CHIEF COMPLAINT: 35F with 6 months of headaches and intermittent dizziness who
was found to have a 2.4cm left cerebellar brain mass

PRESENT ILLNESS: 35 year old female presents with approximately 6 months of
headaches and intermittent dizziness. She reports no visual
changes, no new gait disturbances, no numbness, or tingling. Her
PCP referred her to Dr. [**Last Name (STitle) **] who ordered an MRI of the brain.
She had this in [**2119-1-10**] and the study revealed a brain
mass in the left cerebellum measuring 2.4 cm at the greatest
diameter. Dr. [**Last Name (STitle) **] then referred her to Dr. [**Last Name (STitle) **] for
neurosurgical
consultation.

MEDICAL HISTORY: sarcoidosis (affecting liver and kidneys) - dx in [**2115**],
multiple ear infections s/p multiple surgeries, s/p lymph node
biopsy, s/p kidney biopsy, s/p cyst removal, HTN (secondary to
sarcoidosis in kidneys), hypercholesterolemia

MEDICATION ON ADMISSION: CeleXA 20mg',Jolessa 0.15mg/30mcg',Valsartan 160mg', Lorazepam
prn spasm,Diazepam 5mg"',Omeprazole 40mg'

ALLERGIES: Latex / Erythromycin Base / Percocet / Vicodin / Sulfa
(Sulfonamides) / Penicillins / Alcohol / Egg

PHYSICAL EXAM: On Discharge:
Neurologically intact. Scalp incision clean, dry, intact. Rash
to FA significantly improved, with only trace red pigmentation
and non-pruritic.

FAMILY HISTORY: mother:died from metastatic breast CA, maternal
grandmother and [**Name2 (NI) 5358**] aunt both had non-[**Name (NI) 4278**] Lymphoma,
maternal grandfather had leukemia

SOCIAL HISTORY: lives alone, works as Nanny part time
Benign neoplasm of cerebral meninges,Sarcoidosis,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified pruritic disorder
Ben neo cerebr meninges,Sarcoidosis,Hypertension NOS,Pure hypercholesterolem,Pruritic disorder NOS
Admission Date:  [**2119-4-13**]              Discharge Date:   [**2119-4-18**]

Date of Birth:  [**2084-2-7**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Latex / Erythromycin Base / Percocet / Vicodin / Sulfa
(Sulfonamides) / Penicillins / Alcohol / Egg

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
35F with 6 months of headaches and intermittent dizziness who
was found to have a 2.4cm left cerebellar brain mass

Major Surgical or Invasive Procedure:
[**2119-4-13**]:Left suboccipital craniotomy for tumor resection with
cranioplasty


History of Present Illness:
35 year old female presents with approximately 6 months of
headaches and intermittent dizziness. She reports no visual
changes, no new gait disturbances, no numbness, or tingling. Her
PCP referred her to Dr. [**Last Name (STitle) **] who ordered an MRI of the brain.
She had this in [**2119-1-10**] and the study revealed a brain
mass in the left cerebellum measuring 2.4 cm at the greatest
diameter. Dr. [**Last Name (STitle) **] then referred her to Dr. [**Last Name (STitle) **] for
neurosurgical
consultation.

Past Medical History:
sarcoidosis (affecting liver and kidneys) - dx in [**2115**],
multiple ear infections s/p multiple surgeries, s/p lymph node
biopsy, s/p kidney biopsy, s/p cyst removal, HTN (secondary to
sarcoidosis in kidneys), hypercholesterolemia


Social History:
lives alone, works as Nanny part time

Family History:
mother:died from metastatic breast CA, maternal
grandmother and [**Name2 (NI) 5358**] aunt both had non-[**Name (NI) 4278**] Lymphoma,
maternal grandfather had leukemia


Physical Exam:
On Discharge:
Neurologically intact. Scalp incision clean, dry, intact. Rash
to FA significantly improved, with only trace red pigmentation
and non-pruritic.

Pertinent Results:
Labs on Admission:
[**2119-4-13**] 01:59PM BLOOD Hct-34.9*
[**2119-4-14**] 01:26AM BLOOD Plt Ct-311

------------------
IMAGING:
-----------------
NCHCT [**4-13**](post-op): stable, with expected post-operative
changes.

MRI Head [**4-14**](post-op): Expected postsurgical changes identified
at the left posterior fossa, status post meningioma resection as
described. There is no evidence of intracranial hemorrhage or
ischemic changes. The previously noted meningioma at the left
posterior fossa has been resected with no evidence of residual
mass, followup after complete reabsorption of the post-surgical
blood products is recommended


Brief Hospital Course:
Patient presented electively for resection of left posterior
fossa mass on [**2119-4-13**] and underwent left suboccipital craniotomy
for resection of mass with cranioplasty without complications.
Preliminary pathology in the OR showed that the mass was a
menigioma.  She was extubated in the OR and transferred to the
ICU post-op.  Upon her post-op check she was found to be full
strength, with PERRL, EOM's intact, no drift, and no dysmetria.

On POD#1, her examination was stable, so she was transferred to
the neurosurgery floor following her routine post-operative MRI.
Her steroids were ordered to taper to off over four days.

She was seen and evaluated by PT and OT who determined that she
was safe to go home without services. The patient developed a
rash on the left forearm which was initially thought to be
cellulitis or an allergic reaction. She was placed on
clindamycin for a couple of days. The rash was pruritic in
nature and improved greatly with benadryl. Therefore the
Clindamycin was discontinued. The rash subsequently improved

The patient continued to have pain that was [**6-19**] on [**4-17**] so her
pain regimen was adjusted accordingly. She responded well, and
was discharged to home in good condition on [**2119-4-18**].  of note,
the rash to her L FA was very faint and no longer pruritic at
the time of discharge.


Medications on Admission:
CeleXA 20mg',Jolessa 0.15mg/30mcg',Valsartan 160mg', Lorazepam
prn spasm,Diazepam 5mg"',Omeprazole 40mg'

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
2. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) as needed for itching.
4. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3H (every 3
hours) as needed for Pain: No driving while on this medication.
Disp:*50 Tablet(s)* Refills:*0*
5. Valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**2-11**]
Drops Ophthalmic [**Hospital1 **] (2 times a day).
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Methocarbamol 500 mg Tablet Sig: 1.5 Tablets PO TID (3 times
a day).
Disp:*135 Tablet(s)* Refills:*0*
9. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for headache.
10. Methocarbamol 500 mg Tablet Sig: Two (2) Tablet PO TID (3
times a day).
Disp:*180 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Left posterior fossa meningioma


Discharge Condition:
Neurologically Stable


Discharge Instructions:
GENERAL INSTRUCTIONS
WOUND CARE:
??????	You or a family member should inspect your wound every day and
report any of the following problems to your physician.
??????	Keep your incision clean and dry.
??????	You may wash your hair with a mild shampoo 24 hours after your
sutures are removed.
??????	Do NOT apply any lotions, ointments or other products to your
incision.
??????	DO NOT DRIVE until you are seen at the first follow up
appointment.
??????	Do not lift objects over 10 pounds until approved by your
physician.

DIET
Usually no special diet is prescribed after a craniotomy. A
normal well balanced diet is recommended for recovery, and you
should resume any specially prescribed diet you were eating
before your surgery.  Be sure however, to remain well hydrated,
and increase your consumption of fiber, as pain medications may
cause constipation.

MEDICATIONS:
??????	Take all of your medications as ordered.  You do not have to
take pain medication unless it is needed.  It is important that
you are able to cough, breathe deeply, and is comfortable enough
to walk.
??????	Do not use alcohol while taking pain medication.
??????	Medications that may be prescribed include:
-Narcotic pain medication such as Dilaudid (hydromorphone).
	-An over the counter stool softener for constipation (Colace or
Docusate). If you become constipated, try products such as
Dulcolax, Milk of Magnesia, first, and then Magnesium Citrate or
Fleets enema if needed). Often times, pain medication and
anesthesia can cause constipation.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc, as this can increase your chances of bleeding.
??????	You are being sent home on steroid medication(taper to off),
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.

ACTIVITY:
The first few weeks after you are discharged you may feel tired
or fatigued. This is normal. You should become a little stronger
every day. Activity is the most important measure you can take
to prevent complications and to begin to feel like yourself
again. In general:
??????	Follow the activity instructions given to you by your doctor
and therapist.
??????	Increase your activity slowly; do not do too much because you
are feeling good.
??????	You may resume sexual activity as your tolerance allows.
??????	If you feel light headed or fatigued after increasing
activity, rest, decrease the amount of activity that you do, and
begin building your tolerance to activity more slowly.
??????	DO NOT DRIVE until you speak with your physician.
??????	Do not lift objects over 10 pounds until approved by your
physician.
??????	Avoid any activity that causes you to hold your breath and
push, for example weight lifting, lifting or moving heavy
objects, or straining at stool.
??????	Do your breathing exercises every two hours.
??????	Use your incentive spirometer 10 times every hour, that you
are awake.

WHEN TO CALL YOUR SURGEON:
With any surgery there are risks of complications. Although your
surgery is over, there is the possibility of some of these
complications developing. These complications include:
infection, blood clots, or neurological changes. Call your
Physician Immediately if you Experience:

??????	Confusion, fainting, blacking out, extreme fatigue, memory
loss, or difficulty speaking.
??????	Double, or blurred vision. Loss of vision, either partial or
total.
??????	Hallucinations
??????	Numbness, tingling, or weakness in your extremities or face.
??????	Stiff neck, and/or a fever of 101.5F or more.
??????	Severe sensitivity to light. (Photophobia)
??????	Severe headache or change in headache.
??????	Seizure
??????	Problems controlling your bowels or bladder.
??????	Productive cough with yellow or green sputum.
??????	Swelling, redness, or tenderness in your calf or thigh.

Call 911 or go to the Nearest Emergency Room if you Experience:
??????	Sudden difficulty in breathing.
??????	New onset of seizure or change in seizure, or seizure from
which you wake up confused.
??????	A seizure that lasts more than 5 minutes.

Important Instructions Regarding Emergencies and After-Hour
Calls
??????	If you have what you feel is a true emergency at any time,
please present immediately to your local emergency room, where a
doctor there will evaluate you and contact us if needed. Due to
the complexity of neurosurgical procedures and treatment of
neurosurgical problems, effective advice regarding emergency
situations cannot be given over the telephone.
??????	Should you have a situation which is not life-threatening, but
you feel needs addressing before normal office hours or on the
weekend, please present to the local emergency room, where the
physician there will evaluate you and contact us if needed.


Followup Instructions:
??????Please return to the office in [**11-23**] days (from your date of
surgery) for removal of your sutures and 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 [**5-8**] @
9:30am.  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 will not need an MRI of the brain as this was done during
your hospitalization



Completed by:[**2119-4-18**]
{'Benign neoplasm of cerebral meninges,Sarcoidosis,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified pruritic disorder'}


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: 35F with 6 months of headaches and intermittent dizziness who
was found to have a 2.4cm left cerebellar brain mass

PRESENT ILLNESS: 35 year old female presents with approximately 6 months of
headaches and intermittent dizziness. She reports no visual
changes, no new gait disturbances, no numbness, or tingling. Her
PCP referred her to Dr. [**Last Name (STitle) **] who ordered an MRI of the brain.
She had this in [**2119-1-10**] and the study revealed a brain
mass in the left cerebellum measuring 2.4 cm at the greatest
diameter. Dr. [**Last Name (STitle) **] then referred her to Dr. [**Last Name (STitle) **] for
neurosurgical
consultation.

MEDICAL HISTORY: sarcoidosis (affecting liver and kidneys) - dx in [**2115**],
multiple ear infections s/p multiple surgeries, s/p lymph node
biopsy, s/p kidney biopsy, s/p cyst removal, HTN (secondary to
sarcoidosis in kidneys), hypercholesterolemia

MEDICATION ON ADMISSION: CeleXA 20mg',Jolessa 0.15mg/30mcg',Valsartan 160mg', Lorazepam
prn spasm,Diazepam 5mg"',Omeprazole 40mg'

ALLERGIES: Latex / Erythromycin Base / Percocet / Vicodin / Sulfa
(Sulfonamides) / Penicillins / Alcohol / Egg

PHYSICAL EXAM: On Discharge:
Neurologically intact. Scalp incision clean, dry, intact. Rash
to FA significantly improved, with only trace red pigmentation
and non-pruritic.

FAMILY HISTORY: mother:died from metastatic breast CA, maternal
grandmother and [**Name2 (NI) 5358**] aunt both had non-[**Name (NI) 4278**] Lymphoma,
maternal grandfather had leukemia

SOCIAL HISTORY: lives alone, works as Nanny part time 

### Response:
{'Benign neoplasm of cerebral meninges,Sarcoidosis,Unspecified essential hypertension,Pure hypercholesterolemia,Unspecified pruritic disorder'}
