CHIEF COMPLAINT: Patient presents with known ACOMM aneurysm for coiling

PRESENT ILLNESS: Known ACOMM aneurysm

MEDICAL HISTORY: -HTN

MEDICATION ON ADMISSION: Asprin 325mg daily
Metoprolol 100 mg ER daily
Simvastatin 40mg daily
lisinopril 20 mg daily
amlodipine 5mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: NECK: no carotid bruits; ROM full;
CV; RRR, no murmurs
Pulm; CTA
Abd; soft, nt, nd
Extr; no edema, clubbing, cyanosis; distal pulses can be
palpated;

FAMILY HISTORY: -mother with cerebral aneurysm rupture

SOCIAL HISTORY: -smokes tobacco daily, no etoh or drugs.
Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Tobacco use disorder
Nonrupt cerebral aneurym,Hypertension NOS,Tobacco use disorder
Admission Date:  [**2137-5-8**]              Discharge Date:   [**2137-5-9**]

Date of Birth:  [**2085-4-12**]             Sex:   F

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Patient presents with known ACOMM aneurysm for coiling

Major Surgical or Invasive Procedure:
Coiling of ACOMM aneurysm


History of Present Illness:
Known ACOMM aneurysm

Past Medical History:
-HTN


Social History:
-smokes tobacco daily, no etoh or drugs.

35Pack year history


Family History:
-mother with cerebral aneurysm rupture


Physical Exam:
NECK: no carotid bruits; ROM full;
CV; RRR, no murmurs
Pulm; CTA
Abd; soft, nt, nd
Extr; no edema, clubbing, cyanosis; distal pulses can be
palpated;

Neuro;
MS; A&Ox3,   attentive; able to relate history without
difficulty.  Speech fluent.  Naming, repetition, and
comprehension intact. No apraxia; Memory: 3/3/3 minutes;
moderate
fund of knowledge;

CN; PERRL 4mm-->2mm, Fundus: no edema; EOM's intact, no
nystagmus.  Face sensation intact V1-V3, very mild flattening of
left NLF, but left face moves similar to right; hearing
symmetric; [**Doctor Last Name 11586**] midline;  palate symmetric,  trapezius
symmetric, tongue midline.

Motor; normal bulk and tone; mild left pronator drift;  5/5
strength on the right arm and both legs; 5-/5 at left wrist and
finger extensor and IO;

Reflexes: slightly more pronounced on the left; ankle reflexes
diminished bilaterally; upgoing toe on left;

Sensory; intact to light touch and pinprick throughout

Coordination; mild dysmetria on FNF on the left; slowed FFM on
the left; HTS symmetric;  nl stance and gait;

Exam on Discharge:  Neurologically intact, with the exception of
some left arm weakness which may be due to pain in the shoulder.

Brief Hospital Course:
Patient was admitted to undergo an elective coiling for ACOMM
aneurysm. The preformed procedure was uncomplicated. Post
procedure the patient was transferred to the surgical ICU for
close monitoring. She remained on a Heparin drip until the
morning at which time we discontinued the heparin and started
her on Plavix.

Patient is being discharged home with appropriate follow up.

Medications on Admission:
Asprin 325mg daily
Metoprolol 100 mg ER daily
Simvastatin 40mg daily
lisinopril 20 mg daily
amlodipine 5mg daily

Discharge Medications:
1. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for Pain.
Disp:*40 Tablet(s)* Refills:*0*
2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. metoprolol succinate 100 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
4. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
7. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

8. amlodipine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).


Discharge Disposition:
Home

Discharge Diagnosis:
Anterior communicatin artery anerusym


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Angiogram with Embolization and/or Stent placement
Medications:
??????	Take Aspirin 325mg (enteric coated) once daily.
??????	Take Plavix (Clopidogrel) 75mg once daily.
??????	Continue all other medications you were taking before surgery,
unless otherwise directed
??????	You make take Tylenol or prescribed pain medications for any
post procedure pain or discomfort.

What activities you can and cannot do:
??????	When you go home, you may walk and go up and down stairs.
??????	You may shower (let the soapy water run over groin incision,
rinse and pat dry)
??????	Your incision may be left uncovered, unless you have small
amounts of drainage from the wound, then place a dry dressing or
band aid over the area that is draining, as needed
??????	No heavy lifting, pushing or pulling (greater than 5 lbs) for
1 week (to allow groin puncture to heal).
??????	After 1 week, you may resume sexual activity.
??????	After 1 week, gradually increase your activities and distance
walked as you can tolerate.
??????	No driving until you are no longer taking pain medications

What to report to office:
??????	Changes in vision (loss of vision, blurring, double vision,
half vision)
??????	Slurring of speech or difficulty finding correct words to use
??????	Severe headache or worsening headache not controlled by pain
medication
??????	A sudden change in the ability to move or use your arm or leg
or the ability to feel your arm or leg
??????	Trouble swallowing, breathing, or talking
??????	Numbness, coldness or pain in lower extremities
??????	Temperature greater than 101.5F for 24 hours
??????	New or increased drainage from incision or white, yellow or
green drainage from incisions
??????	Bleeding from groin puncture site

*SUDDEN, SEVERE BLEEDING OR SWELLING
(Groin puncture site)
Lie down, keep leg straight and have someone apply firm pressure
to area for 10 minutes. If bleeding stops, call our office. If
bleeding does not stop, call 911 for transfer to closest
Emergency Room!


Followup Instructions:
Please call our office for a follow up appointment with Dr.
[**First Name (STitle) **]. You will need a MRI/MRA before your visit. We will
schedule this study for you when you call. You should maake an
appointment 4 weeks from the date of your coiling.



Completed by:[**2137-5-9**]
{'Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Tobacco use disorder'}


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: Patient presents with known ACOMM aneurysm for coiling

PRESENT ILLNESS: Known ACOMM aneurysm

MEDICAL HISTORY: -HTN

MEDICATION ON ADMISSION: Asprin 325mg daily
Metoprolol 100 mg ER daily
Simvastatin 40mg daily
lisinopril 20 mg daily
amlodipine 5mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: NECK: no carotid bruits; ROM full;
CV; RRR, no murmurs
Pulm; CTA
Abd; soft, nt, nd
Extr; no edema, clubbing, cyanosis; distal pulses can be
palpated;

FAMILY HISTORY: -mother with cerebral aneurysm rupture

SOCIAL HISTORY: -smokes tobacco daily, no etoh or drugs. 

### Response:
{'Cerebral aneurysm, nonruptured,Unspecified essential hypertension,Tobacco use disorder'}
