CHIEF COMPLAINT: Headaches

PRESENT ILLNESS: Mr. [**Known lastname 87072**] is a 47 yo Right handed man with a PMH signifiant
only for mild hyperlipidemia and gout. He was in this state of
good health until three weeks ago when he noticed the onset of
HA. He describes this as being relegated to the Right temporal
region, and relatively mild. He also, at that time, had the
first of what would be a few episodes of "light-headedness." He
denies a crescendo increase in HA over the past few weeks and
denies any other associated neurological sx such as unilateral
weakness, numbness, ataxia, seizures, diplopia, dysarthria.

MEDICAL HISTORY: mildly increased cholesterol
Gout
Epicondylitis

MEDICATION ON ADMISSION: ASA

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T: 98.2 P: 101 R: 16 BP: 129/83 SaO2: 100%
General: Awake, cooperative, NAD.
HEENT: No scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity

FAMILY HISTORY: No neurological or oncological history

SOCIAL HISTORY: He is a salesman. He lives with wife and son.  [**Name (NI) **] denies
smoking, alcohol, or illicits.
Malignant neoplasm of temporal lobe,Cerebral edema,Pure hypercholesterolemia,Gout, unspecified,Vasectomy status
Mal neo temporal lobe,Cerebral edema,Pure hypercholesterolem,Gout NOS,Vasectomy status
Admission Date:  [**2155-3-15**]              Discharge Date:   [**2155-3-20**]

Date of Birth:  [**2107-7-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

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

Major Surgical or Invasive Procedure:
Right sided craniotomy


History of Present Illness:
Mr. [**Known lastname 87072**] is a 47 yo Right handed man with a PMH signifiant
only for mild hyperlipidemia and gout. He was in this state of
good health until three weeks ago when he noticed the onset of
HA. He describes this as being relegated to the Right temporal
region, and relatively mild. He also, at that time, had the
first of what would be a few episodes of "light-headedness." He
denies a crescendo increase in HA over the past few weeks and
denies any other associated neurological sx such as unilateral
weakness, numbness, ataxia, seizures, diplopia, dysarthria.

His HA increased substantially in intensity on [**3-12**], to the
point
of being [**11-24**]. He did not seek medical care at the time. The
pain subsided, but came back very strong again on [**3-14**] in the
early am. Today, he began to have nausea associated with the HA
so presented to the ED. Here, a head CT showed a large R
temporal
mass with a hypodense center and surrounding vasogenic edema.

ROS: Denies any recent weight loss, malaise, fever, chills,
cough. He has traveled to [**Country 149**] within the past year. Also,
while in Aruba about two years ago both he and his son
contracted
a diarrheal illness and was told it was a "parasite."



Past Medical History:
mildly increased cholesterol
Gout
Epicondylitis


Social History:
He is a salesman. He lives with wife and son.  [**Name (NI) **] denies
smoking, alcohol, or illicits.


Family History:
No neurological or oncological history


Physical Exam:
Vitals: T: 98.2 P: 101 R: 16 BP: 129/83 SaO2: 100%
General: Awake, cooperative, NAD.
HEENT: No scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity

Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurological Examination:

Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Recall: [**4-17**] 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 [**6-19**] throughout. No pronator drift

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

Reflexes: 2+ and symmetric

Toes downgoing bilaterally

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

On discharge: left nasolabial fold flattening, otherwise intact

Pertinent Results:
[**3-15**] CT Head
Large cystic mass in the right temporal lobe with surounding
vasogenic edema and mass effect causing 9-mm leftward shift of
normally
midline structures. An MRI is recommende for further
characterization.

[**3-15**] MRI Brain
Solitary right temporal lobe mass concerning for high-grade
glioma or
metastatic lesion.

[**3-16**] CTA HEAD
1. Right temporal mass, similar to the recent MRI with marked
mass effect and vasogenic edema; the overall appearance is
highly suspicious for a high-grade primary glial neoplasm.
2. Expected mass effect upon adjacent vessels particularly right
MCA and PCA branches to the temporal lobe.
3. No evidence of flow-limiting stenosis and no aneurysm greater
than 2 mm.

[**3-16**] CT Torso
1. Indeterminate pulmonary nodule, 4 mm, posterior segment right
upper lobe likely inflammatory in origin.
2.Splenic hemangioma or cyst.
3.No evidence for primary malignancy.

[**3-16**] MRI Brain
Rim-enhancing right temporal lobe mass, similar to recent
examinations with marked adjacent mass effect including uncal
herniation and deviation and deformity of the midbrain. There is
overall little change compared to prior examinations. This
examination was limited and done only for preoperative planning.
The appearance is most suspicious for a high-grade primary glial
neoplasm.

[**3-18**] CT Head
Expected post-surgical changes s/p right temporal resection.
Unchanged right hemispheric vasogenic edema and essentially
unchanged supratenorial mass effect. Slighly decreased mass
effect on the midbrain.

[**3-18**] MRI Brain
1. Post-surgical changes in the right temporal/parietal lobe
with decreased but persistent FLAIR/T2 abnormality and decreased
contralateral midline shift. Right fronto-parieto-temporal
extra-axial collection with fluid and air is likely
postoperative. Continued followup is recommended for followup of
evolution of the postoperative change and continued assessment
of the resection cavity.

2. 27 x 18 mm (CC x TV) area in the posterior fossa which was
present on the prior examination now demonstrates change in
signal intensity(hyperintense) likley hemorrhage in an arachnoid
cyst.


Brief Hospital Course:
Mr [**Known lastname 87072**] was admitted to the neurosurgery service. He
underwent an MRI which showed large cystic comparing mass in the
right temporal lobe with
irregular rim enhancement and mild nodular components appear
inferiorly
measuring 2.7 x 5.2 cm with significant surrounding vasogenic
edema. He was started on Decadron and monitored closely on the
neuroscience floor. He underwent CT of his torso which was
negative for any malignancy. A CTA of his head did not show any
vascular abnormalities or potential vessels that could
complicate the surgery. On [**3-17**] he underwent a right side
cranitomy for mass resection as well as temporal lobectomy. He
tolerated the procedure well and was transported to the ICU
post-operatively.  On [**3-18**] he was stable in the ICU however he
was hypertensive requiring Nipride. He reported severe headache
as well which initially responded to IV Dilaudid and PO
Fioricet. Overnight into [**3-19**] he did not require Nipride for BP
management and was deemed fit for trasnfer to the floor.  He was
stable on the floor overnight into [**3-20**], was ambulatory in the
hallways and did not require physical therapy evaluation.  He
was deemed fit for discharge to home.

Medications on Admission:
ASA

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
2. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: [**2-16**]
Tablets PO Q4H (every 4 hours) as needed for headache.
Disp:*90 Tablet(s)* Refills:*0*
3. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
4. dexamethasone 2 mg Tablet Sig: See Taper Tablet PO Q8 (): 3mg
Po q8 hours on [**3-20**] and [**3-21**], 2mg q8 hours on [**3-22**] and [**3-23**], 2mg [**Hospital1 **]
starting [**3-24**] and continue until follow-up.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Right sided brain mass


Discharge Condition:
Neurologically stable


Discharge Instructions:
??????	Have a friend/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,
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.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????       You 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.


Followup Instructions:
??????Please return to the office in [**8-24**] 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 [**2155-3-24**] @
3PM.  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.



Completed by:[**2155-3-20**]
{'Malignant neoplasm of temporal lobe,Cerebral edema,Pure hypercholesterolemia,Gout, unspecified,Vasectomy status'}


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: Headaches

PRESENT ILLNESS: Mr. [**Known lastname 87072**] is a 47 yo Right handed man with a PMH signifiant
only for mild hyperlipidemia and gout. He was in this state of
good health until three weeks ago when he noticed the onset of
HA. He describes this as being relegated to the Right temporal
region, and relatively mild. He also, at that time, had the
first of what would be a few episodes of "light-headedness." He
denies a crescendo increase in HA over the past few weeks and
denies any other associated neurological sx such as unilateral
weakness, numbness, ataxia, seizures, diplopia, dysarthria.

MEDICAL HISTORY: mildly increased cholesterol
Gout
Epicondylitis

MEDICATION ON ADMISSION: ASA

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T: 98.2 P: 101 R: 16 BP: 129/83 SaO2: 100%
General: Awake, cooperative, NAD.
HEENT: No scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity

FAMILY HISTORY: No neurological or oncological history

SOCIAL HISTORY: He is a salesman. He lives with wife and son.  [**Name (NI) **] denies
smoking, alcohol, or illicits. 

### Response:
{'Malignant neoplasm of temporal lobe,Cerebral edema,Pure hypercholesterolemia,Gout, unspecified,Vasectomy status'}
