CHIEF COMPLAINT: seizure, mass on CT

PRESENT ILLNESS: Mr. [**Known lastname 74031**] is a 51 year old right handed male who presents
following a seizure, found to have a left parietal mass on CT at
and OSH. He was driving home from [**Hospital3 635**] with his 12yo son
when
he started to feel "dizzy," no vertigo, just a strange feeling.
He pulled the car over to the side of the road and at that time
was only producing garbled speech, but he could still understand
his son. [**Name (NI) **] got up and walked around the car, but his speech
deficit did not resolve. EMS arrived within ~10minutes where he
then reportedly had a GTC seizure in the ambulance. He
recollects
being at the [**Hospital3 **]. Head CT revealed Left parietal
mass. He was loaded on dilantin and given 2mg ativan IV.
Transferred to [**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: Sinus surgery for chronic sinusitis [**4-18**]
Tonsillectomy
Osteoarthritis of knees

MEDICATION ON ADMISSION: Flonase PRN

ALLERGIES: Mold/Yeast/Dust / Cefazolin

PHYSICAL EXAM: Vitals: T: 98 P: 68  R: 16 BP: 148/70 SaO2: 100%RA
General: asleep on the gurney, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no JVD or carotid bruits appreciated. No nuchal
rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Mother- breast cancer, alive and well.
Grandfather- had lung cancer.
Brother- alive and well.

SOCIAL HISTORY: Lives with his girlfriend and sister, he has shared custody of
his two children, he works in logistics for proctor and gamble.
He was planning to fly to [**Country 4194**] tonight for a four day business
trip. He smoked ~[**2-12**] ppd x 20 years, quit four years ago, he
drinks 1-3 drinks on rare occasion. No history of illicit or IV
drug use.
Malignant neoplasm of occipital lobe,Pulmonary collapse,Other convulsions,Cerebral edema,Nontoxic uninodular goiter,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg
Mal neo occipital lobe,Pulmonary collapse,Convulsions NEC,Cerebral edema,Nontox uninodular goiter,Loc osteoarth NOS-l/leg
Admission Date:  [**2172-10-4**]              Discharge Date:   [**2172-10-10**]

Date of Birth:  [**2120-11-25**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Mold/Yeast/Dust / Cefazolin

Attending:[**First Name3 (LF) 1854**]
Chief Complaint:
seizure, mass on CT

Major Surgical or Invasive Procedure:
Neurosurgery [**2172-10-8**]

History of Present Illness:
Mr. [**Known lastname 74031**] is a 51 year old right handed male who presents
following a seizure, found to have a left parietal mass on CT at
and OSH. He was driving home from [**Hospital3 635**] with his 12yo son
when
he started to feel "dizzy," no vertigo, just a strange feeling.
He pulled the car over to the side of the road and at that time
was only producing garbled speech, but he could still understand
his son. [**Name (NI) **] got up and walked around the car, but his speech
deficit did not resolve. EMS arrived within ~10minutes where he
then reportedly had a GTC seizure in the ambulance. He
recollects
being at the [**Hospital3 **]. Head CT revealed Left parietal
mass. He was loaded on dilantin and given 2mg ativan IV.
Transferred to [**Hospital1 18**] for further evaluation.

He notes that in the last few weeks the vision in his right eye
seems poor, but he denies bumping into objects. No scotoma. He
also noted that on long car trips in the last few weeks he has
noted a feeling of "dizziness" no vertigo, just a strange
feeling
while in the car only. No odd smells, sounds, flashing lights or
other phenomena. No rising abdominal sensation. He denies any
headaches.

At present he denies any numbness, weakness, paresthesia. No
bowel or bladder incontinence. He bit his tongue with the GTC
earlier today. No diplopia, dysphagia. No facial droop. No
difficulty with his gait.

ROS:
No recent fever or chills.  No night sweats or recent weight
loss
or gain. Denied cough, shortness of breath.  Denied chest pain
or
tightness, palpitations.  Denied nausea, vomiting, diarrhea,
constipation or abdominal pain.  No recent change in bowel or
bladder habits.  No dysuria.  Denied arthralgias or myalgias.
Denied rash.


Past Medical History:
Sinus surgery for chronic sinusitis [**4-18**]
Tonsillectomy
Osteoarthritis of knees


Social History:
Lives with his girlfriend and sister, he has shared custody of
his two children, he works in logistics for proctor and gamble.
He was planning to fly to [**Country 4194**] tonight for a four day business
trip. He smoked ~[**2-12**] ppd x 20 years, quit four years ago, he
drinks 1-3 drinks on rare occasion. No history of illicit or IV
drug use.


Family History:
Mother- breast cancer, alive and well.
Grandfather- had lung cancer.
Brother- alive and well.


Physical Exam:
Vitals: T: 98 P: 68  R: 16 BP: 148/70 SaO2: 100%RA
General: asleep on the gurney, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no JVD or carotid bruits appreciated. No nuchal
rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: Alert, oriented x 3.  Able to relate history
without difficulty.  He is somewhat inattentive and skips months
in [**Doctor Last Name 1841**] backwards without noticing. Language is fluent with
intact
repetition and comprehension.  Normal prosody.  There were no
paraphasic errors. Pt. was able to name both high and low
frequency objects.  Able to read without difficulty.  Speech was
not dysarthric. Able to follow both midline and appendicular
commands. Pt. was able to register 3 objects and recall [**2-13**] at 5
minutes, [**4-13**] with cues.  The pt. had good knowledge of current
events.  There was no apraxia or neglect. He constricts the
right
side of the clock in clock drawing task, but is able to complete
the task without difficulty.


-Cranial Nerves: Olfaction not tested.  PERRL 3 to 2mm and
brisk.
VFF to confrontation with a red object.  There is no ptosis
bilaterally. Funduscopic exam revealed no papilledema, exudates,
or hemorrhages. EOMI prominent nystagmus in all fields of gaze,
most prominent in left gaze.  Normal saccades. Facial sensation
intact to pinprick. No facial droop, facial musculature
symmetric. Hearing intact to finger-rub bilaterally.  Palate
elevates symmetrically.  5/5 strength in trapezii and SCM
bilaterally. Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No adventitious movements
noted. No asterixis noted.
No pronator drift bilaterally.

  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5    5  5    5  5  5  5   5   5  5    5     5    5
R  5    5    5  5    5  5  5  5   5   5  5    5     5    5

-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.

-Coordination: No intention tremor, dysdiadochokinesia noted. No
dysmetria on FNF or HKS bilaterally.

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
R  2+  2+  2+   2+  1
L  1   1   1    2   1

Plantar response was flexor bilaterally.

-Gait: Good initiation. Narrow-based, normal stride and arm
swing.  He is unable to tandem. Romberg absent.


Pertinent Results:
[**2172-10-4**] 02:30PM   WBC-11.7*# RBC-4.92 HGB-14.8 HCT-41.0 MCV-83
MCH-30.2 MCHC-36.1* RDW-13.5
[**2172-10-4**] 02:30PM   NEUTS-83.3* LYMPHS-12.2* MONOS-3.7 EOS-0.5
BASOS-0.4
[**2172-10-4**] 02:30PM   PLT COUNT-221
[**2172-10-4**] 02:30PM   GLUCOSE-111* UREA N-15 CREAT-1.1 SODIUM-139
POTASSIUM-3.8 CHLORIDE-100 TOTAL CO2-30 ANION GAP-13

IMAGING:
CT head: ~1.7 cm diameter hypodensity in left parietal
subcortical region extending through several cuts on axial
series. No mass effect.

Chest Xray: no cardiopulmonary process.


Brief Hospital Course:
Hospital course on neurology service [**10-4**] - [**10-8**]:
Neurology - Initially on dilantin then changed to keppra for
seizure control.  No seizures during [**Hospital **] hospital stay.
Neurologic exam unchanged from admission.  Neurosurgical team
consulted, recommended surgical resection for likely primary
brain tumor vs metastasis.

FEN/GI - Normal po intake.  Electrolytes within normal limits.

CV/Resp - Stable throughout.

ID - Infectious team consulted, though low likelihood of
infectious process.  Sent serum toxoplasma antibodies,
cystercircosis antibodies, and cryptococcal antigen.

ENDO: On CT torso, while looking for potential primary tumors
(of which none identified) a thyroid nodule was serendipitously
identified. He is scheduled for an outpt Bx/FNA on [**2172-10-14**].

Transferred to the neurosurgical service on [**10-8**] after surgical
resection.
Pt underwent successful resection of the tumor [**10-8**]. He was
subsequently started on Decadron 4 mg IV Q8hrs and this was
decreased to 2 mg PO Q8hrs on DC. Post-op course was complicated
only by a one-time fever to 101.2F, likely secondary to
atelectasis, and blood and urine cultures from [**10-9**] remain
negative to date. CXR showed only some bibasilar atelectasis. He
remained afebrile subsequently.

Medications on Admission:
Flonase PRN

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
2. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
Disp:*14 Tablet(s)* Refills:*1*
3. Levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q6H (every 6 hours) as needed for pain.
Disp:*80 Tablet(s)* Refills:*0*
5. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
7. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours).
Disp:*90 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Brain tumor

Discharge Condition:
Stable

Discharge Instructions:
Provide adequate periods of rest for the next few weeks.  No
heavy lifting greater than 10 pounds, no straining. This
includes heavy house or yardwork.

Please monitor any headaches you may develop and the frequency.
Headaches should be relieved with the narcotic analgesics you
have been prescribed. You may wean yourself from them as you no
longer need. Do not stop taking any other medications without
first consulting with your healthcare team.

You should not drive until after your appointment with the
surgeon or oncologist as you are on an anti seizure medication
that prohibits the use of a motorvehicle.


Followup Instructions:
Radiation CT Simulation with Dr. [**Last Name (STitle) 3929**] on [**2172-10-19**]. The office
will call with the time. Dr. [**Last Name (STitle) 3929**] also [**2172-10-23**] @ 12noon.
Please call to confirm the second appointment. The appointments
will be on the [**First Name8 (NamePattern2) **] [**First Name4 (NamePattern1) 1675**] [**Last Name (NamePattern1) **] [**First Name (Titles) **] [**Last Name (Titles) **] [**Hospital Ward Name 22747**]
[**Location 23**] Building [**Location (un) **].
Keep your stitches/staples dry until they are removed, 10 days
post-surgery. Call your primary care physician's office or Dr. [**Name (NI) 28838**] office ([**Telephone/Fax (1) 88**] for an appt for staple removal,
whichever is more convenient for you.
Call Dr.[**Name (NI) 12757**] office for follow-up appt following the tumor
board meeting: ([**Telephone/Fax (1) 88**]

Provider:  [**Name10 (NameIs) 703**] ULTRASOUND Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2172-10-14**]
11:00



Completed by:[**2172-10-10**]
{'Malignant neoplasm of occipital lobe,Pulmonary collapse,Other convulsions,Cerebral edema,Nontoxic uninodular goiter,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg'}


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: seizure, mass on CT

PRESENT ILLNESS: Mr. [**Known lastname 74031**] is a 51 year old right handed male who presents
following a seizure, found to have a left parietal mass on CT at
and OSH. He was driving home from [**Hospital3 635**] with his 12yo son
when
he started to feel "dizzy," no vertigo, just a strange feeling.
He pulled the car over to the side of the road and at that time
was only producing garbled speech, but he could still understand
his son. [**Name (NI) **] got up and walked around the car, but his speech
deficit did not resolve. EMS arrived within ~10minutes where he
then reportedly had a GTC seizure in the ambulance. He
recollects
being at the [**Hospital3 **]. Head CT revealed Left parietal
mass. He was loaded on dilantin and given 2mg ativan IV.
Transferred to [**Hospital1 18**] for further evaluation.

MEDICAL HISTORY: Sinus surgery for chronic sinusitis [**4-18**]
Tonsillectomy
Osteoarthritis of knees

MEDICATION ON ADMISSION: Flonase PRN

ALLERGIES: Mold/Yeast/Dust / Cefazolin

PHYSICAL EXAM: Vitals: T: 98 P: 68  R: 16 BP: 148/70 SaO2: 100%RA
General: asleep on the gurney, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no JVD or carotid bruits appreciated. No nuchal
rigidity
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

FAMILY HISTORY: Mother- breast cancer, alive and well.
Grandfather- had lung cancer.
Brother- alive and well.

SOCIAL HISTORY: Lives with his girlfriend and sister, he has shared custody of
his two children, he works in logistics for proctor and gamble.
He was planning to fly to [**Country 4194**] tonight for a four day business
trip. He smoked ~[**2-12**] ppd x 20 years, quit four years ago, he
drinks 1-3 drinks on rare occasion. No history of illicit or IV
drug use. 

### Response:
{'Malignant neoplasm of occipital lobe,Pulmonary collapse,Other convulsions,Cerebral edema,Nontoxic uninodular goiter,Osteoarthrosis, localized, not specified whether primary or secondary, lower leg'}
