CHIEF COMPLAINT: elective coiling of anterior communicating artery aneurysm

PRESENT ILLNESS: HISTORY OF PRESENT ILLNESS:  This is a 48-year-old female with a
recent history of new onset of headache.  [**Known firstname 1356**] is a pleasant
neuro ICU nurse who struck her head while at work in [**Month (only) **].  She
had no loss of consciousness, but developed persistent occipital
headaches.  Two weeks post injury, her headaches continued and
she developed nausea.  She denied any visual disturbances or
weakness or numbness to her extremities.  She reported to work
and a CT scan was done with negative results. Symptoms continued
and she complained of a "sharp stabbing pain" to her occipital
area .  An MRI was done and an AComm aneurysm reported.  Her
headaches still continue daily, today [**3-10**], her nausea has
subsided. She takes Fioricet with relief.  She also notes that
she has been under a considerable amount of stress.  Recently,
her mother was diagnosed with lung cancer and her husband was
recently diagnosed with multiple sclerosis. She denies any
weakness, numbness, tingling sensation,visual disturbances,
hearing deficit,bowel or bladder dysfunction.

MEDICAL HISTORY: PAST MEDICAL HISTORY:  Non-contributory. Childbirth X 3

MEDICATION ON ADMISSION: fiorocet prn

ALLERGIES: Dicloxacillin

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITAL SIGNS:  Temperature 98.6, BP is 138/94, heart rate 72,
respirations 18, O2 sat 99%.Weight 230  Height 5'9"
GENERAL:  She is comfortable, in no acute distress.
HEENT:  Pupils are equal and reactive of [**5-1**] bilaterally.  EOMs
intact.
NECK:  Supple.
EXTREMITIES:  Warm, well perfused 4+ pedal pulses.
NEURO:  Mental Status:  Alert and oriented x3.  Speech is fluent
with good comprehension.  Bilateral upper and lower extremity
strength 5/5.  Cranial nerves II-XII grossly intact.  Motor:
Normal bulk and tone.  Strength:  Full power [**6-2**].  Sensation
intact to light touch.  Coordination:  Normal
finger-nose-finger.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: SOCIAL HISTORY:  Married, three children age 16, 17 and 20.
Works
as an ICU nurse.  Previously smoked, quit six years ago.[**3-3**]
drinks week. Weight fluctuates greatly.
Cerebral aneurysm, nonruptured
Nonrupt cerebral aneurym
Admission Date:  [**2140-9-19**]              Discharge Date:   [**2140-9-20**]

Date of Birth:  [**2092-2-13**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Dicloxacillin

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
elective coiling of anterior communicating artery aneurysm

Major Surgical or Invasive Procedure:
Diangostic cerebral angiogram with coiling anterior
communicating artery aneurysm


History of Present Illness:
HISTORY OF PRESENT ILLNESS:  This is a 48-year-old female with a
recent history of new onset of headache.  [**Known firstname 1356**] is a pleasant
neuro ICU nurse who struck her head while at work in [**Month (only) **].  She
had no loss of consciousness, but developed persistent occipital
headaches.  Two weeks post injury, her headaches continued and
she developed nausea.  She denied any visual disturbances or
weakness or numbness to her extremities.  She reported to work
and a CT scan was done with negative results. Symptoms continued
and she complained of a "sharp stabbing pain" to her occipital
area .  An MRI was done and an AComm aneurysm reported.  Her
headaches still continue daily, today [**3-10**], her nausea has
subsided. She takes Fioricet with relief.  She also notes that
she has been under a considerable amount of stress.  Recently,
her mother was diagnosed with lung cancer and her husband was
recently diagnosed with multiple sclerosis. She denies any
weakness, numbness, tingling sensation,visual disturbances,
hearing deficit,bowel or bladder dysfunction.


Past Medical History:
PAST MEDICAL HISTORY:  Non-contributory. Childbirth X 3


Social History:
SOCIAL HISTORY:  Married, three children age 16, 17 and 20.
Works
as an ICU nurse.  Previously smoked, quit six years ago.[**3-3**]
drinks week. Weight fluctuates greatly.


Family History:
non contributory

Physical Exam:
PHYSICAL EXAMINATION:
VITAL SIGNS:  Temperature 98.6, BP is 138/94, heart rate 72,
respirations 18, O2 sat 99%.Weight 230  Height 5'9"
GENERAL:  She is comfortable, in no acute distress.
HEENT:  Pupils are equal and reactive of [**5-1**] bilaterally.  EOMs
intact.
NECK:  Supple.
EXTREMITIES:  Warm, well perfused 4+ pedal pulses.
NEURO:  Mental Status:  Alert and oriented x3.  Speech is fluent
with good comprehension.  Bilateral upper and lower extremity
strength 5/5.  Cranial nerves II-XII grossly intact.  Motor:
Normal bulk and tone.  Strength:  Full power [**6-2**].  Sensation
intact to light touch.  Coordination:  Normal
finger-nose-finger.


Pertinent Results:
the report for the diagnostic cerbral angiogram is not finalized
at this time of discharge.
[**2140-9-19**] 02:00PM   PT-11.7 PTT-22.3 INR(PT)-1.0
[**2140-9-19**] 02:00PM   PLT COUNT-213
[**2140-9-19**] 02:00PM   WBC-4.4 RBC-3.92* HGB-12.5 HCT-34.9* MCV-89
MCH-31.8 MCHC-35.7* RDW-13.5
[**2140-9-19**] 06:54PM   GLUCOSE-140* UREA N-12 CREAT-0.6 SODIUM-141
POTASSIUM-3.5 CHLORIDE-110* TOTAL CO2-25 ANION GAP-10
[**2140-9-19**] 06:54PM   CALCIUM-7.7* PHOSPHATE-4.4 MAGNESIUM-1.2*
[**2140-9-19**] 06:54PM   WBC-6.9# RBC-3.76* HGB-12.0 HCT-33.9* MCV-90
MCH-31.9 MCHC-35.4* RDW-13.6

Brief Hospital Course:
Pt was admitted through Radiology care unit for elective
diagnostic cerebral angiogram under general anesthesia with
possible coil.  The pt was intubated in the INR suite iwhtout
event.  She underwent the diangostic cerebral angiogram without
complication.  There were three aneurysms noted. The first was
the previsouly known about, acomm aneurysm which was
successfully coiled. The second was a left cavernous carotid
artery aneurysm.  This will not require treatment.  The third is
a right superior cerebellar artery aneurysm.  This was not
treated but will be discussed with the pt in the near future as
how to best procede.

The pt was kept on a heparin drip overnight with a right 5
french short groin sheath in place.  The heparin was stopped at
730 am the following am.  The femoral sheath was removed 2 hours
later.  Her right leg was kept straight x 7 hours. She was
cleared for discharge home on asa daily till follow up in six
months - she agrees with this plan.

Medications on Admission:
fiorocet prn

Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain fever.
2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*6*
3. fiorocet  Sig: 1-2 tablets  every four (4) hours as needed
for pain.
Disp:*40 * Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
Anterior communicating artery s/p coiling
Superior cerebellar [**Last Name (un) **] aneurysm


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily / continue to
take this until you are told to stop
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room!


Followup Instructions:
Please follow up with Dr [**First Name (STitle) **] in six months wiht MRI MRA with
[**Doctor Last Name **] protocol
Please call the office to schedule an appointment at
[**Telephone/Fax (1) **]
Dr. [**First Name (STitle) **] will call you at home within the next week to discuss
the findings of the superior cerebellar artery aneurysm.



Completed by:[**2140-9-20**]
{'Cerebral aneurysm, nonruptured'}


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: elective coiling of anterior communicating artery aneurysm

PRESENT ILLNESS: HISTORY OF PRESENT ILLNESS:  This is a 48-year-old female with a
recent history of new onset of headache.  [**Known firstname 1356**] is a pleasant
neuro ICU nurse who struck her head while at work in [**Month (only) **].  She
had no loss of consciousness, but developed persistent occipital
headaches.  Two weeks post injury, her headaches continued and
she developed nausea.  She denied any visual disturbances or
weakness or numbness to her extremities.  She reported to work
and a CT scan was done with negative results. Symptoms continued
and she complained of a "sharp stabbing pain" to her occipital
area .  An MRI was done and an AComm aneurysm reported.  Her
headaches still continue daily, today [**3-10**], her nausea has
subsided. She takes Fioricet with relief.  She also notes that
she has been under a considerable amount of stress.  Recently,
her mother was diagnosed with lung cancer and her husband was
recently diagnosed with multiple sclerosis. She denies any
weakness, numbness, tingling sensation,visual disturbances,
hearing deficit,bowel or bladder dysfunction.

MEDICAL HISTORY: PAST MEDICAL HISTORY:  Non-contributory. Childbirth X 3

MEDICATION ON ADMISSION: fiorocet prn

ALLERGIES: Dicloxacillin

PHYSICAL EXAM: PHYSICAL EXAMINATION:
VITAL SIGNS:  Temperature 98.6, BP is 138/94, heart rate 72,
respirations 18, O2 sat 99%.Weight 230  Height 5'9"
GENERAL:  She is comfortable, in no acute distress.
HEENT:  Pupils are equal and reactive of [**5-1**] bilaterally.  EOMs
intact.
NECK:  Supple.
EXTREMITIES:  Warm, well perfused 4+ pedal pulses.
NEURO:  Mental Status:  Alert and oriented x3.  Speech is fluent
with good comprehension.  Bilateral upper and lower extremity
strength 5/5.  Cranial nerves II-XII grossly intact.  Motor:
Normal bulk and tone.  Strength:  Full power [**6-2**].  Sensation
intact to light touch.  Coordination:  Normal
finger-nose-finger.

FAMILY HISTORY: non contributory

SOCIAL HISTORY: SOCIAL HISTORY:  Married, three children age 16, 17 and 20.
Works
as an ICU nurse.  Previously smoked, quit six years ago.[**3-3**]
drinks week. Weight fluctuates greatly. 

### Response:
{'Cerebral aneurysm, nonruptured'}
