CHIEF COMPLAINT: Transfer from OSH for seizures, AMS

PRESENT ILLNESS: Ms. [**Known lastname 3123**] is a 41 year-old lady w/ melanoma (dx [**2136**])
metastatic to breast s/p resection '[**42**], colon s/p R-colectomy
'[**42**], and brain s/p L-frontal resection and XRT ([**6-24**]) who was
recently hospitalized (d/c [**2146-5-10**]) for abdominal pain/
nausea/ vomiting thought to be secondary to an enlarging 12cm
pelvic mass, treated with bupivicaine epidural who now presents
for seizures and AMS. Per husband's report, patient had been
feeling lightheaded and weak the day prior to presentation, w/
nausea and vomiting. She reportedly c/o "spinning rainbows" in
her eyes all afternoon w/ both eyes. She was in the commode
around [**2165**] that night and started seeing "Triple" per her
husband. She then developed slurred speech followed by an
episode of 10-15s of B/L arm shaking (not legs per husband). Her
eyes were open and L-deviated and she also lost urine and bowel
continence. She then became confused for around 30min. She was
taken urgently to [**Hospital **] Medical Center, where she underwent
head CT. CT revealed scattered areas of vasogenic edema along
the anterior L-frontal lobe, B/L basal ganglia and B/L
parieto-occipital lobes. A subtle mass was suspected along the
R-anterior frontal [**Doctor Last Name 534**] w/ mild mass effect- no evidence of ICH.
After the scan around 0100, she had another witnessed
tonic-clonic seizure w/ B/L arm shaking and drooling. She was
given Phenytoin 1gm IV x 1, Lorazepam 1mg IV x 1 and
Dexamethasone 4mg IV x 1. She was transferred to [**Hospital1 18**] for
further management.
.
In the ED, initial VS: T 98.7, HR 103, BP 162/105, RR 20 SaO2
100% RA. Patient was arousable but very lethargic/sluggish, not
answering questions. CT Head was done which showed extensive
supratentorial and infratentorial hypodensities, concerning for
PRES or another toxic/metabolic abnormality- could also be
related to edema from her metastatic disease. She was
transferred to the ICU secondary to altered mental status, and
was intially hemodynamicalyl stable, and was confirmed DNR/DNI.
In the ICU, pt appears seriously ill, not responding to
questions/commands or painful stimuli. She is [**Last Name (un) 6055**]-[**Doctor Last Name **]
breathing and continues to have B/L Leftward beating nystagmus.

MEDICAL HISTORY: Metastatic Melanoma - First diagnosed in right lower back in
[**2136**] for which she underwent wide local excision and inguinal
lymph node biopsy; [**12-25**] lymph nodes were removed from inguinal
lymph node dissection were without metastasis. She was enrolled
in the group protocol S0008. In [**2137**] she had recurrence in the
scar for which she had surgical resection and XRT. In [**2140**] she
was found to have metastatic disease with multiple pulmonary
nodules, and was on high-dose IL-2 showing some resolution and
response. She had another
metastasis in the breast in [**2143-10-17**], and then was
diagnosed with a colonic mass for which she had a right
colectomy and retroperitoneal exploration. She subsequently
presented with confusion and difficulty in concentrating and was

MEDICATION ON ADMISSION: Zofran
Decadron
Ativan
Bupivicaine epidural
Lansoprazole
Amlodipine

ALLERGIES: Naprosyn / Iodine / Adhesive Tape

PHYSICAL EXAM: GEN: seriously ill-appearing pale F lying in bed w/ eyes closed
and mouth open, not responding to commands or painful stimuli
HEENT: + left horizontal beating nystagmus OU, sclerae anicteric

FAMILY HISTORY: Maternal Aunt - Melanoma

SOCIAL HISTORY: Home: lives with her husband and dogs, supportive family
Occupation: previously employed as a financial analyst
Tobacco: Denies
EtOH: Denies
Drugs: Denies
Secondary malignant neoplasm of other specified sites,Grand mal status,Personal history of malignant melanoma of skin,Personal history of antineoplastic chemotherapy,Encounter for palliative care
Secondary malig neo NEC,Grand mal status,Hx-malig skin melanoma,Hx antineoplastic chemo,Encountr palliative care
Admission Date:  [**2146-5-15**]              Discharge Date:   [**2146-5-19**]

Date of Birth:  [**2105-1-19**]             Sex:   F

Service: MEDICINE

Allergies:
Naprosyn / Iodine / Adhesive Tape

Attending:[**First Name3 (LF) 8790**]
Chief Complaint:
Transfer from OSH for seizures, AMS

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms. [**Known lastname 3123**] is a 41 year-old lady w/ melanoma (dx [**2136**])
metastatic to breast s/p resection '[**42**], colon s/p R-colectomy
'[**42**], and brain s/p L-frontal resection and XRT ([**6-24**]) who was
recently hospitalized (d/c [**2146-5-10**]) for abdominal pain/
nausea/ vomiting thought to be secondary to an enlarging 12cm
pelvic mass, treated with bupivicaine epidural who now presents
for seizures and AMS. Per husband's report, patient had been
feeling lightheaded and weak the day prior to presentation, w/
nausea and vomiting. She reportedly c/o "spinning rainbows" in
her eyes all afternoon w/ both eyes. She was in the commode
around [**2165**] that night and started seeing "Triple" per her
husband. She then developed slurred speech followed by an
episode of 10-15s of B/L arm shaking (not legs per husband). Her
eyes were open and L-deviated and she also lost urine and bowel
continence. She then became confused for around 30min. She was
taken urgently to [**Hospital **] Medical Center, where she underwent
head CT. CT revealed scattered areas of vasogenic edema along
the anterior L-frontal lobe, B/L basal ganglia and B/L
parieto-occipital lobes. A subtle mass was suspected along the
R-anterior frontal [**Doctor Last Name 534**] w/ mild mass effect- no evidence of ICH.
After the scan around 0100, she had another witnessed
tonic-clonic seizure w/ B/L arm shaking and drooling. She was
given Phenytoin 1gm IV x 1, Lorazepam 1mg IV x 1 and
Dexamethasone 4mg IV x 1. She was transferred to [**Hospital1 18**] for
further management.
.
In the ED, initial VS: T 98.7, HR 103, BP 162/105, RR 20 SaO2
100% RA. Patient was arousable but very lethargic/sluggish, not
answering questions. CT Head was done which showed extensive
supratentorial and infratentorial hypodensities, concerning for
PRES or another toxic/metabolic abnormality- could also be
related to edema from her metastatic disease. She was
transferred to the ICU secondary to altered mental status, and
was intially hemodynamicalyl stable, and was confirmed DNR/DNI.
In the ICU, pt appears seriously ill, not responding to
questions/commands or painful stimuli. She is [**Last Name (un) 6055**]-[**Doctor Last Name **]
breathing and continues to have B/L Leftward beating nystagmus.

ROS unobtainable given pts mental status


Past Medical History:
Metastatic Melanoma - First diagnosed in right lower back in
[**2136**] for which she underwent wide local excision and inguinal
lymph node biopsy; [**12-25**] lymph nodes were removed from inguinal
lymph node dissection were without metastasis. She was enrolled
in the group protocol S0008. In [**2137**] she had recurrence in the
scar for which she had surgical resection and XRT. In [**2140**] she
was found to have metastatic disease with multiple pulmonary
nodules, and was on high-dose IL-2 showing some resolution and
response. She had another
metastasis in the breast in [**2143-10-17**], and then was
diagnosed with a colonic mass for which she had a right
colectomy and retroperitoneal exploration. She subsequently
presented with confusion and difficulty in concentrating and was

found to have a left frontal brain metastasis. She underwent
resection and XRT. In [**2145**] she was found to have a 12-cm pelvic

mass and underwent resection of abdominal wall metastasis. In
[**2146-3-17**] she was started in a compassionate use ipilimumab

trial.


Social History:
Home: lives with her husband and dogs, supportive family
Occupation: previously employed as a financial analyst
Tobacco: Denies
EtOH: Denies
Drugs: Denies



Family History:
Maternal Aunt - Melanoma

Physical Exam:
GEN: seriously ill-appearing pale F lying in bed w/ eyes closed
and mouth open, not responding to commands or painful stimuli
HEENT: + left horizontal beating nystagmus OU, sclerae anicteric

Lungs: Clear to auscultation anteriorly
CV: RRR nl S1, S2 no murmurs appreciated
Abdomen: +BS soft +distended, cannot assess tenderness d/t MS
[**Name13 (STitle) **]: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: obtunded, not arousable


Pertinent Results:
[**2146-5-15**] 04:25AM BLOOD WBC-8.8 RBC-3.17* Hgb-8.3* Hct-25.0*
MCV-79* MCH-26.2* MCHC-33.3 RDW-18.7* Plt Ct-165
[**2146-5-15**] 04:25AM BLOOD Glucose-153* UreaN-18 Creat-1.2* Na-138
K-3.1* Cl-99 HCO3-24 AnGap-18
[**2146-5-15**] 04:25AM BLOOD Albumin-3.4*
[**2146-5-15**] 09:35PM BLOOD Phenyto-10.2
[**2146-5-15**] 01:51PM BLOOD Type-ART pO2-139* pCO2-39 pH-7.41
calTCO2-26 Base XS-0
[**2146-5-15**] 01:51PM BLOOD Lactate-1.7
[**2146-5-15**] 01:51PM BLOOD freeCa-1.12

Brief Hospital Course:
This is a 41 yof with history of metastatic melanoma who was
recently hospitalized for abdominal pain/N/V thought to be
secondary to enlarging pelvic mass who now presents for seizures
and AMS.
.
# Seizures/AMS: Most likely this is caused by her metastatic
disease. CT Head shows extensive white matter hypodensities,
likely metastatic disease, although radiology recommending MRI
for further characterization. Lower on the differential is
infection such as meningitis which could be introduced through
epidural catheter. As per initial Neuro recommendations (who saw
pt in ED).  An EEG confirmed status epilepticus and she was
started on fosphynytoin and keppra.  She came out of status
epilipticus.  She was breifly treated with antibiotics for
bacterial meningitis.  However given her overall clinical
prognosis a goals of care discussion was held and she was made
Comfort Measures Only.  Her antiepileptics were continued to
keep her out of status epiliepticus for her and her husbands
comfort.  [**Name2 (NI) **] antibiotics were at that time stopped.
.
# Metastatic Melanoma: as per onc notes, pt had undergone 1
cycle of compassionate ipilimumab therapy but continuing on
ipilimumab is not possible given worsening status. Per onc notes
[**4-29**], advanced directives were discussed and [**Known firstname 36211**] would like
to be at home if possible. She would like to be DNR/DNI and be
comfortable.
.
Code: DNR/DNI (confirmed) and transitioned to CMO on [**5-15**] -
[**5-16**].
.
The pt passed away early in the am of [**2146-5-19**].

Medications on Admission:

Zofran
Decadron
Ativan
Bupivicaine epidural
Lansoprazole
Amlodipine


Discharge Medications:
n/a

Discharge Disposition:
Expired

Discharge Diagnosis:
Deceased

Discharge Condition:
Deceased

Discharge Instructions:
n/a

Followup Instructions:
n/a


Completed by:[**2146-5-19**]
{'Secondary malignant neoplasm of other specified sites,Grand mal status,Personal history of malignant melanoma of skin,Personal history of antineoplastic chemotherapy,Encounter for palliative care'}


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: Transfer from OSH for seizures, AMS

PRESENT ILLNESS: Ms. [**Known lastname 3123**] is a 41 year-old lady w/ melanoma (dx [**2136**])
metastatic to breast s/p resection '[**42**], colon s/p R-colectomy
'[**42**], and brain s/p L-frontal resection and XRT ([**6-24**]) who was
recently hospitalized (d/c [**2146-5-10**]) for abdominal pain/
nausea/ vomiting thought to be secondary to an enlarging 12cm
pelvic mass, treated with bupivicaine epidural who now presents
for seizures and AMS. Per husband's report, patient had been
feeling lightheaded and weak the day prior to presentation, w/
nausea and vomiting. She reportedly c/o "spinning rainbows" in
her eyes all afternoon w/ both eyes. She was in the commode
around [**2165**] that night and started seeing "Triple" per her
husband. She then developed slurred speech followed by an
episode of 10-15s of B/L arm shaking (not legs per husband). Her
eyes were open and L-deviated and she also lost urine and bowel
continence. She then became confused for around 30min. She was
taken urgently to [**Hospital **] Medical Center, where she underwent
head CT. CT revealed scattered areas of vasogenic edema along
the anterior L-frontal lobe, B/L basal ganglia and B/L
parieto-occipital lobes. A subtle mass was suspected along the
R-anterior frontal [**Doctor Last Name 534**] w/ mild mass effect- no evidence of ICH.
After the scan around 0100, she had another witnessed
tonic-clonic seizure w/ B/L arm shaking and drooling. She was
given Phenytoin 1gm IV x 1, Lorazepam 1mg IV x 1 and
Dexamethasone 4mg IV x 1. She was transferred to [**Hospital1 18**] for
further management.
.
In the ED, initial VS: T 98.7, HR 103, BP 162/105, RR 20 SaO2
100% RA. Patient was arousable but very lethargic/sluggish, not
answering questions. CT Head was done which showed extensive
supratentorial and infratentorial hypodensities, concerning for
PRES or another toxic/metabolic abnormality- could also be
related to edema from her metastatic disease. She was
transferred to the ICU secondary to altered mental status, and
was intially hemodynamicalyl stable, and was confirmed DNR/DNI.
In the ICU, pt appears seriously ill, not responding to
questions/commands or painful stimuli. She is [**Last Name (un) 6055**]-[**Doctor Last Name **]
breathing and continues to have B/L Leftward beating nystagmus.

MEDICAL HISTORY: Metastatic Melanoma - First diagnosed in right lower back in
[**2136**] for which she underwent wide local excision and inguinal
lymph node biopsy; [**12-25**] lymph nodes were removed from inguinal
lymph node dissection were without metastasis. She was enrolled
in the group protocol S0008. In [**2137**] she had recurrence in the
scar for which she had surgical resection and XRT. In [**2140**] she
was found to have metastatic disease with multiple pulmonary
nodules, and was on high-dose IL-2 showing some resolution and
response. She had another
metastasis in the breast in [**2143-10-17**], and then was
diagnosed with a colonic mass for which she had a right
colectomy and retroperitoneal exploration. She subsequently
presented with confusion and difficulty in concentrating and was

MEDICATION ON ADMISSION: Zofran
Decadron
Ativan
Bupivicaine epidural
Lansoprazole
Amlodipine

ALLERGIES: Naprosyn / Iodine / Adhesive Tape

PHYSICAL EXAM: GEN: seriously ill-appearing pale F lying in bed w/ eyes closed
and mouth open, not responding to commands or painful stimuli
HEENT: + left horizontal beating nystagmus OU, sclerae anicteric

FAMILY HISTORY: Maternal Aunt - Melanoma

SOCIAL HISTORY: Home: lives with her husband and dogs, supportive family
Occupation: previously employed as a financial analyst
Tobacco: Denies
EtOH: Denies
Drugs: Denies 

### Response:
{'Secondary malignant neoplasm of other specified sites,Grand mal status,Personal history of malignant melanoma of skin,Personal history of antineoplastic chemotherapy,Encounter for palliative care'}
