CHIEF COMPLAINT: headaches on bending, fever

PRESENT ILLNESS: 56 y/o female presents to ER with cheif complaint of headaches
upon bending. She has a very compilicated history that includes
a rt temporoparietal resection in [**2128**] with the placement of a
VP shunt. She has significant left sided weakness at baseline.
She was recently seen at [**Hospital1 18**] for a UTI and was treated with
Macrobid. She denied any fever, chills, or nightsweats.

MEDICAL HISTORY: 1. TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2. Focal motor seizures. Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3. VP shunt [**2128**] done when temporal lobectomy performed
4. Depression
5. OCD
6. HTN
7. COPD
8. Neurogenic bladder
9. Eating disorder (anorexia)
10. PUD
11. History of chronic left lower extremity edema
12. Right hip, fracture to the left, and fracture of the lateral

MEDICATION ON ADMISSION: Acetaminophen (Tylenol) prn
Baclofen (Lioresal) 5 mg TID
Detrol 4 mg daily
Dulcolax (Bisacodyl) twice weekly
Effexor (Venlafaxine XR) 300 mg daily
Fosamax 70 mg weekly
Motrin (Ibuprofen) 600 mg AM- to stop
Multi Vitamin daily
evista 60 mg daily
Phenobarbital (Phenob)30 mg AM and 4 PM; 60 mg
at hs
Risperdal (Risperidone)0.5 mg AM; 1.5 mg at hs
Tegretol (Carbamazepine) 400 mg [**Hospital1 **]
Vicodin (Hydrocodone w/APAP) 5/500 mg prn rarely
demeclocycline 450 mg [**Hospital1 **]

ALLERGIES: Valium / Aspirin / Levofloxacin / Levaquin

PHYSICAL EXAM: On Admission:
Tm 102.1  BP: 112/71    HR: 70  R: 18   O2Sats: 95RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3-->2 bilaterally  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. Somewhat slow, slurred speech (aparrently her baseline).
Orientation: Oriented to person, place, and date.
Recall: [**2-4**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Mother- Pancreatic CA
Grandfather- Breast CA, leukemia

SOCIAL HISTORY: Patient lives in a long term care facility ([**Location (un) 169**])
Wheelchair to ambulate
Volunteers at [**Hospital6 4620**]
0 Tobacco
0 ETOH
Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Depressive disorder, not elsewhere classified,Obsessive-compulsive disorders,Unspecified essential hypertension,Neurogenic bladder NOS,Hip joint replacement,Personal history of Methicillin resistant Staphylococcus aureus,Infection and inflammatory reaction due to nervous system device, implant, and graft,Staphylococcal meningitis,Hyposmolality and/or hyponatremia,Obstructive hydrocephalus,Epilepsia partialis continua, without mention of intractable epilepsy,Secondary hyperparathyroidism (of renal origin),Bacteremia,Hemiplegia, unspecified, affecting unspecified side
Mth sus Stph aur els/NOS,Chr airway obstruct NEC,Depressive disorder NEC,Obsessive-compulsive dis,Hypertension NOS,Neurogenic bladder NOS,Joint replaced hip,Hx Methicln resist Staph,React-nerv sys dev/graft,Staphylococc meningitis,Hyposmolality,Obstructiv hydrocephalus,Epil par cont w/o int ep,Sec hyperparathyrd-renal,Bacteremia,Unsp hemiplga unspf side
Admission Date:  [**2155-4-19**]              Discharge Date:   [**2155-5-14**]

Date of Birth:  [**2098-10-28**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Valium / Aspirin / Levofloxacin / Levaquin

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
headaches on bending, fever

Major Surgical or Invasive Procedure:
1. Removal of right frontal ventricular catheter.
2. Removal of right parietal connector and external tubing.
3. Placement of new right frontal external ventricular drain and
placement of right parietal external ventricular drain.


History of Present Illness:
56 y/o female presents to ER with cheif complaint of headaches
upon bending. She has a very compilicated history that includes
a rt temporoparietal resection in [**2128**] with the placement of a
VP shunt. She has significant left sided weakness at baseline.
She was recently seen at [**Hospital1 18**] for a UTI and was treated with
Macrobid. She denied any fever, chills, or nightsweats.

Upon arrival to [**Hospital1 18**], she reports headaches that is made worse
when bending. She states this is a new symptom which was first
noticed 3 weeks ago. Her headaces are located in the posterior
occipital area. She denies any photophobia or diplopia. In ER,
patient was noted to have a Tmax of 102.1 and was given steroids
and vanc/ceftriaxone for suspected meningitis. Neurosurgery was
consulted for questionable VP shunt malfunction vs meningitis.

Past Medical History:
1. TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2. Focal motor seizures. Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3. VP shunt [**2128**] done when temporal lobectomy performed
4. Depression
5. OCD
6. HTN
7. COPD
8. Neurogenic bladder
9. Eating disorder (anorexia)
10. PUD
11. History of chronic left lower extremity edema
12. Right hip, fracture to the left, and fracture of the lateral

ischial ring on the right side.
13. Left hip frequent dislocations status post left hip
replacement c/b MRSA inf currently without a left hip
14. Secondary hyperparathyroidism
15. Iron deficiency anemia
16. Severe progressive cervical spondylosis s/p occiput to C4
fusion and C2-C3 laminectomy [**2150**]
17: C2-3 anterolisthesis s/p posterior cervical spine fusion
[**1-13**]


Social History:
Patient lives in a long term care facility ([**Location (un) 169**])
Wheelchair to ambulate
Volunteers at [**Hospital6 4620**]
0 Tobacco
0 ETOH

Family History:
Mother- Pancreatic CA
Grandfather- Breast CA, leukemia


Physical Exam:
On Admission:
Tm 102.1  BP: 112/71    HR: 70  R: 18   O2Sats: 95RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3-->2 bilaterally  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. Somewhat slow, slurred speech (aparrently her baseline).
Orientation: Oriented to person, place, and date.
Recall: [**2-4**] objects at 5 minutes.
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, 3 to 2
mm bilaterally.
III, IV, VI: Extraocular movements intact bilaterally without
nystagmus.
V, VII: Facial strength and sensation slightly superior on right
versus left though both intact. With very slight facial droop on
right.
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: Strength 5/5 on right in both upper and lower extremity.
Left lower extremity with minimal movement and left upper
extremity with 2/5 finger extension.

Labs:
++UA (+ nit, + LE, few bacteria)
8>9.0/27.3<293
129 | 93 | 11 < 104   AGap=13
3.6 | 27 | 0.3
Ca: 8.2 Mg: 1.9 P: 2.1

CSF:  WBC 15  RBC 11
Poly 33%  Lymp 30%  Mono 6% Macroph 26%
Prot 58  Gluc 63
Gram stain negative

On Discharge:
Alert, oriented to person, place and date. Left sided
hemiplegia. Right side with full strength throughout. Slight
left sided facial droop. Slow speech.

Pertinent Results:
CT Head W/O contrast ([**4-19**])-
1. Interval increase in caliber of the ventricular system, with
suggestion of periventricular white matter low attenuation,
which could reflect
transependymal flow of CSF. This may indicate a shunt
malfunction.
2. Stable area of encephalomalacia in the right temporoparietal
and occipital
lobes.

CT HEAD W/O CONTRAST ([**4-21**])-
The lateral and third ventricles have increased in size compared
to
the prior study. The fourth ventricle is stable. This is
concerning for
shunt malfunction. There are two intraventricular catheters in
stable
positions. A right frontal approach catheter terminates in the
left frontal [**Doctor Last Name 534**], and the second right temporal approach
catheter terminates in the right lateral ventricle near the
posterior septum pellucidum.

Portable TTE (Complete) Done [**2155-4-21**] at 4:23:21 PM
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thicknesses and cavity size are normal. Right
ventricular chamber size and free wall motion are normal. The
diameters of aorta at the sinus, ascending and arch levels are
normal. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No masses or vegetations are
seen on the aortic valve. No aortic regurgitation is seen. The
mitral valve leaflets are mildly thickened. There is no mitral
valve prolapse. No mass or vegetation is seen on the mitral
valve. Mild (1+) mitral regurgitation is seen. The estimated
pulmonary artery systolic pressure is normal. There is no
pericardial effusion.
Compared with the prior study (images reviewed) of [**2152-10-23**], the
mitral and aortic valve leaflets are mildly thickened, but
without discrete vegetation. Mitral regurgitation severity is
similar.
If the clinical suspicion for endocarditis is moderate or
greater, a TEE is suggested to better define the valve leaflets.


CT HEAD W/O CONTRAST Study Date of [**2155-4-22**] 4:28 AM
1. Stable-appearing enlarged lateral, third and fourth
ventricles. Possible transependymal flow of CSF seen. Persistent
sulcal effacement, particularly in the right frontal lobe
suggestive of mild edema.
2. Stable post-surgical encephalomalacic changes in the right
frontal,
temporal, and parietal lobes with stable right-sided craniotomy
and
craniectomy.

CT HEAD W/O CONTRAST Study Date of [**2155-4-23**] 6:11 AM
Intraventricular catheters remain in place, with interval
decrease in size of the lateral and third ventricles compared to
[**2155-4-22**]. Diffuse sulcal
effacement persists.

Head CT [**5-4**]:
FINDINGS: Intraventricular shunts are unchanged in position,
including right frontal approach terminating in the left lateral
ventricle and the right parietal approach terminating near the
atrium of the right lateral ventricle. Compared to [**2155-5-1**]
study, there is no significant change in size and configuration
of the lateral or third ventricles. Moderate periventricular
white matter hypodensity is unchanged, with no evidence of
transependymal migration of CSF. Diffuse sulcal effacement is
stable in appearance. There is a large area of cystic
encephalomalacia involving right temporoparietal lobe. The
craniotomy changes and fixation hardware are again seen. There
is no acute intracranial hemorrhage or shift of normally midline
structures. With the exception of right maxillary small
mucus-retention cyst, imaged paranasal sinuses and mastoid air
cells are well-aerated.
IMPRESSION:
1. No change in size or configuration of the lateral and third
ventricles
compared to [**2155-5-1**].
2. Unchanged diffuse sulcal effacement.
3. No hemorrhage.

Head CT [**5-7**]:
FINDINGS: There is large-volume pneumocephalus in bilateral
anterior frontal horns and in the right temporal region. There
has been interval
redistribution of pneumocephalus which may have slightly
decreased in size
compared to the previous examination. Overall examination is
limited by
streak and motion artifact. Large-volume fluid collection in the
right
temporal lobe with encephalomalacia appears stable. There is
diffuse sulcal effacement likely due to the presence of mild
hydrocephalus and large-volume pneumocephalus. The right frontal
and right temporal approach catheters' tips terminate in the
left frontal [**Doctor Last Name 534**] and right posterior septum pellucidum
respectively. Patient is status post right craniectomy with
probable dural graft. No areas of acute hemorrhage are present.
Hypodensities are present in the white matter in bilateral
frontal horns likely due to the presence of transependymal flow.
There is occipital and cervical fixation hardware, which appear
stable.
IMPRESSION:
1. Stable appearance to large-volume pneumocephalus which has
undergone mild re-distribution.
2. Broad distribution sulcal effacement due to large-volume
pneumocephalus
which appears stable.
3. Unchanged appearance to right temporal fluid collection with
encephalomalacia.
4. Right frontal and right temporal approach ventriculostomy
catheters in
stable position compared to previous examination.

EKG [**5-5**]:
Sinus rhythm. Borderline low voltage. Since the previous tracing
of [**2155-1-29**] probably no significant change.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
87 136 80 342/389 60 7 80

CT Head [**5-12**]:
FINDINGS: There is decreased pneumocephalus compared to the
previous
examination. Ventricular size appears stable. Right frontal and
parietal
approach catheters are in unchanged position. There is unchanged
large fluid collection in the right temporoparietal lobe status
post right parietotemporal lobe resection with encephalomalacia.
[**Doctor Last Name **]-white matter differentiation appears unchanged with
persistent sulcal and gyral effacement. Calcifications are
stable along the posterior tentorium. The patient is status post
right craniotomy with a dural calcification. Multiple bur holes
are stable. Fixation of hardware appears unchanged. Paranasal
sinuses, ethmoid and mastoid air cells remain well aerated.
IMPRESSION:
1. Slight interval decrease in volume of pneumocephalus with
stable
ventricular size.
2. The ventriculostomy catheters are in unchanged position.
3. Stable appearance to [**Doctor Last Name 352**]-white matter differentiation, no
areas of
hemorrhage.

LENIS [**5-9**]:
BILATERAL LOWER EXTREMITY VENOUS ULTRASOUND: [**Doctor Last Name **]-scale and
Doppler
son[**Name (NI) 493**] examination was performed of the both common
femoral, superficial femoral, and popliteal veins. The study
demonstrates normal low, respiratory variation, augmentation,
and compressibility. No intraluminal thrombus is seen. Normal
compressibility is also demonstrated in the calf veins
bilaterally.
IMPRESSION: No evidence of DVT seen in either lower extremity.




Brief Hospital Course:
56 y/o female presents to [**Hospital1 18**] 4 days ago with a UTI that was
treated with Macrobid. She has a history of R temporoparietal
resection with left sided weakness at baseline. Patient returns
to ER on [**4-19**] complaining of headaches on bending that was first
noticed 3 weeks ago. She states that her headaches are located
in the posterior occipital area and are made worse when bending.
While in the ER, she was observed to have a Tmax of 102.1 and
treated with vanc/ceftriaxone for suspected meningitis.  CT scan
revealed mild to moderate increase in ventricular size with VP
shunt catheter in place. VP shunt was tapped under sterile
conditions in the ER where the opening pressure was 11 cm H2O.
Neurosurgery was consulted for VP malfunction. Patient was then
taken to the OR for suspected shunt infection and cultures were
obtained.

Operative procedure:
1. Removal of right frontal ventricular catheter.
2. Removal of right parietal connector and external tubing.
3. Placement of new right frontal external ventricular
    drain and placement of right parietal external
    ventricular drain.

Patient transferred to TSICU. CSF cultures were obtained and ID
consulted. R frontal EVD drained at 20 and R parietal at 15 cc
H2O. Na level monitored for a level at 125. On [**4-21**], Na level
drops from 125-120 and patient placed on 2gm salt tabs, fluid
restrictions of 500cc, and 3% hypertonic solution at 20/hr. NA
was monitored Q4H and her antibiotic, vancomycin, was double
concentrated in NS. In AM, NA level increased from 120 to 130,
3% hypertonic solution was discontinued and patient's NA
monitored Q4H. Patient became more lethargic and disoriented on
[**4-22**], CT scan in AM showed hydrocephalus and EVDs were dropped
to 5 cmH2O. Infectious disease changed her antibiotics to
nafcillin to treat MSSA meningitis.

on [**4-23**], patient A&O x3, EVDs at 5 and draining. CSF cultures
resent on request for ID, and nafcillin double concentrated in
NS for a NA level of 127. Follow up CT scan showed interval
decrease in ventricle size from previous scan.

[**4-25**] Pt is A&Ox3, EVDs remain draining at 5. CSF cx pending.

Patient remained stable and Na was stable, her water restriction
was changed to 1L daily and then 1500cc daily. Her CSF cx also
showed no growth on [**4-29**] and she completed her 2 weeks course of
abx.

On [**5-6**], she was taken to the operating room for
internalization of her external drain. She tolerated this
procedure well.

On [**5-9**] a non-contrast head CT was done, and this showed
ongoing resolution of pneumocephalus.

She was seen and evaluated by physical and occupational therapy
who determined She would be safe to return to her facility. She
was discharged on [**5-14**].

Medications on Admission:
Acetaminophen (Tylenol) prn
Baclofen (Lioresal) 5 mg TID
Detrol 4 mg daily
Dulcolax (Bisacodyl) twice weekly
Effexor (Venlafaxine XR) 300 mg daily
Fosamax 70 mg weekly
Motrin (Ibuprofen) 600 mg AM- to stop
Multi Vitamin daily
evista 60 mg daily
Phenobarbital (Phenob)30 mg AM and 4 PM; 60 mg
at hs
Risperdal (Risperidone)0.5 mg AM; 1.5 mg at hs
Tegretol (Carbamazepine) 400 mg [**Hospital1 **]
Vicodin (Hydrocodone w/APAP) 5/500 mg prn rarely
demeclocycline 450 mg [**Hospital1 **]

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed for pain.
3. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QFRI (every
Friday).
4. Demeclocycline 150 mg Tablet Sig: Three (3) Tablet PO bid ().

5. Phenobarbital 30 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
6. Phenobarbital 30 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
7. Raloxifene 60 mg Tablet Sig: One (1) Tablet PO daily ().
8. Risperidone 0.5 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
9. Risperidone 0.5 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime): a total of 1.5mg at bedtime.
10. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: Five (5)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
11. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
12. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
13. Multivitamin,Tx-Minerals     Tablet Sig: One (1) Tablet PO
DAILY (Daily).
14. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**12-6**]
Drops Ophthalmic PRN (as needed) as needed for dry eyes.
15. Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1)
Injection TID (3 times a day).
16. Oxycodone 5 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours)
as needed for sever pain.
17. Tolterodine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
18. Famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every
12 hours).
19. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2)
Tablet, Chewable PO BID (2 times a day).
20. Potassium & Sodium Phosphates 280-160-250 mg Powder in
Packet Sig: One (1) Powder in Packet PO QID (4 times a day).
21. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for indigestion.
22. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical [**Hospital1 **]
(2 times a day) as needed for rash.
23. Senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times
a day).
24. Carbamazepine 100 mg Tablet, Chewable Sig: Three (3) Tablet,
Chewable PO QID (4 times a day).
25. Meclizine 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
26. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain .
27. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
28. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
Temporary Central Access-ICU: Flush with 10mL Normal Saline
daily and PRN.
29. Sodium Chloride 0.9%  Flush 10 mL IV PRN line flush
PICC, non-heparin dependent: Flush with 10 mL Normal Saline
daily and PRN per lumen.
30. Vancomycin 500 mg Recon Soln Sig: 1250mg Recon Solns
Intravenous Q 12H (Every 12 Hours) for 9 days.
31. Sodium Chloride 0.9%  Flush 3 mL IV Q8H:PRN line flush
Peripheral line: Flush with 3 mL Normal Saline every 8 hours and
PRN.


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 10283**] Center - [**Location (un) **]

Discharge Diagnosis:
meningitis in setting of VP shunt
Post-op Pneumocephalus
Hyponatremia


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 prescribed an anti-seizure
medicine(Carbamazepine and Phenobarbitol), take it as prescribed
and follow up with laboratory blood drawing in one week.  Please
have results faxed to [**Telephone/Fax (1) 87**].
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

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 Appointment Instructions

??????Please return to the office in [**6-13**] days from your date of
surgery for a wound check and for suture removal. You will also
need to schedule an appointment for [**5-25**] to see Dr. [**First Name (STitle) **],
so that he can sample your V-P shunt.
??????Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**First Name (STitle) **], to be seen in 4 weeks.
??????You will need a CT scan of the brain without contrast.



Completed by:[**2155-5-14**]
{'Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Depressive disorder, not elsewhere classified,Obsessive-compulsive disorders,Unspecified essential hypertension,Neurogenic bladder NOS,Hip joint replacement,Personal history of Methicillin resistant Staphylococcus aureus,Infection and inflammatory reaction due to nervous system device, implant, and graft,Staphylococcal meningitis,Hyposmolality and/or hyponatremia,Obstructive hydrocephalus,Epilepsia partialis continua, without mention of intractable epilepsy,Secondary hyperparathyroidism (of renal origin),Bacteremia,Hemiplegia, unspecified, affecting unspecified side'}


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: headaches on bending, fever

PRESENT ILLNESS: 56 y/o female presents to ER with cheif complaint of headaches
upon bending. She has a very compilicated history that includes
a rt temporoparietal resection in [**2128**] with the placement of a
VP shunt. She has significant left sided weakness at baseline.
She was recently seen at [**Hospital1 18**] for a UTI and was treated with
Macrobid. She denied any fever, chills, or nightsweats.

MEDICAL HISTORY: 1. TLE s/p surgery - right temporoparietal resection [**2128**]. Has
minimal use of her LUE & LLE, is wheelchair-bound.
2. Focal motor seizures. Has sz approx once a month -> shaking
of her right arm, no loss of consciousness, but the sz affects
her tongue so she cannot speak.
3. VP shunt [**2128**] done when temporal lobectomy performed
4. Depression
5. OCD
6. HTN
7. COPD
8. Neurogenic bladder
9. Eating disorder (anorexia)
10. PUD
11. History of chronic left lower extremity edema
12. Right hip, fracture to the left, and fracture of the lateral

MEDICATION ON ADMISSION: Acetaminophen (Tylenol) prn
Baclofen (Lioresal) 5 mg TID
Detrol 4 mg daily
Dulcolax (Bisacodyl) twice weekly
Effexor (Venlafaxine XR) 300 mg daily
Fosamax 70 mg weekly
Motrin (Ibuprofen) 600 mg AM- to stop
Multi Vitamin daily
evista 60 mg daily
Phenobarbital (Phenob)30 mg AM and 4 PM; 60 mg
at hs
Risperdal (Risperidone)0.5 mg AM; 1.5 mg at hs
Tegretol (Carbamazepine) 400 mg [**Hospital1 **]
Vicodin (Hydrocodone w/APAP) 5/500 mg prn rarely
demeclocycline 450 mg [**Hospital1 **]

ALLERGIES: Valium / Aspirin / Levofloxacin / Levaquin

PHYSICAL EXAM: On Admission:
Tm 102.1  BP: 112/71    HR: 70  R: 18   O2Sats: 95RA
Gen: WD/WN, comfortable, NAD.
HEENT: Pupils: 3-->2 bilaterally  EOMs intact
Neck: Supple.
Lungs: CTA bilaterally.
Cardiac: RRR. S1/S2.
Abd: Soft, NT, BS+
Extrem: Warm and well-perfused.
Neuro:
Mental status: Awake and alert, cooperative with exam, normal
affect. Somewhat slow, slurred speech (aparrently her baseline).
Orientation: Oriented to person, place, and date.
Recall: [**2-4**] objects at 5 minutes.
Language: Speech fluent with good comprehension and repetition.
Naming intact. No dysarthria or paraphasic errors.

FAMILY HISTORY: Mother- Pancreatic CA
Grandfather- Breast CA, leukemia

SOCIAL HISTORY: Patient lives in a long term care facility ([**Location (un) 169**])
Wheelchair to ambulate
Volunteers at [**Hospital6 4620**]
0 Tobacco
0 ETOH 

### Response:
{'Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Chronic airway obstruction, not elsewhere classified,Depressive disorder, not elsewhere classified,Obsessive-compulsive disorders,Unspecified essential hypertension,Neurogenic bladder NOS,Hip joint replacement,Personal history of Methicillin resistant Staphylococcus aureus,Infection and inflammatory reaction due to nervous system device, implant, and graft,Staphylococcal meningitis,Hyposmolality and/or hyponatremia,Obstructive hydrocephalus,Epilepsia partialis continua, without mention of intractable epilepsy,Secondary hyperparathyroidism (of renal origin),Bacteremia,Hemiplegia, unspecified, affecting unspecified side'}
