsiness and seizure
control. We decided not to treat the actual PLEDs, as she was
clinically improving.

CV/Resp:
She did not have any further acute issues during her stay. We
continued her anti-hypertensive medications.

FEN/GI:
She was initially too sleepy to eat on her own and therefore was
placed on tube feeds. She took her own tube out on [**4-1**], and as
she was awake enough, we decided not to replace it and allow her
to PO. We advanced her diet to soft + thin liquids based on the
recommendations of speech therapy, and she tolerated it well.
She needs to continue to work on her diet, and she needs
supplmentation with ensure.

ID:
She received 7 days of ceftriaxone for her UTI, she was
afebrile, and had no further complications.

We kept her foley in because she developed a bed sore, and we
did not want the area to become wet. The foley can come out once
the area has healed.

Medications on Admission:
Transfer Medications:
LEV 1000 [**Hospital1 **]
NovoLog sliding scale
Lovenox 40 SC
Mag PRN
PHT 100 q8h
CTX 1g daily,
ASA 325
Nexium 20 [**Hospital1 **]
APAP 650 q6h prn


Discharge Medications:
1. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
2. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
3. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
4. levetiracetam 100 mg/mL Solution Sig: 1000 (1000) mg PO BID
(2 times a day).
5. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1107**] [**Hospital **] Hospital - [**Location (un) 38**]

Discharge Diagnosis:
Seizures


Discharge Condition:
Condition: good
Mental status: Alert, oriented to self and year, fluctuates in
terms of orientation to day/city.
Ambulatory: currently bed bound.


Discharge Instructions:
Dear Mrs. [**Known lastname 110651**],
It has been a great pleasure taking care of you.
You were admitted to our neurology/epilepsy service because you
were having seizures after you had your cardiac arrest.
Your EEG did show that you were having a lot of epileptic
discharges, you were placed on two medications, and we only kept
you on one of them, which was enough to control the seizures.
You also had a urinary tract infection which we treated.
Your mental status continued to improve dramatically.
You required a feeding tube through your nose initially, but you
were able to start eating by mouth soon after and therefore did
not need it anymore.

Followup Instructions:
Our neurology clinic will contact you for a follow up
appointment.
{'Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy,Other encephalopathy,Urinary tract infection, site not specified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of sudden cardiac arrest,Personal history of traumatic fracture,Personal history of malignant neoplasm of thyroid'}


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: seizures

PRESENT ILLNESS: The patient is a [**Age over 90 **] year old woman with a recent
cardiopulmonary arrest of unknown etiology and seizures who has
been transferred from [**Hospital1 **] [**Location (un) 620**] for further management of
suspected status epilepticus. This history was obtained from
discussion with her son [**Name (NI) 333**] and from review of the medical
record. On [**2108-2-18**] she was found down at her residence and was
noted to be bradycardic, hypotensive, hypothermic, and
lethargic.
She was transported to an ED at Upstate [**Location (un) **] Hospital in
NY
where she had a cardiopulmonary arrest and was intubated and
resuscitated. The intubation was difficult and she was found to
have a mediastinal mass (multinodular goiter with papillary
microcarcinoma, which was removed). She had a complicated
hospital course with hospital-associated pneumonia, lung
collapse
s/p bronchoscopy, sepsis, corneal abrasion/chemosis,
perioperative anemia from blood loss, and then confusion. She
was
started on quetiapine initially for suspected ICU-related
delirium. However, she started showing clinical signs of
seizures
(sudden behavioral arrest, blank stare, eye deviation to the
left
and down) which resolved with low dose of lorazepam. Despite
reportedly unremarkable head imaging, she was thought to
potentially has PRES (unclear what the blood pressure
measurements were at the time). She was started on Levetiracetam
750 mg [**Hospital1 **] for seizure prevention. An EEG done at that time
reportedly suggested potential epileptiform foci but no seizures
were seen. She was discharged to a rehab but per her family did
not return to her prior highly functional baseline mental
status.
On [**2108-3-21**], she was even more lethargic than usual and did not
respond promptly to sternal rub. She was observed as having
right
face and right shoulder twitches with associated bowel/bladder
incontinence which ceased with diazepam 2.5 mg given twice. She
had a normal blood sugar of 81 at that time and otherwise normal
vital signs after the episode. She was transferred to
[**Hospital1 **]
for further management where she was given two loading doses of
Fosphenytoin 500 mg with some improvement in the focal motor
activity. Neurology was consulted there and recommended
increasing Levetiracetam to 1000 mg [**Hospital1 **] and continuing
Phenytoin.
She had an unremarkable NCHCT. She was found to have a UTI and
was started on Ceftriaxone on [**3-21**]. She was thought to
potentially have pneumonia as well, but chest imaging did not
reveal an infiltrate so this was stopped. An EEG was obtained
which potentially showed frequent left parasagittal epileptiform
discharges, so she was transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: [] Neurologic - Seizures (s/p cardiac arrest, ? hypoxic brain
injury), Recent ? Posterior Reversible Leukoencephalopathy
Syndrome (clinical diagnosis at onset of seizures)
[] MSK - Left hip fracture (s/p ORIF)
[] Cardiovascular - Recent cardiac arrest, HTN, HL, reportedly
CAD
[] Pulmonary - Recent hypoxic respiratory failure
[] Endocrine - Multinodular goiter with papillary carcinoma (s/p
resection, discovered during difficult intubation)
[] Ophthalmologic - Corneal abrasion/chemosis

MEDICATION ON ADMISSION: Transfer Medications:
LEV 1000 [**Hospital1 **]
NovoLog sliding scale
Lovenox 40 SC
Mag PRN
PHT 100 q8h
CTX 1g daily,
ASA 325
Nexium 20 [**Hospital1 **]
APAP 650 q6h prn

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: General: NAD, lying in bed comfortably.
Head: NC/AT, no conjunctival icterus, no oropharyngeal lesions
Neck: Supple, no nuchal rigidity, no meningismus
Cardiovascular: RRR, no M/R/G
Pulmonary: Equal air entry bilaterally, no crackles or wheezes
Abdomen: Soft, NT, ND, no guarding
Extremities: Warm, no edema, palpable radial/dorsalis pedis
pulses
Skin: No rashes or lesions

FAMILY HISTORY: Ovarian cancer (mother)

SOCIAL HISTORY: Until recently living independently, driving. Now
at [**Hospital3 4103**] on the [**Doctor Last Name **]. No tobacco, ETOH, or illicit drug
use. 

### Response:
{'Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy,Other encephalopathy,Urinary tract infection, site not specified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Personal history of sudden cardiac arrest,Personal history of traumatic fracture,Personal history of malignant neoplasm of thyroid'}
