CHIEF COMPLAINT: Anterior communicating artery aneurysm

PRESENT ILLNESS: 44 yo F presented to OSH w/ pain and swelling in mouth.
Patient received a Maxillary CT for concern for periorbital
abscess and an incidental finding was an Acomm aneurysm measured
at 7 x 4 mm at OSH. Patient is asymptomatic. No headaches,
slurred speech, diplopia, nausea, vomiting, or weakness.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On examination, her pupils are equal and reactive to light.
Extraocular movements are intact.  Cranial nerves II through XII
are intact.  Motor strength is [**5-15**] in all 4 extremities.
Reflexes are symmetric. No pronator drift, face symetric and
tongue midline.  Gait and coordination is normal.  Chest shows
good air entry bilaterally.

FAMILY HISTORY: Father died of pancreatic cancer

SOCIAL HISTORY: She smokes a pack of cigarettes per day and uses
six-pack of alcohol per week.  She works as a waitress.
Cerebral aneurysm, nonruptured,Family history of malignant neoplasm of gastrointestinal tract
Nonrupt cerebral aneurym,Family hx-gi malignancy
Admission Date:  [**2148-9-25**]              Discharge Date:   [**2148-9-26**]

Date of Birth:  [**2103-8-21**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Anterior communicating artery aneurysm


Major Surgical or Invasive Procedure:
Coiling of acomm aneurysm


History of Present Illness:
44 yo F presented to OSH w/ pain and swelling in mouth.
Patient received a Maxillary CT for concern for periorbital
abscess and an incidental finding was an Acomm aneurysm measured
at 7 x 4 mm at OSH. Patient is asymptomatic. No headaches,
slurred speech, diplopia, nausea, vomiting, or weakness.

She presents today as an elective admission for coiling of her
aneurysm

Past Medical History:
None

Social History:
She smokes a pack of cigarettes per day and uses
six-pack of alcohol per week.  She works as a waitress.


Family History:
Father died of pancreatic cancer

Physical Exam:
On examination, her pupils are equal and reactive to light.
Extraocular movements are intact.  Cranial nerves II through XII
are intact.  Motor strength is [**5-15**] in all 4 extremities.
Reflexes are symmetric. No pronator drift, face symetric and
tongue midline.  Gait and coordination is normal.  Chest shows
good air entry bilaterally.

The patient's CTA is consistent with a 7-mm anterior
communicating artery aneurysm.


Pertinent Results:
[**2148-9-25**] 12:30PM   PT-12.4 PTT-20.2* INR(PT)-1.0
[**2148-9-25**] 12:30PM   PLT COUNT-266
[**2148-9-25**] 12:30PM   WBC-11.5* RBC-4.76 HGB-13.5 HCT-38.9 MCV-82
MCH-28.3 MCHC-34.6 RDW-14.3
[**2148-9-25**] 12:30PM   CALCIUM-9.5 MAGNESIUM-1.9 URIC ACID-4.7
[**2148-9-25**] 12:30PM   GLUCOSE-93 UREA N-11 CREAT-0.5 SODIUM-138
POTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-23 ANION GAP-15

[**2148-8-20**] CT head

1. 7 x 5 mm anterior communicating artery aneurysm.
2. Soft tissue stranding anterior to the right globe extending
into the
anterior right maxillary subcutaneous soft tissue suspicious for
cellulitis.



Brief Hospital Course:
Pt admitted to neurosurgery service for elective coiling of
acomm aneurysm found as incidental finding. She underwent
uncomplicated coiling of this aneurysm on [**2148-9-26**]. Post
operatively she was started on a heparin IV gtt with goal PTT
50-70 and was transferred to the ICU for q1 neuro checks and
strict blood pressure control less than 140. Upon post op exam
she is AOx3 and following commands. She moves all extremities
with full strength and has no change from her neurological
baseline. Her groin sheath is in place with no signs of hematoma
and she has good distal pulses and her extremities are warm to
the touch. She remained in the ICU overnight and did well. On
the morning of [**9-27**] pt was seen on morning rounds and doing
well. She remained neurologically intact and had no complaints.
Her heparin IV gtt was discontinued and her femoral sheath was
removed without complication. She did remain flat bed rest for 6
hours post removal and was discharged home in stable condition
on POD #1. She will continue to take ASA 325mg daily and will FU
with Dr. [**First Name (STitle) **] in 6 weeks with an MRI/MRA head.

Medications on Admission:
None

Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for headache.
Disp:*40 Tablet(s)* Refills:*0*
3. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
Disp:*3 Patch 24 hr(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Coiling of acomm aneurysm


Discharge Condition:
AOx3
Activity as tolerated. No heavy lifting greater than 5lbs for 1
week.


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily.
??????	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 FU with Dr. [**First Name (STitle) **] in 6 weeks with MRI/MRA of the head.
You may call [**Telephone/Fax (1) 87518**] to schedule an appointment with this
scan.



Completed by:[**2148-9-26**]
{'Cerebral aneurysm, nonruptured,Family history of malignant neoplasm of gastrointestinal tract'}


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: Anterior communicating artery aneurysm

PRESENT ILLNESS: 44 yo F presented to OSH w/ pain and swelling in mouth.
Patient received a Maxillary CT for concern for periorbital
abscess and an incidental finding was an Acomm aneurysm measured
at 7 x 4 mm at OSH. Patient is asymptomatic. No headaches,
slurred speech, diplopia, nausea, vomiting, or weakness.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On examination, her pupils are equal and reactive to light.
Extraocular movements are intact.  Cranial nerves II through XII
are intact.  Motor strength is [**5-15**] in all 4 extremities.
Reflexes are symmetric. No pronator drift, face symetric and
tongue midline.  Gait and coordination is normal.  Chest shows
good air entry bilaterally.

FAMILY HISTORY: Father died of pancreatic cancer

SOCIAL HISTORY: She smokes a pack of cigarettes per day and uses
six-pack of alcohol per week.  She works as a waitress. 

### Response:
{'Cerebral aneurysm, nonruptured,Family history of malignant neoplasm of gastrointestinal tract'}
