CHIEF COMPLAINT: Syncope, seizure

PRESENT ILLNESS: This is a 54 year female with past medical history of
hypertension and osteoporosis, who presents as a transfer from
OSH s/p syncope and seizure, and with abnormal head CT.  In
summary, the patient was reportedly attending a funeral today
when she had a syncopal episode and fell.  She was sent to
[**First Name4 (NamePattern1) 189**]
[**Last Name (NamePattern1) **] Hospital for further evaluation.  Shortly following
admission, she was found slumped over and unresponsive in a
chair, and subsequently seized. Resolved with Ativan.  Continued
to seize 1-2 times later in the evening. Received a total of
14mg of Ativan. Intubated for increasing mental status changes
and lethargy.  Transferred to [**Hospital1 18**] for continued care.

MEDICAL HISTORY: 1. Hypertension
2. Osteoporosis

MEDICATION ON ADMISSION: 1. Ecotrin 81m Daily
2. Pepcid 20mg [**Hospital1 **]
3. Lopressor 25mg Daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
PHYSICAL EXAM:
O: T: 101.8 BP: 119/76         HR:76    R:20       O2Sats: 100%t
Gen: WD/WN, comfortable, NAD. Off sedation, agitated.
HEENT: NC/AT Pupils: PERRLA         EOMs N/A
Extrem: Warm and well-perfused.
Neuro:
Mental status: Intubated. No EO

FAMILY HISTORY: She has no hx of cancers and FH only notable for maternal aunt
who was diagnosed
with breast cancer in her 60's.

SOCIAL HISTORY: She works as a registered nurse at the Home Away from Home. She
is a former smoker. She quit over 15 years ago but has about 30
pack year hx. Her HCP is
her husband and she is DNR per her husband.
Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Cerebral edema,Malignant neoplasm of other parts of bronchus or lung,Unspecified essential hypertension,Osteoporosis, unspecified,Other convulsions,Dermatitis due to drugs and medicines taken internally,Personal history of tobacco use,Other opiates and related narcotics causing adverse effects in therapeutic use
Sec mal neo brain/spine,Intracerebral hemorrhage,Cerebral edema,Mal neo bronch/lung NEC,Hypertension NOS,Osteoporosis NOS,Convulsions NEC,Drug dermatitis NOS,History of tobacco use,Adv eff opiates
Admission Date:  [**2104-5-19**]              Discharge Date:   [**2104-5-26**]

Date of Birth:  [**2049-8-22**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Syncope, seizure

Major Surgical or Invasive Procedure:
[**2104-5-22**] Right Frontal crani for mass x 2 resection


History of Present Illness:
This is a 54 year female with past medical history of
hypertension and osteoporosis, who presents as a transfer from
OSH s/p syncope and seizure, and with abnormal head CT.  In
summary, the patient was reportedly attending a funeral today
when she had a syncopal episode and fell.  She was sent to
[**First Name4 (NamePattern1) 189**]
[**Last Name (NamePattern1) **] Hospital for further evaluation.  Shortly following
admission, she was found slumped over and unresponsive in a
chair, and subsequently seized. Resolved with Ativan.  Continued
to seize 1-2 times later in the evening. Received a total of
14mg of Ativan. Intubated for increasing mental status changes
and lethargy.  Transferred to [**Hospital1 18**] for continued care.


Past Medical History:
1. Hypertension
2. Osteoporosis

Social History:
She works as a registered nurse at the Home Away from Home. She
is a former smoker. She quit over 15 years ago but has about 30
pack year hx. Her HCP is
her husband and she is DNR per her husband.


Family History:
She has no hx of cancers and FH only notable for maternal aunt
who was diagnosed
with breast cancer in her 60's.

Physical Exam:
On Admission:
PHYSICAL EXAM:
O: T: 101.8 BP: 119/76         HR:76    R:20       O2Sats: 100%t
Gen: WD/WN, comfortable, NAD. Off sedation, agitated.
HEENT: NC/AT Pupils: PERRLA         EOMs N/A
Extrem: Warm and well-perfused.
Neuro:
Mental status: Intubated. No EO

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, 4 to 2mm
bilaterally. Visual fields are full to confrontation.
III, IV, VI: N/A
V, VII: N/A
VIII: N/A
IX, X: Gag reflex Present
[**Doctor First Name 81**]: N/A
XII: N/A

Motor: Normal bulk and tone bilaterally. No abnormal movements.
Moves all extremities x 4 purposefully, equally, when off
sedation.

Toes downgoing bilaterally.

On Discharge:
Awake, alert and oriented to person, place and date. Face is
symmetric, tongue with a slight left deviation. Full strength
and sensation throughout. Wound is clean, dry and intact without
signs of infection.

Pertinent Results:
[**2104-5-19**] CT Head:
IMPRESSION: There are two rim-enhancing lesions peripherally
located within the right frontal lobe, as described above, with
associated vasogenic edema and mass effect. The inferior lesion
demonstrates a punctate focus of hemorrhage. While the superior
lesion does abut the dura, it lacks characteristic dural tail,
making meningioma a less likely consideration.  Moreover, the
more inferior lesion does appear intra-axial on coronal and
sagittal reformatted images. Differential diagnosis
includes metastatic disease versus abscess.

[**2104-5-19**] MRI Brain w/ & w/o:
1. Two enhancing right frontal lesions most consistent with
metastases with surrounding vasogenic edema and right frontal
sucal effacment.
2. 2mm leftward shift of midline structures.

CT Torso:
1. No definite evidence of malignancy. Consolidation within the
superior
segment of the left lower lobe may represent infection, but
there is a
slightly more rounded appearance inferiorly, and consider repeat
chest CT
following treatment. Prominent left-sided intrapulmonary lymph
nodes may be reactive.
2. Gallbladder sludge.
3. Gas tracking in the posterior subcutaneous tissues and
extending into the left paraspinal musculature and left psoas
muscle. Findings are likely
related to pressure erosion. There is no focal fluid collection.

4. Trace pelvic free fluid. Slightly limited evaluation of the
pelvis due to motion artifact, but no gross abnormalities are
identified.

CT head [**2104-5-22**]:
Expected postoperative appearance status-post right craniotomy.
Unchanged 2mm leftward shift of midline structures

MRI brain [**5-23**]:
1. Two curvilinear foci of residual enhancement of the right
frontal lobe.  Continued attention on followup studies is
recommended.
2. Interval resection of the two right frontal lesions.
Persistent,
unchanged right frontal edema and 2 mm leftward shift of midline
structures.
3. No evidence of acute infarct.


Brief Hospital Course:
This is a 54 year old F in her usual state of health until an
episode of syncope and seizure. OSH CT revealed a brain mass
with vasogenic edema. Patient was transferred to [**Hospital1 18**] where a
Head CT was repeated- again showing a  two rim-enhancing lesions
peripherally located within the right frontal lobe with
associated vasogenic edema and mass effect.  Pt was admitted to
the ICU under Dr.[**Name (NI) 9034**] care. A Brain MRI was done on
[**2104-5-19**] which showed two enhancing right frontal lesions most
consistent with metastases with surrounding vasogenic edema and
right frontal sulcal effacement

A CT Torso was done on [**5-19**], which was negative for any primary
lesion or mets, but did show ground glass opacity in RUL.

She was consented and pre-oped, and went to the OR for resection
of this mass on [**5-22**]. The procedure went well without
complications. The preliminary pathology report was metastatic
carcinoma. She remained in the PACU overnight for Q1 hour neuro
checks post-op. CT head was negative for hemorrhage.

She was stable on [**5-23**] and she was transferred to the Step down
unit. Her Foley and A-line was discontinued. She had an MRI.

PT and OT were ordered. She was cleared for home on [**5-26**] with PT
outpatient needs.

Medications on Admission:
1. Ecotrin 81m Daily
2. Pepcid 20mg [**Hospital1 **]
3. Lopressor 25mg Daily


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
3. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
4. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QSUN (every
Sunday).
5. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain: max APAP 4g/24hrs.
7. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*0*
8. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
9. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
Disp:*60 Tablet(s)* Refills:*0*
10. Outpatient Physical Therapy


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Right sideded frontal brain masses


Discharge Condition:
Neurologically stable
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.


Discharge Instructions:
General Instructions/Information

??????	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 have been removed.
??????	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 have been prescribed Keppra for anti-seizure medicine,
take it as prescribed.
??????	You are being sent home on steroid medication(taper to 2mg
twice daily), 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 [**10-30**] 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 [**6-9**]
at 11:30.  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.
??????Please follow up with medical oncology. You should be receiving
a call from them once pathology has been finalizined.  If you do
not hear from them by Friday [**5-30**] please call Dr. [**First Name (STitle) **] at
[**Telephone/Fax (1) 86318**] to schedule an appointment or if you have any
questions



Completed by:[**2104-5-26**]
{'Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Cerebral edema,Malignant neoplasm of other parts of bronchus or lung,Unspecified essential hypertension,Osteoporosis, unspecified,Other convulsions,Dermatitis due to drugs and medicines taken internally,Personal history of tobacco use,Other opiates and related narcotics causing adverse effects in therapeutic use'}


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: Syncope, seizure

PRESENT ILLNESS: This is a 54 year female with past medical history of
hypertension and osteoporosis, who presents as a transfer from
OSH s/p syncope and seizure, and with abnormal head CT.  In
summary, the patient was reportedly attending a funeral today
when she had a syncopal episode and fell.  She was sent to
[**First Name4 (NamePattern1) 189**]
[**Last Name (NamePattern1) **] Hospital for further evaluation.  Shortly following
admission, she was found slumped over and unresponsive in a
chair, and subsequently seized. Resolved with Ativan.  Continued
to seize 1-2 times later in the evening. Received a total of
14mg of Ativan. Intubated for increasing mental status changes
and lethargy.  Transferred to [**Hospital1 18**] for continued care.

MEDICAL HISTORY: 1. Hypertension
2. Osteoporosis

MEDICATION ON ADMISSION: 1. Ecotrin 81m Daily
2. Pepcid 20mg [**Hospital1 **]
3. Lopressor 25mg Daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission:
PHYSICAL EXAM:
O: T: 101.8 BP: 119/76         HR:76    R:20       O2Sats: 100%t
Gen: WD/WN, comfortable, NAD. Off sedation, agitated.
HEENT: NC/AT Pupils: PERRLA         EOMs N/A
Extrem: Warm and well-perfused.
Neuro:
Mental status: Intubated. No EO

FAMILY HISTORY: She has no hx of cancers and FH only notable for maternal aunt
who was diagnosed
with breast cancer in her 60's.

SOCIAL HISTORY: She works as a registered nurse at the Home Away from Home. She
is a former smoker. She quit over 15 years ago but has about 30
pack year hx. Her HCP is
her husband and she is DNR per her husband. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Intracerebral hemorrhage,Cerebral edema,Malignant neoplasm of other parts of bronchus or lung,Unspecified essential hypertension,Osteoporosis, unspecified,Other convulsions,Dermatitis due to drugs and medicines taken internally,Personal history of tobacco use,Other opiates and related narcotics causing adverse effects in therapeutic use'}
