CHIEF COMPLAINT: Incidental finding of Left MCA aneurysm

PRESENT ILLNESS: Pt. is a 59 y/o female who presented to the ED some time ago
after a fall when she struck her head, on cranial imaging a 7mm
left MCA aneurysm was found.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: Plavix

ALLERGIES: Penicillins

PHYSICAL EXAM: On examination on admission, she is a pleasant woman.  She is
awake, alert,
oriented x 3.  Her memory recent and remote was good.  Attention
and concentration is appropriate.  Language and fund of
knowledge
is good.  Cranial nerves II through XII are intact.  Motor
strength is [**6-13**] in all four extremities.  Gait and coordination
is normal.

FAMILY HISTORY: Family history is significant for mother who had heart valve
replacement.

SOCIAL HISTORY: She works as a computer trainer and has smoked in the past and
in
the last 15 years she smoked a pack per week.  She takes about
four glasses of wine on a nightly basis.
Cerebral aneurysm, nonruptured,Tobacco use disorder,Personal history of irradiation, presenting hazards to health
Nonrupt cerebral aneurym,Tobacco use disorder,Hx of irradiation
Admission Date:  [**2144-7-1**]              Discharge Date:   [**2144-7-2**]

Date of Birth:  [**2084-8-18**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins

Attending:[**First Name3 (LF) 78**]
Chief Complaint:
Incidental finding of Left MCA aneurysm

Major Surgical or Invasive Procedure:
Coiling of Left MCA aneurysm


History of Present Illness:
Pt. is a 59 y/o female who presented to the ED some time ago
after a fall when she struck her head, on cranial imaging a 7mm
left MCA aneurysm was found.

Past Medical History:
None

Social History:
She works as a computer trainer and has smoked in the past and
in
the last 15 years she smoked a pack per week.  She takes about
four glasses of wine on a nightly basis.


Family History:
Family history is significant for mother who had heart valve
replacement.


Physical Exam:
On examination on admission, she is a pleasant woman.  She is
awake, alert,
oriented x 3.  Her memory recent and remote was good.  Attention
and concentration is appropriate.  Language and fund of
knowledge
is good.  Cranial nerves II through XII are intact.  Motor
strength is [**6-13**] in all four extremities.  Gait and coordination
is normal.

On examination at discharge:
GEN: middle aged woman lying in bed in NAD
HEENT: OP clear
CV: RRR
PULM: CTAB
ABD: soft, NT, ND
EXT: dried blood on R groin dressing, DP and PT pulses 2+, no
bruit auscultated at site, no pain or TTP at site.

NEURO:
MS - AAOx3, speech fluent
CN - PERRL 4->2, EOMI, face symmetrical, facial sensation equal
bilaterally, tongue midling
MOTOR - [**6-13**] throughout
SENSATON - intct to LT throughout
GAIT - narrow based, independent


Pertinent Results:
Review of CTA is consistent with a 6-7 mm aneurysm at the left
MCA bifurcation.

ADMISSION LABS:

[**2144-7-1**] 04:56PM BLOOD WBC-3.5* RBC-3.87* Hgb-11.8* Hct-36.1
MCV-93 MCH-30.6 MCHC-32.8 RDW-13.0 Plt Ct-262
[**2144-7-1**] 04:56PM BLOOD PT-10.8 PTT-108.5* INR(PT)-1.0
[**2144-7-1**] 04:56PM BLOOD Glucose-111* UreaN-14 Creat-0.7 Na-142
K-4.0 Cl-110* HCO3-23 AnGap-13
[**2144-7-1**] 04:56PM BLOOD Calcium-8.5 Phos-3.9 Mg-1.8

DISCHARGE LABS:

[**2144-7-2**] 01:57AM BLOOD WBC-5.0 RBC-3.59* Hgb-11.0* Hct-33.4*
MCV-93 MCH-30.7 MCHC-33.0 RDW-13.1 Plt Ct-246
[**2144-7-2**] 01:57AM BLOOD PT-10.4 PTT-47.1* INR(PT)-1.0
[**2144-7-2**] 01:57AM BLOOD Glucose-119* UreaN-13 Creat-0.7 Na-138
K-4.3 Cl-105 HCO3-24 AnGap-13
[**2144-7-2**] 01:57AM BLOOD Calcium-8.7 Phos-4.0 Mg-1.9

REPORTS:
ANGIO [**2144-7-1**]: [**Known lastname 40127**],[**Known firstname **] [**Medical Record Number 110016**] F  59  [**2084-8-18**]

Radiology Report CAROT/CEREB [**Hospital1 **] Study Date of [**2144-7-1**] 1:03 PM


[**Last Name (LF) **],[**First Name3 (LF) **] J. SDS   [**2144-7-1**] 1:03 PM
CAROT/CEREB [**Hospital1 **]   Clip # [**Clip Number (Radiology) 110017**]
Reason: stent assisted coiling of mca aneurysmAnesthesia has
been bo
Contrast: OPTIRAY Amt: 200



[**Hospital 93**] MEDICAL CONDITION:
   59 year old woman with left mca aneurysm
REASON FOR THIS EXAMINATION:
   stent assisted coiling of mca aneurysmAnesthesia has been
booked for [**7-1**] at
   1pm



*** UNAPPROVED (PRELIMINARY) REPORT ***
Preliminary ReportANGIO REPORT

Preliminary ReportDATE OF SERVICE: [**2144-7-1**].

Preliminary ReportPREOPERATIVE DIAGNOSIS: Left middle cerebral
artery aneurysm.

Preliminary ReportPROCEDURE: Left common carotid artery
arteriogram, left internal carotid
Preliminary Reportartery arteriogram, stent-assisted coiling of
left middle cerebral artery
Preliminary Reportaneurysm with Enterprise 4 x 28 mm stent and
Target coils. Right common
Preliminary Reportfemoral artery arteriogram and Angio-Seal
closure of right common femoral
Preliminary Reportartery puncture site.

Preliminary ReportATTENDING: [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.

Preliminary ReportASSISTANT: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.

Preliminary ReportANESTHESIA: General.

Preliminary ReportDETAILS OF PROCEDURE: The patient was brought
to the angiography suite. Anesthesia was induced in the supine
position. Following this, access was gained to the right common
femoral artery using a Seldinger technique and a 6 French
vascular sheath was placed in the right common femoral artery.
Following this, the left common carotid artery was catheterized
and AP, lateral filming done along with three-dimensional
rotational angiography.  After the appropriate angles were
chosen, the left internal carotid artery was catheterized and a
6 French Neuron catheter placed in the left internal carotid
artery. Following this, we now passed an XT-27 catheter into the
left middle cerebral artery inferior division and a separate
SL-10 microcatheter into the left middle cerebral artery
aneurysm. However, since the catheter fell out, we decided to
place the stent first. An Enterprise 28 x 4 mm stent was placed
without difficulty from the left middle cerebral artery
extending into the left internal carotid artery. Following this,
the aneurysm was catheterized through the cells of the stent and
an SL-10 microcatheter was placed inside the catheter. We now
coiled the aneurysm with a 4 mm x 15 cm
coil and a 3 mm x 8 cm coil. Following this, one loop had
prolapsed outside the aneurysm and was trapped between the wall
of the the middle cerebral artery and the stent. At this point,
we decided that it would be better to bring her back if
necessary for a later procedure to finish the coiling.

A right common femoral artery arteriogram was done and a 6
French Angio-Seal was used for closure of the right common
femoral artery puncture site.

FINDINGS: Left internal carotid artery arteriogram shows filling
of the left internal carotid artery along the cervical, petrous,
cavernous and
supraclinoid portion. The anterior and middle cerebral arteries
are seen well. There is 5 x 4 mm aneurysm of the left middle
cerebral artery
Preliminary Reportbifurcation.

Left internal carotid artery arteriogram status post placement
of Enterprise stent shows that there is no evidence of stenosis
or thrombus in the stent.

Coiling of left middle cerebral artery aneurysm after
embolization shows that there is one coil loops that is
prolapsed into the left middle cerebral artery inferior
division; however, this is trapped behind the struts of the
stent.  The aneurysm still fills. Right common femoral artery
arteriogram shows idely patent right common femoral artery.

(reliminary Report)MPRESSION: [**Known firstname **] [**Known lastname **] underwent cerebral
angiography and coil embolization of a middle cerebral artery
aneurysm with Target coils and the assistance of an Enterprise
stent. This was uneventful. She still had residual filling at
the end of the procedure. It is expected that she may go on to
thrombose the aneurysm with withdrawal of heparin and
antiplatelet therapy. If she has persistent filling, she will be
brought back in two months' time for another interventional
procedure.



Brief Hospital Course:
Ms. [**Known lastname **] was admited to the hospital to undergo an elective
left MCA coiling. She was intubated and sedated and underwent
the procedure under general anesthesia. The coiling was
performed without complication. She was extubated and
transferred to the ICU on a heparin gtt. Post operatively she
was neurologically intact and her groin was c/d/i.  Her heparin
gtt was D/C'd at 7am on the day after her angio and she was sent
home with plavix for 6 weeks and ASA until Dr. [**First Name (STitle) **] told her
to stop.  She had a non-focal neurological exam at discharge.

Medications on Admission:
Plavix

Discharge Medications:
.
1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily): Please take 1 tab a day for 6 weeks (until [**2144-8-14**]).
Disp:*30 Tablet(s)* Refills:*2*
2. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as
needed for constipation.
Disp:*30 Tablet(s)* Refills:*0*
5. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*6*
6. aspirin, buffered 325 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*6*


Discharge Disposition:
Home

Discharge Diagnosis:
Left MCA aneurysm


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
75 mg po daily for 6 weeks

??????	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!

We made the following changes to your medications:
1) We STARTED you on PLAVIX 75mg once a day for 6 weeks (to
finish on [**8-13**])
2) We STARTED you on OXYCODONE 5-10mg every 4 hours as needed
for pain.  Do not drive, operate heavy machinery, drink alcohol
or take other sedating medications while you take this
medication, as it can make you dangerously sleepy.
3) We STARTED you on DOCUSATE 100mg twice a day to prevent
constipation while you are taking oxycodone.
4) We STARTED you on SENNA 8.6mg at night as needed for
constipation.
5) We STARTED you on FAMOTIDINE 20mg twice a day.  You should
take this to protect your stomach while you are taking aspirin.
6) We STARTED you on ASPIRIN 325mg once a day.  You should keep
taking this medication every day until your physician tells you
to stop.

Followup Instructions:
Department: MRI
When: THURSDAY [**2144-9-3**] at 12:40 PM
With: MRI [**Telephone/Fax (1) 590**]
Building: CC [**Location (un) 591**] [**Hospital 1422**]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Department: NEUROSURGERY
When: THURSDAY [**2144-9-3**] at 2:00 PM
With: [**Name6 (MD) **] [**Last Name (NamePattern4) 7746**], MD [**Telephone/Fax (1) 3666**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{'Cerebral aneurysm, nonruptured,Tobacco use disorder,Personal history of irradiation, presenting hazards to health'}


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: Incidental finding of Left MCA aneurysm

PRESENT ILLNESS: Pt. is a 59 y/o female who presented to the ED some time ago
after a fall when she struck her head, on cranial imaging a 7mm
left MCA aneurysm was found.

MEDICAL HISTORY: None

MEDICATION ON ADMISSION: Plavix

ALLERGIES: Penicillins

PHYSICAL EXAM: On examination on admission, she is a pleasant woman.  She is
awake, alert,
oriented x 3.  Her memory recent and remote was good.  Attention
and concentration is appropriate.  Language and fund of
knowledge
is good.  Cranial nerves II through XII are intact.  Motor
strength is [**6-13**] in all four extremities.  Gait and coordination
is normal.

FAMILY HISTORY: Family history is significant for mother who had heart valve
replacement.

SOCIAL HISTORY: She works as a computer trainer and has smoked in the past and
in
the last 15 years she smoked a pack per week.  She takes about
four glasses of wine on a nightly basis. 

### Response:
{'Cerebral aneurysm, nonruptured,Tobacco use disorder,Personal history of irradiation, presenting hazards to health'}
