CHIEF COMPLAINT: cerebellar mass

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 63-year-old right-handed man who has a
progressive right cerebellar meningioma.  This meningioma has
been slowly growing since [**2096**], followed by Dr. [**Last Name (STitle) 724**] in Brain
[**Hospital 341**] Clinic s/p Chemotherapy treatment. He presents now for
resection due to enlargement of the mass despite treatment.

MEDICAL HISTORY: - [**Doctor Last Name **] grade 6 (3 + 3) adenocarcinoma of the prostate managed
with watchful waiting
- right cerebellar meningioma with growth to 4.4 cm x 3.1 cm.
- nephrolithiasis
- ocular migraine
- hepatitis B
- mononucleosis with subsequent hepatitis
- genital herpes
- leg fracture
- ocular migraine
- pyloric stenosis as an infant

MEDICATION ON ADMISSION: quinidine gluconate, verapamil, cialis, multiple vitamins

ALLERGIES: Penicillins

PHYSICAL EXAM: On Admission:
He is awake, alert, and oriented times 3.  His language is
fluent with good comprehension.  His short-term recall is
intact.

FAMILY HISTORY: CAD in both grandfathers who died in their 60s testicular and
prostate cancer in father who died at 77.

SOCIAL HISTORY: Professor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] in the School of Government. Lives at home
with wife and 13 [**Name2 (NI) **] daughter.
-Tobacco history: 1 cigar daily for 5 yrs in his 30s. No other
tobacco
-ETOH: 3-4 beers per week plus [**12-21**] hard drinks over the weekend
Benign neoplasm of cerebral meninges,Other forms of migraine, without mention of intractable migraine without mention of status migrainosus,Personal history of malignant neoplasm of prostate,Personal history of urinary calculi
Ben neo cerebr meninges,Othr migrne wo ntrc mgrn,Hx-prostatic malignancy,Prsnl hst urnr dsrd calc
Admission Date:  [**2105-12-23**]              Discharge Date:   [**2105-12-25**]

Date of Birth:  [**2040-11-4**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Penicillins

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

Major Surgical or Invasive Procedure:
[**2105-12-23**]: Suboccipital Craniotomy for resection of cerebellar
meningioma


History of Present Illness:
[**Known firstname **] [**Known lastname **] is a 63-year-old right-handed man who has a
progressive right cerebellar meningioma.  This meningioma has
been slowly growing since [**2096**], followed by Dr. [**Last Name (STitle) 724**] in Brain
[**Hospital 341**] Clinic s/p Chemotherapy treatment. He presents now for
resection due to enlargement of the mass despite treatment.


Past Medical History:
- [**Doctor Last Name **] grade 6 (3 + 3) adenocarcinoma of the prostate managed
with watchful waiting
- right cerebellar meningioma with growth to 4.4 cm x 3.1 cm.
- nephrolithiasis
- ocular migraine
- hepatitis B
- mononucleosis with subsequent hepatitis
- genital herpes
- leg fracture
- ocular migraine
- pyloric stenosis as an infant


Social History:
Professor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] in the School of Government. Lives at home
with wife and 13 [**Name2 (NI) **] daughter.
-Tobacco history: 1 cigar daily for 5 yrs in his 30s. No other
tobacco
-ETOH: 3-4 beers per week plus [**12-21**] hard drinks over the weekend

-Illicit drugs: no cocaine or IVDU. Occasional ecstasy use.


Family History:
CAD in both grandfathers who died in their 60s testicular and
prostate cancer in father who died at 77.


Physical Exam:
On Admission:
He is awake, alert, and oriented times 3.  His language is
fluent with good comprehension.  His short-term recall is
intact.

Cranial Nerve Examination:  His pupils are equal and reactive to
light, 4 mm to 2 mm bilaterally.  Extraocular movements are
full.
Visual fields are full to confrontation.  His face is symmetric.

Facial sensation is intact bilaterally.  His hearing is intact
bilaterally.  His tongue is midline.  Palate goes up in the
midline.  Sternocleidomastoids and upper trapezius are strong.

Motor Examination:  He does not have a drift.  His muscle
strengths are [**4-24**] at all muscle groups.  His muscle tone is
normal.  His reflexes are 2- bilaterally in the upper
extremities
excepet for 0 reflexes at the elbows.  His knee jerks are 2-.
His ankle jerk is absent on the right but 2- on the left.  His
toes are down going.  Sensory examination is intact to touch and
proprioception.
Coordination examination does not reveal dysmetria.
His gait is normal.  He can do tandem. Romberg negative.

PHYSICAL EXAM UPON DISCHARGE:
non focal. incision c/d/i, dissolvable sutures


Pertinent Results:
[**12-23**] MRI Brain: IMPRESSION: Unchanged homogeneously enhancing
extra-axial mass lesion in the right posterior fossa, likely
consistent with a meningioma, no new lesions are identified
since the most recent study. Fiducial markers are in place.
Persistent mild effacement of the fourth ventricle and
pre-pontine cistern.

[**12-23**] CT Head: IMPRESSION: Post-surgical changes related to
suboccipital craniectomy and resection of the cerebellar
meningioma

[**12-24**] Brain MRI:
IMPRESSION:
1. 3.2 x 2.6 cm enhancing probable residual tumor in the
posterior right
cerebellar resection cavity.
2. Status post suboccipital craniectomy with small anterior
inferior right
cerebellar infarct along anterior aspect of the surgical cavity.

3. No acute infarct or new hemorrhage in the supratentorial
brain.
4. Left mastoid opacification.


Brief Hospital Course:
Patient was admitted for elective resection of cerebellar
meningioma and underwent a suboccipital craniotomy on [**2105-12-23**].
The patient tolerated the procedure well, was extubated and
transfered to the ICU for Q1 hour neuro checks and systolic
blood pressure control less than 140.  Postoperatively he was
started on Dexamethasone 4mg Q6 and GI prophylaxis with
Protonix.  He received perioperative antibiotics.

Postoperative Head CT revealed no hemorrhage or strokes. He
remained neurologically stable overnight. On POD#1 he was
cleared for transfer to the floor. His decadron was tapered and
he underwent an MRI which revealed subtotal resection as
expected. Neuro and Rad Onc were consulted for assistance with
further treatment planning.

On POD#2 he was again neurologically stable. His pain was
controlled, he was ambulating independently, tolerating a PO
diet and voiding without problem. His decadron was tapered and
he was cleared for discharge home. His family and himself were
in agreement with this plan.

Medications on Admission:
quinidine gluconate, verapamil, cialis, multiple vitamins


Discharge Medications:
1. aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day: you
may resume this medication on [**1-2**].
2. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for Pain.
Disp:*60 Tablet(s)* Refills:*0*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
5. verapamil 80 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
6. quinidine gluconate 324 mg Tablet Extended Release Sig: One
(1) Tablet Extended Release PO Q8H (every 8 hours).
7. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) as needed for muscle spasm.
Disp:*30 Tablet(s)* Refills:*0*
8. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day): continue while on steroids.
Disp:*60 Tablet(s)* Refills:*2*
9. dexamethasone 2 mg Tablet Sig: taper Tablet PO taper for 5
days: 3mg Q8h [**12-25**], 2mg Q8h [**12-26**], 1mg Q8h [**12-27**], 1mg Q12h [**12-28**], 1mg
q24 [**12-29**] then d/c,.
Disp:*qs Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Cerebellar Meningioma

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

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 have dissolving sutures and you may wash your hair 3 days
after surgery.
??????	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 may restart your home dose of Aspirin 325mg
Daily on [**2106-1-2**].
??????	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.
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:
Follow-Up Appointment Instructions

??????	You have an apointment in the Brain [**Hospital 341**] Clinic to be seen on
[**2106-1-7**] @ 10AM.  The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 5074**] 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:[**2105-12-25**]
{'Benign neoplasm of cerebral meninges,Other forms of migraine, without mention of intractable migraine without mention of status migrainosus,Personal history of malignant neoplasm of prostate,Personal history of urinary calculi'}


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: cerebellar mass

PRESENT ILLNESS: [**Known firstname **] [**Known lastname **] is a 63-year-old right-handed man who has a
progressive right cerebellar meningioma.  This meningioma has
been slowly growing since [**2096**], followed by Dr. [**Last Name (STitle) 724**] in Brain
[**Hospital 341**] Clinic s/p Chemotherapy treatment. He presents now for
resection due to enlargement of the mass despite treatment.

MEDICAL HISTORY: - [**Doctor Last Name **] grade 6 (3 + 3) adenocarcinoma of the prostate managed
with watchful waiting
- right cerebellar meningioma with growth to 4.4 cm x 3.1 cm.
- nephrolithiasis
- ocular migraine
- hepatitis B
- mononucleosis with subsequent hepatitis
- genital herpes
- leg fracture
- ocular migraine
- pyloric stenosis as an infant

MEDICATION ON ADMISSION: quinidine gluconate, verapamil, cialis, multiple vitamins

ALLERGIES: Penicillins

PHYSICAL EXAM: On Admission:
He is awake, alert, and oriented times 3.  His language is
fluent with good comprehension.  His short-term recall is
intact.

FAMILY HISTORY: CAD in both grandfathers who died in their 60s testicular and
prostate cancer in father who died at 77.

SOCIAL HISTORY: Professor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] in the School of Government. Lives at home
with wife and 13 [**Name2 (NI) **] daughter.
-Tobacco history: 1 cigar daily for 5 yrs in his 30s. No other
tobacco
-ETOH: 3-4 beers per week plus [**12-21**] hard drinks over the weekend 

### Response:
{'Benign neoplasm of cerebral meninges,Other forms of migraine, without mention of intractable migraine without mention of status migrainosus,Personal history of malignant neoplasm of prostate,Personal history of urinary calculi'}
