CHIEF COMPLAINT: left hemiplegia

PRESENT ILLNESS: Asked to eval this 51 year old white male known to this service
for GBM. Pt presented with one week progression of left sided
weakness.  Went into the bathroom but was too weak to get out.
Wife present for events.  Pt did fall but did not have LOC or
anything that they noticed to be seizure like activity.  No
incontinence of stool or urine.  They called EMS.  It appears on
initial eval that the pt is having focal left sided seizures.

MEDICAL HISTORY: 1. Recurrent left spontaneous pneumothoraces with left apical
blebs, s/p left upper lobe bleb resection, pleurodesis, and
sclerosis in [**2105**]; had post operative air leak requiring
exploratory thoracotomy
2. Right tension pneumothorax, s/p bullectomy with mechanical
pleurodesis in [**2108**]
3. Childhood strabismus, s/p multiple corrective procedures,
last
at age 14
4. Benign connective tissue nevus
5. GBM

MEDICATION ON ADMISSION: Butalbital-Acetaminophen-Caff [Fioricet], Dexamethasone 2 mg
Tablet QOD, Levetiracetam 1000mg [**Hospital1 **], Propranolol XR 60 daily

ALLERGIES: Dilantin

PHYSICAL EXAM: Exam upon admission:
T:AF  BP:140 /100  HR:100    R20       O2Sats100
Gen: WD/WN, uncomfortable at rest, NAD.
HEENT: Pupils: [**3-20**] bilaterally          EOM intact however does
not seem to be able to [**Last Name (un) **] the sclera in lateral gaze, no
diplopia
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Son had a febrile seizure at age eight.  Has a niece with
generalized seizures, now ~age 27.   No stroke, hemorrhage, or
aneurysm.

SOCIAL HISTORY: Lives with wife and two children. Former smoker, 1-2 packs daily
for 10 years but quit years ago. He denies a history of illicit
drug use. He drinks "an occasional beer."
Mechanical complication of nervous system device, implant, and graft,Malignant neoplasm of brain, unspecified,Cerebral edema,Hemiplegia, unspecified, affecting unspecified side,Epilepsy, unspecified, without mention of intractable epilepsy
Malfun neuro device/graf,Malig neo brain NOS,Cerebral edema,Unsp hemiplga unspf side,Epilep NOS w/o intr epil
Admission Date:  [**2122-4-19**]              Discharge Date:   [**2122-4-24**]

Date of Birth:  [**2071-3-22**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Dilantin

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
left hemiplegia

Major Surgical or Invasive Procedure:
[**4-23**]: Revision of GBM intracystic catheter


History of Present Illness:
Asked to eval this 51 year old white male known to this service
for GBM. Pt presented with one week progression of left sided
weakness.  Went into the bathroom but was too weak to get out.
Wife present for events.  Pt did fall but did not have LOC or
anything that they noticed to be seizure like activity.  No
incontinence of stool or urine.  They called EMS.  It appears on
initial eval that the pt is having focal left sided seizures.


Past Medical History:
1. Recurrent left spontaneous pneumothoraces with left apical
blebs, s/p left upper lobe bleb resection, pleurodesis, and
sclerosis in [**2105**]; had post operative air leak requiring
exploratory thoracotomy
2. Right tension pneumothorax, s/p bullectomy with mechanical
pleurodesis in [**2108**]
3. Childhood strabismus, s/p multiple corrective procedures,
last
at age 14
4. Benign connective tissue nevus
5. GBM


Social History:
Lives with wife and two children. Former smoker, 1-2 packs daily
for 10 years but quit years ago. He denies a history of illicit
drug use. He drinks "an occasional beer."

Family History:
Son had a febrile seizure at age eight.  Has a niece with
generalized seizures, now ~age 27.   No stroke, hemorrhage, or
aneurysm.


Physical Exam:
Exam upon admission:
T:AF  BP:140 /100  HR:100    R20       O2Sats100
Gen: WD/WN, uncomfortable at rest, NAD.
HEENT: Pupils: [**3-20**] bilaterally          EOM intact however does
not seem to be able to [**Last Name (un) **] the sclera in lateral gaze, no
diplopia
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

Cranial Nerves:
I: Not tested
II: Pupils equally round and reactive to light, to
mm bilaterally. Visual fields are full to confrontation.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation intact and symmetric.
VIII: Hearing intact to voice.
IX, X: Palatal elevation symmetrical.
[**Doctor First Name 81**]: Sternocleidomastoid and trapezius normal bilaterally.
XII: Tongue midline without fasciculations.

Motor: Normal bulk and tone bilaterally. Positive jerking
motions
seen intermittently to LLE > LUE.
Motor RUE [**Hospital1 **] 4+, Tri 5, grip 5. RLE full throughout.
      LUE [**Hospital1 **] [**1-22**], tri2/5, grip 0/5, LLE IP3/5 DF/PF [**12-22**]
No clonus present

Exam upon discharge:
Alert, oriented to person, place and date. Pupils are equally
round and reactive to light. Full motor strength throughout
upper and lower extremities, however with some deconditioning to
the left side.  Left pronator drift.

Pertinent Results:
CT Head [**2122-4-19**]:
FINDINGS: The patient has undergone prior resection of GBM. A
cystic
collection in the resection bed of the right parietal lobe
appears slightly larger than on the prior exam, now measuring
5.4 x 3.5 cm, previously 4.7 x 3.5 cm. Again, the collection
contains an intracranial catheter. Surrounding edema within the
white matter is unchanged, again extending across the splenium
of the corpus callosum to the left. Subfalcine herniation of 7
mm is similar to the prior study, measuring 6 mm. Overlying
sulcal effacement is stable. There is no new intracranial
hemorrhage, new edema, or new shift of normally midline
structures. There is no major vascular territorial infarct. The
[**Doctor Last Name 352**]-white differentiation is preserved. The basilar cisterns
are symmetric. There is no fracture. Mastoid air cells and
paranasal sinuses are well aerated. Soft tissues are
unremarkable.
IMPRESSION:
1. Small interval increase in size of cystic collection at the
site of GBM
resection, with intracranial catheter in place. Stable degree of
subfalcine herniation.
2. No new intracranial hemorrhage, edema or herniation.

MRI Head [**2122-4-20**]:
FINDINGS: The surgical cavity in the right parietal lobe is
stable in size. A catheter remains present within the cavity.
Irregular enhancement along the cavity margins, thickest in the
anterolateral and superior aspects, is unchanged. High T2 signal
surrounding the cavity and extending into the frontal, parietal,
temporal and anterior occipital white matter of the right
cerebral hemisphere has increased in extent, resulting in mild
leftward shift of the septum pellucidum, which is new since the
previous study. The extent of high T2 signal crossing the
posterior corpus collosum is unchanged. Compression of the
atrium of the right lateral ventricle is not significantly
changed. No new enhancing foci are seen.
There is mucosal thickening in the maxillary sinuses, left
greater than right, and in the left middle ethmoid air cell. The
major arterial flow voids are preserved.
IMPRESSION: Stable size of the surgical cavity and stable extent
of
associated irregular, nodular rim enhancement. Increased
associated edema
with new mild leftward shift of the septum pellucidum. These
findings are
likely related to recent radiation therapy. Close follow-up is
recommended to exclude tumor progression.

[**4-19**] EKG:
Baseline artifact, Sinus tachycardia, Normal ECG except for rate

Since previous tracing of [**2122-3-16**], sinus tachycardia now
present.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
108 132 92 312/396 75 31 61

Head PET Scan [**4-24**]:Study read pending at the time of discharge.



Brief Hospital Course:
The patient was admitted to the ICU with left hemiplegia and
focal left sided seizures. He was recently tapered of steroids
and was reloaded with 10mg of IV decadron and started on 4mg Q6
hours. He improved significantly in a few days and was able to
lift his leg against gravity. His arm was about 2/5 strength on
[**2122-4-21**].
The patient had a brain MRI which showed a large amount of
post-radiation edema. There was also new mild leftward shift of
the septum pellucidum. On [**4-21**] the patient was felt to be safe to
transfer out of the ICU to the neurosurgical floor. He did have
what is thought to be two brief focal seizures that day which
did not require medication. They both stopped in under a minute.
his Keppra dosing was increased to 1500mg twice daily however in
the event these were in fact seizures.

The patient went to the OR on [**4-23**] for revision of the
intracystic catheter. Post-operatively he was monitored
uneventfully in the recovery room without incident.

On [**4-24**], he was seen and evaluated by PT and determined to be
appropriate for home disposition, and was done so after his PET
scan on the [**Hospital Ward Name 516**].

Medications on Admission:
Butalbital-Acetaminophen-Caff [Fioricet], Dexamethasone 2 mg
Tablet QOD, Levetiracetam 1000mg [**Hospital1 **], Propranolol XR 60 daily

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain fever.
2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): continue to take as long as you require narcotic
pain medication.
Disp:*30 Capsule(s)* Refills:*0*
3. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): After three days; decrease dose to one tablet twice
daily. .
Disp:*90 Tablet(s)* Refills:*0*
4. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**12-19**]
Tablets PO Q4H (every 4 hours) as needed for headache.
Disp:*30 Tablet(s)* Refills:*0*
5. Propranolol 60 mg Capsule,Sustained Action 24 hr Sig: One (1)
Capsule,Sustained Action 24 hr PO DAILY (Daily).
6. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).
Disp:*60 Tablet(s)* Refills:*0*
7. Levetiracetam 500 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*0*
8. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Glioblastoma cyst recurrance
Failed Rickham catheter


Discharge Condition:
Neurologically stable


Discharge Instructions:
??????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 discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	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, unless you have been instructed not to.
**Make sure to continue to take a medication such as
Omeprazole(Prilosec) daily to protect your stomach while you are
taking your Decadron, as this is likely to cause stomach
irritation.

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: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-up with Dr. [**Last Name (STitle) **] in 4 weeks with a non-contrast head
CT. Call [**Telephone/Fax (1) 1669**] to make an appointment.

You have an appointment with [**Name6 (MD) 5005**] [**Last Name (NamePattern4) 5342**], MD
Phone:[**Telephone/Fax (1) 44**] [**2122-5-4**] at 9:30 am on the [**Hospital Ward Name 516**] on
[**Hospital Ward Name 23**] 8
You will also be having a CT scan of the head without contrast
prior to you appointment. Please call [**Telephone/Fax (1) 44**] to have a
time assigned.  You will not need to have your PET scan as this
will have been done prior to your discharge.



Completed by:[**2122-5-3**]
{'Mechanical complication of nervous system device, implant, and graft,Malignant neoplasm of brain, unspecified,Cerebral edema,Hemiplegia, unspecified, affecting unspecified side,Epilepsy, unspecified, without mention of intractable epilepsy'}


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: left hemiplegia

PRESENT ILLNESS: Asked to eval this 51 year old white male known to this service
for GBM. Pt presented with one week progression of left sided
weakness.  Went into the bathroom but was too weak to get out.
Wife present for events.  Pt did fall but did not have LOC or
anything that they noticed to be seizure like activity.  No
incontinence of stool or urine.  They called EMS.  It appears on
initial eval that the pt is having focal left sided seizures.

MEDICAL HISTORY: 1. Recurrent left spontaneous pneumothoraces with left apical
blebs, s/p left upper lobe bleb resection, pleurodesis, and
sclerosis in [**2105**]; had post operative air leak requiring
exploratory thoracotomy
2. Right tension pneumothorax, s/p bullectomy with mechanical
pleurodesis in [**2108**]
3. Childhood strabismus, s/p multiple corrective procedures,
last
at age 14
4. Benign connective tissue nevus
5. GBM

MEDICATION ON ADMISSION: Butalbital-Acetaminophen-Caff [Fioricet], Dexamethasone 2 mg
Tablet QOD, Levetiracetam 1000mg [**Hospital1 **], Propranolol XR 60 daily

ALLERGIES: Dilantin

PHYSICAL EXAM: Exam upon admission:
T:AF  BP:140 /100  HR:100    R20       O2Sats100
Gen: WD/WN, uncomfortable at rest, NAD.
HEENT: Pupils: [**3-20**] bilaterally          EOM intact however does
not seem to be able to [**Last Name (un) **] the sclera in lateral gaze, no
diplopia
Neck: Supple.
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect.
Orientation: Oriented to person, place, and date.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Son had a febrile seizure at age eight.  Has a niece with
generalized seizures, now ~age 27.   No stroke, hemorrhage, or
aneurysm.

SOCIAL HISTORY: Lives with wife and two children. Former smoker, 1-2 packs daily
for 10 years but quit years ago. He denies a history of illicit
drug use. He drinks "an occasional beer." 

### Response:
{'Mechanical complication of nervous system device, implant, and graft,Malignant neoplasm of brain, unspecified,Cerebral edema,Hemiplegia, unspecified, affecting unspecified side,Epilepsy, unspecified, without mention of intractable epilepsy'}
