CHIEF COMPLAINT: Seizure

PRESENT ILLNESS: 43 year-old man with a history of [**Location (un) 849**]-Gastaut syndrome,
recent hip surgery presents with increased seizures today.

MEDICAL HISTORY: 1. seizures as above s/p lobectomy at Montreal Neurological
Institute for partial seizures; h/o status, anoxic damage?
2. Lumbar diskectomy in [**2141**].
3. Recurrent UTIs.
4. History of aggressive impulsive behaviors.
5. Cognitive deficits/MR

MEDICATION ON ADMISSION: Keppra 1500 [**Hospital1 **], lamictal 300 tid, zonegran 600 hs,
naprosyn 375 [**Hospital1 **], zyprexa 7.5 hs, ativan 0.5mg prn, CaCO3 500
[**Hospital1 **]

ALLERGIES: Tegretol

PHYSICAL EXAM: PE: T 99.4  BP 108/74  HR 104  RR 16  O2 sat 97% RA
General: Appears stated age, occasionally moaning
HEENT: Sclera anicteric
Neck: Supple
Lungs: Clear to auscultation anterolaterally
CV: RRR, nl S1, S2, no murmur. 2+ carotids without bruit
Abd: Soft, nontender, normoactive bowel sounds
Extr: No edema, warm. Right hip with healing scar.

FAMILY HISTORY: No family history of seizures.  Three healthy siblings.

SOCIAL HISTORY: Lives [**Hospital 109859**] Rehab and Nursing Home in [**Hospital1 **], MA,
although patient stated during interview that he lives in
[**Location **]??????[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **].  Per records he graduated from high school
and attended [**Hospital3 **] Community College.  He does not smoke and
does not drink alcohol.
Mom cell: [**Telephone/Fax (1) 109860**]
[**Name2 (NI) **] (sister): [**Telephone/Fax (1) 109861**]
Generalized convulsive epilepsy, without mention of intractable epilepsy,Unspecified intellectual disabilities,Osteoporosis, unspecified
Gen cnv epil w/o intr ep,Intellect disability NOS,Osteoporosis NOS
Admission Date:  [**2162-7-14**]              Discharge Date:   [**2162-7-20**]

Date of Birth:  [**2119-3-1**]             Sex:   M

Service: NEUROLOGY

Allergies:
Tegretol

Attending:[**First Name3 (LF) 2927**]
Chief Complaint:
Seizure

Major Surgical or Invasive Procedure:
Long-term EEG monitoring


History of Present Illness:
43 year-old man with a history of [**Location (un) 849**]-Gastaut syndrome,
recent hip surgery presents with increased seizures today.

Pt at his nursing home. Per family he had approximately 5 "grand
mal" seizures today, and received 0.5mg PO ativan after each
one.
Seizures lasted about 1-2 minutes. At baseline, pt does have
daily seizures (wears helmet) but they are usually quite brief
and are not generalized tonic-clonic. It is very unusual for him
to have this many GTC seizures and for them to last this long.
They were occurring every 30-60 minutes, and he remained
lethargic and post-ictal between events. Since arrival in ED,
family witnessed two "small" seizures that were his more typical
brief events (face "fluttered" and eyes rolled back) and 1 GTC
seizure that lasted ~3-4 minutes. Peripheral IV access was
unattainable, and thus he was given 2mg IM ativan. Since then,
he
has had no further seizures.


Past Medical History:
1. seizures as above s/p lobectomy at Montreal Neurological
Institute for partial seizures; h/o status, anoxic damage?
2. Lumbar diskectomy in [**2141**].
3. Recurrent UTIs.
4. History of aggressive impulsive behaviors.
5. Cognitive deficits/MR

Social History:
Lives [**Hospital 109859**] Rehab and Nursing Home in [**Hospital1 **], MA,
although patient stated during interview that he lives in
[**Location **]??????[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **].  Per records he graduated from high school
and attended [**Hospital3 **] Community College.  He does not smoke and
does not drink alcohol.
Mom cell: [**Telephone/Fax (1) 109860**]
[**Name2 (NI) **] (sister): [**Telephone/Fax (1) 109861**]


Family History:
No family history of seizures.  Three healthy siblings.

Physical Exam:
PE: T 99.4  BP 108/74  HR 104  RR 16  O2 sat 97% RA
General: Appears stated age, occasionally moaning
HEENT: Sclera anicteric
Neck: Supple
Lungs: Clear to auscultation anterolaterally
CV: RRR, nl S1, S2, no murmur. 2+ carotids without bruit
Abd: Soft, nontender, normoactive bowel sounds
Extr: No edema, warm. Right hip with healing scar.

Neurologic Examination:
Mental Status: Initially, very lethargic, responds to noxious
with shouting but no verbal output and does not follow commands.
Is somewhat restless in bed. Later, eyes spontaenously open,
very
restless and continually kicking off gown and blankets, though
still non-verbal and not following commands.

Cranial Nerves: PERRL. Blinks to threat. Unable to visualize
fundi as turns head away. Shouts to nasal tickle but only
minimal
grimace. Face appears symmetric at rest.

Sensation: Shouts to noxious x4.

Motor: Normal bulk. Moves all extremities equally, though right
leg somewhat pain limited. Minimal withdrawal to pain.

Reflexes: DTRs decreased throughout. Toes up bilaterally

Coordination and gait: Unable due to mental status


Pertinent Results:
[**2162-7-16**] 07:45AM BLOOD WBC-5.3 RBC-4.17* Hgb-11.9* Hct-36.5*
MCV-88 MCH-28.6 MCHC-32.7 RDW-14.7 Plt Ct-266
[**2162-7-13**] 03:30PM BLOOD Neuts-79.1* Lymphs-13.3* Monos-5.7
Eos-1.5 Baso-0.3
[**2162-7-16**] 07:45AM BLOOD Plt Ct-266
[**2162-7-16**] 07:45AM BLOOD Glucose-106* UreaN-10 Creat-0.8 Na-142
K-3.5 Cl-107 HCO3-23 AnGap-16
[**2162-7-15**] 03:24AM BLOOD Calcium-9.3 Phos-3.8 Mg-2.1
[**2162-7-13**] 03:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2162-7-13**] 03:41PM BLOOD Glucose-87
[**2162-7-14**] 06:26PM BLOOD ZONISAMIDE(ZONEGRAN)-PND
[**2162-7-14**] 06:26PM BLOOD LEVETIRACETAM (KEPPRA)-PND
[**2162-7-14**] 06:26PM BLOOD LAMOTRIGINE-PND

   RADIOLOGY  Final Report

CT HEAD W/O CONTRAST  [**2162-7-14**] 8:04 AM

CT HEAD W/O CONTRAST

Reason: evaluate for bleed/mass

[**Hospital 93**] MEDICAL CONDITION:
43 year old man with status epilepticus
REASON FOR THIS EXAMINATION:
evaluate for bleed/mass
CONTRAINDICATIONS for IV CONTRAST: None.

NON-CONTRAST HEAD CT SCAN

HISTORY: Status epilepticus. Evaluate for bleed or mass.

TECHNIQUE: Non-contrast head CT scan.

COMPARISON STUDY: [**2162-1-20**] head CT scan.

FINDINGS: The study is degraded by patient motion. Within these
limitations, there is no overt sign for the presence of an
intracranial hemorrhage. Postsurgical changes incident to a
prior right temporal lobectomy are again seen. Both the prior
and present studies show a moderate degree of cerebellar
atrophy. Has the patient received Dilantin in the past ? Also
seen on both studies is malacic change within the right frontal
lobe. Such a finding could indicate prior trauma, as opposed to
an infarct. All of these abnormalities were visible on a prior
MR study of [**2157-6-19**], confirming that the findings are
chronic in age. A right frontal temporal craniotomy flap is
again seen. There may be a small amount of scalp soft tissue
swelling near the cerebral vertex posteriorly. Is this the site
for recent head trauma?

CONCLUSION: No intracranial hemorrhage. Other findings as noted
above.

   RADIOLOGY  Final Report

CHEST (PORTABLE AP)  [**2162-7-13**] 10:52 PM

CHEST (PORTABLE AP)

Reason: 43 year old man with sz r/o infection/pna

[**Hospital 93**] MEDICAL CONDITION:
43 year old man with sz r/o infection/pna
REASON FOR THIS EXAMINATION:
43 year old man with sz r/o infection/pna
INDICATION: Seizure, question infection.

COMPARISON: None.

FINDINGS: The lungs are clear. The pleura are normal. There are
no pneumothoraces. The heart and mediastinal contours are
normal. The pulmonary vasculature is normal.

IMPRESSION: No acute cardiopulmonary process.

Brief Hospital Course:
..#Seizures
Patient was admitted to the Epilepsy Service for work-up of his
breakthough seizure flurry. He was placed on standing Ativan at
1mg Q6h, this was then increased to 1mg 5 times daily as [**Known firstname **]
continued to have short absence-like events. He was continued on
his preadmission medications and a toxic-metabolic work-up was
negative. He spent two nights in the ICU but did not require
intubation.
His events precipitous declined in frequency on an scheduled
ativan which was also weaned to current dose of 0.5mg PO BID.
He is currently on his pre-admission AED doses:Keppra 1500 [**Hospital1 **],
lamictal 300 tid, zonegran 600 hs,ativan 0.5mg prn.
He is without seizures.

..# Diarrhea
He had developed some diarrhea and a C. diff toxin was sent. He
was placed on metronidazole for empiric coverage until the assay
came back negative and Abx was dicontinued.
He is tolerating an oral diet well now.

Medications on Admission:
Keppra 1500 [**Hospital1 **], lamictal 300 tid, zonegran 600 hs,
naprosyn 375 [**Hospital1 **], zyprexa 7.5 hs, ativan 0.5mg prn, CaCO3 500
[**Hospital1 **]


Discharge Disposition:
Extended Care

Facility:
[**Hospital 6594**] Rehab

Discharge Diagnosis:
[**Location (un) 849**]-Gastaut Syndrome


Discharge Condition:
Improved


Discharge Instructions:
Take your medications. Please continue Ativan 0.5mg [**Hospital1 **] for one
week and then ativan 0.5 mg daily for one week and then stop
scheduled doses.
If you have a prolonged seizure lasting more than 15 minutes or
a flurry seizures (more tha [**6-12**] in a day) please call your
Neurologist or report to a ED.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) 539**] [**Last Name (NamePattern1) 6531**] RN Phone:[**Telephone/Fax (1) 876**]
Date/Time:[**2162-7-29**] 10:15
Provider: [**Last Name (NamePattern4) **]. [**Last Name (STitle) 11347**] [**Name (STitle) **] Phone:[**Telephone/Fax (1) 857**]
Date/Time:[**2162-10-21**] 10:15
{'Generalized convulsive epilepsy, without mention of intractable epilepsy,Unspecified intellectual disabilities,Osteoporosis, unspecified'}


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

PRESENT ILLNESS: 43 year-old man with a history of [**Location (un) 849**]-Gastaut syndrome,
recent hip surgery presents with increased seizures today.

MEDICAL HISTORY: 1. seizures as above s/p lobectomy at Montreal Neurological
Institute for partial seizures; h/o status, anoxic damage?
2. Lumbar diskectomy in [**2141**].
3. Recurrent UTIs.
4. History of aggressive impulsive behaviors.
5. Cognitive deficits/MR

MEDICATION ON ADMISSION: Keppra 1500 [**Hospital1 **], lamictal 300 tid, zonegran 600 hs,
naprosyn 375 [**Hospital1 **], zyprexa 7.5 hs, ativan 0.5mg prn, CaCO3 500
[**Hospital1 **]

ALLERGIES: Tegretol

PHYSICAL EXAM: PE: T 99.4  BP 108/74  HR 104  RR 16  O2 sat 97% RA
General: Appears stated age, occasionally moaning
HEENT: Sclera anicteric
Neck: Supple
Lungs: Clear to auscultation anterolaterally
CV: RRR, nl S1, S2, no murmur. 2+ carotids without bruit
Abd: Soft, nontender, normoactive bowel sounds
Extr: No edema, warm. Right hip with healing scar.

FAMILY HISTORY: No family history of seizures.  Three healthy siblings.

SOCIAL HISTORY: Lives [**Hospital 109859**] Rehab and Nursing Home in [**Hospital1 **], MA,
although patient stated during interview that he lives in
[**Location **]??????[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **].  Per records he graduated from high school
and attended [**Hospital3 **] Community College.  He does not smoke and
does not drink alcohol.
Mom cell: [**Telephone/Fax (1) 109860**]
[**Name2 (NI) **] (sister): [**Telephone/Fax (1) 109861**] 

### Response:
{'Generalized convulsive epilepsy, without mention of intractable epilepsy,Unspecified intellectual disabilities,Osteoporosis, unspecified'}
