CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is an 86-year-old
relatively healthy active male with only past medical history
of diabetes type 2, pneumonia, and hernia repair. He had been
in his usual state of health until the afternoon of [**4-20**]
when family noted him to be confused and more sleepy than
normal. During the day of [**4-21**] he seemed more confused.
Unable to check blood sugars, sleeping most of the day, and
unable to answer questions appropriately. The family brought
him to [**Hospital **] Hospital where a head CT showed an obstructive
lesion at the third ventricle with hemorrhage into the
ventricle. The patient was transferred to [**Hospital1 346**] for further management.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other specified congenital anomalies of brain,Intracerebral hemorrhage,Hyposmolality and/or hyponatremia,Paroxysmal ventricular tachycardia,Obstructive hydrocephalus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Ostium secundum type atrial septal defect
Brain anomaly NEC,Intracerebral hemorrhage,Hyposmolality,Parox ventric tachycard,Obstructiv hydrocephalus,DMII wo cmp nt st uncntr,Secundum atrial sept def
Admission Date: [**2183-4-22**]        Discharge Date: [**2183-5-2**]


Service:  NSU


HISTORY OF PRESENT ILLNESS:  The patient is an 86-year-old
relatively healthy active male with only past medical history
of diabetes type 2, pneumonia, and hernia repair. He had been
in his usual state of health until the afternoon of [**4-20**]
when family noted him to be confused and more sleepy than
normal. During the day of [**4-21**] he seemed more confused.
Unable to check blood sugars, sleeping most of the day, and
unable to answer questions appropriately. The family brought
him to [**Hospital **] Hospital where a head CT showed an obstructive
lesion at the third ventricle with hemorrhage into the
ventricle. The patient was transferred to [**Hospital1 346**] for further management.

PHYSICAL EXAMINATION:  His temperature is 97.1, BP is 206,
heart rate is 87, respiratory rate is 18, saturation is 97%.
HEENT reveals mucous membranes are moist. Pupils are equal,
round and reactive to light. EOMs are full. Pulmonary reveals
the lungs are clear to auscultation bilaterally.
Cardiovascular with a regular rate and rhythm. Abdomen is
soft, nontender, positive bowel sounds. His extremities have
no swelling. His neurologic exam reveals awake, interacting
with son, inattentive at times, following commands, oriented
to [**2183-3-11**]. His strength is [**6-12**] in all muscle
groups. He had no drift. His sensation is intact to light
touch. His reflexes are 2+ throughout, and his toes are
downgoing.

RADIOLOGIC STUDIES:  MRI with and without gadolinium shows a
large third ventricle lesion with enlargement of the lateral
ventricle.

HOSPITAL COURSE:  The patient was approached about the
possibility of surgery, and they did agree. The patient was
preoperatively prepared and taken to surgery. The patient was
also seen by cardiology for a risk assessment for the OR.
They found him to be an intermediate risk. His hematocrit was
to be kept greater than 30, avoid anemia, keep his fluid
status balanced. He had surface echo done. Results from of
the echocardiogram show left atrium with mildly dilated right
atrium, moderately dilated left-to-right shunt across the
interarterial septum is seen at rest, a small arterial septal
defect is present. Left ventricular wall thicknesses are
normal. The left ventricular cavity size is normal. His EF is
55%. There are no masses or thrombi in the left ventricle.
There is no ventriculoseptal defect. Right ventricular
chamber size and free wall motion are normal. The ascending
aorta is mildly dilated. The aortic valve leaflets are mildly
thickened, but aortic stenosis is not present.  The patient
was therefore cleared for surgery. He also was seen by
urology. Urology was consulted due to difficulty placing a
Foley. The patient had a Foley catheter placed, was on
levofloxacin for 3 days, and will follow up as an outpatient.

On [**2183-4-25**] the patient was taken to the operating room
for a transcranial resection of a third ventricle mass
without intraoperative complications. Postoperatively he was
monitored in the ICU for close neurologic observation. He was
intubated but not sedated. Unable to assess neurologic exam
due to intubation. After extubation his EOMs were full. His
pupils equal, round and reactive to light. The smile was
symmetric. Facial sensation was intact. His tongue was
midline. Extubated on [**2183-4-28**]. He was awake and alert.
He had some left hemiparesis postoperatively, was able to
show 2 fingers, his drain was increased to 20. He was seen by
bedside swallow. They said he could advance his diet to soft
solids and thin liquids. He was transferred to stepdown on
[**2183-5-1**]. He remains awake, alert, and attentive.
Following commands x4. His left upper extremity strength has
improved. His drain has been clamped. He has been seen by
physical therapy and occupational therapy and felt to require
acute rehab prior to discharge to home.

MEDICATIONS ON DISCHARGE:
1. Decadron 2 mg p.o. q.8h. going to 2 mg p.o. b.i.d. over 3
   to 4 days.
2. Labetalol 300 mg p.o. t.i.d.
3. Famotidine 20 mg p.o. daily.
4. Dilantin 150 mg p.o. t.i.d.
5. Heparin 5000 units subcutaneous t.i.d.
6. Insulin sliding scale.


CONDITION ON DISCHARGE:  Stable.

DISCHARGE FOLLOWUP:  He will follow up in the brain tumor
clinic in 2 weeks. His staples should be removed on
postoperative day 10.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**]

Dictated By:[**Last Name (NamePattern1) **]
MEDQUIST36
D:  [**2183-5-2**] 10:59:54
T:  [**2183-5-2**] 12:08:06
Job#:  [**Job Number 60901**]


Admission Date: [**2183-4-22**]        Discharge Date: [**2183-5-5**]


Service:  NSU


ADDENDUM:  The patient remained as an inpatient in the Neuro
Step-Down Unit receiving q.2h. neuro-checks and vital signs
which remained within normal limits. However, the sodium did
drop to the 130s, high 120 range. He was started on sodium
tablets 2 b.i.d. and was increased on Monday, the day of
discharge, [**5-5**], to 3 t.i.d. He also had a fluid
restriction of 750 cc per day. His staples were removed prior
to discharge and the site was dry and intact. There was no
drainage and his sutures need to be removed on [**5-8**] at
the rehab facility. He should follow up with Dr. [**First Name (STitle) **] in two
weeks at [**Telephone/Fax (1) 2731**] to check on that appointment and where
to get the head CT at that time.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 8632**]

Dictated By:[**Last Name (NamePattern1) 12790**]
MEDQUIST36
D:  [**2183-5-5**] 11:11:37
T:  [**2183-5-5**] 11:36:13
Job#:  [**Job Number 60902**]
{'Other specified congenital anomalies of brain,Intracerebral hemorrhage,Hyposmolality and/or hyponatremia,Paroxysmal ventricular tachycardia,Obstructive hydrocephalus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Ostium secundum type atrial septal defect'}


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: 

PRESENT ILLNESS: The patient is an 86-year-old
relatively healthy active male with only past medical history
of diabetes type 2, pneumonia, and hernia repair. He had been
in his usual state of health until the afternoon of [**4-20**]
when family noted him to be confused and more sleepy than
normal. During the day of [**4-21**] he seemed more confused.
Unable to check blood sugars, sleeping most of the day, and
unable to answer questions appropriately. The family brought
him to [**Hospital **] Hospital where a head CT showed an obstructive
lesion at the third ventricle with hemorrhage into the
ventricle. The patient was transferred to [**Hospital1 346**] for further management.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other specified congenital anomalies of brain,Intracerebral hemorrhage,Hyposmolality and/or hyponatremia,Paroxysmal ventricular tachycardia,Obstructive hydrocephalus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Ostium secundum type atrial septal defect'}
