CHIEF COMPLAINT: Essential Tremor

PRESENT ILLNESS: This is a very pleasant 76 year old female with essential tremor
diagnosed many years ago. Every attempt with medical management
has failed. Her tremor is significant, especially when she is
anxious and among public people. She
states that alcohol makes the tremor better. She has significant
intentional tremor as well as postural tremor with both upper
extremities, may be left more
than right. She has also moderate resting head tremor.

MEDICAL HISTORY: Hyperlipidemia, depression, pulmonary embolus in [**2166**], protein S
deficiency on anticoagulation with Coumadin, status post left
retinal detachment surgery, status post cataract surgery, status
post right knee replacement surgery, osteoporosis, chol,
hypothyroid, H pylori, B12 def, PE x 5 yrs

MEDICATION ON ADMISSION: Primidone 50 mg one tablet three times daily, levothyroxine,
pravastatin, Lovenox, zoledronic acid, calcium supplementation,
vitamin B12, multivitamin, and MiraLax as needed. Lovenox bridge
40mg SC QD

ALLERGIES: Penicillins / Demerol / Morphine / Shellfish Derived / Sulfa
(Sulfonamide Antibiotics)

PHYSICAL EXAM: Pre-op: She has significant intentional tremor as well as
postural tremor with both upper extremities, may be left more
than right. She has also moderate resting head tremor

FAMILY HISTORY: NC

SOCIAL HISTORY: She is a retired [**Male First Name (un) 1573**] high guidance counselor. She does not
smoke. She has 2 ETOH beverages per day.
Essential and other specified forms of tremor,Hemorrhage complicating a procedure,Primary hypercoagulable state,Other and unspecified hyperlipidemia,Other B-complex deficiencies,Osteoporosis, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Knee joint replacement,Acquired absence of both cervix and uterus,History of fall,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants
Tremor NEC,Hemorrhage complic proc,Prim hypercoagulable st,Hyperlipidemia NEC/NOS,B-complex defic NEC,Osteoporosis NOS,Abn react-artif implant,Joint replaced knee,Acq absnce cervix/uterus,Personal history of fall,Hx-ven thrombosis/embols,Long-term use anticoagul
Admission Date:  [**2172-10-20**]              Discharge Date:   [**2172-10-22**]

Date of Birth:  [**2096-7-23**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Penicillins / Demerol / Morphine / Shellfish Derived / Sulfa
(Sulfonamide Antibiotics)

Attending:[**First Name3 (LF) 1271**]
Chief Complaint:
Essential Tremor

Major Surgical or Invasive Procedure:
Placement of Left VIM Deep Brain Stimulator Stage 1


History of Present Illness:
This is a very pleasant 76 year old female with essential tremor
diagnosed many years ago. Every attempt with medical management
has failed. Her tremor is significant, especially when she is
anxious and among public people. She
states that alcohol makes the tremor better. She has significant
intentional tremor as well as postural tremor with both upper
extremities, may be left more
than right. She has also moderate resting head tremor.

Past Medical History:
Hyperlipidemia, depression, pulmonary embolus in [**2166**], protein S
deficiency on anticoagulation with Coumadin, status post left
retinal detachment surgery, status post cataract surgery, status
post right knee replacement surgery, osteoporosis, chol,
hypothyroid, H pylori, B12 def, PE x 5 yrs


Social History:
She is a retired [**Male First Name (un) 1573**] high guidance counselor. She does not
smoke. She has 2 ETOH beverages per day.

Family History:
NC

Physical Exam:
Pre-op: She has significant intentional tremor as well as
postural tremor with both upper extremities, may be left more
than right. She has also moderate resting head tremor

Pertinent Results:
X-ray orbits [**2172-10-20**]:
Cranial fixation hardware limits evaluations of the orbit.
Within this limitation no radiopaque objects are seen within the
orbits.

CT Head [**2172-10-20**]:
Deep brain stimulator lead through the left frontal approach
with the tip at the level of the left thalamus/left subthalamic
nucleus. Interval hemorrhage into the adjacent lateral ventricle
as well as the third and fourth ventricles. No hydrocephalus.
Follow up as clinically indicated.

CT head [**2172-10-21**]
1. Left transfrontal deep brain stimulator lead terminates in
the left
thalamus/left subthalamic nuclei, unchanged in position from
[**2172-10-20**].
2. Unchanged amount and appearance of hemorrhage in the left
lateral, third and fourth ventricle, with no evidence of
obstructive hydrocephalus.
3. No new hemorrhage.


Brief Hospital Course:
Ms. [**Known lastname **] was admitted to [**Hospital1 18**] on [**2172-10-20**]. The head frame was
placed in the Pre-op area. She had an orbital X-ray to rule out
metallic objects in light of her prior eye surgery. She had an
MRI of the brain. She was taken to the OR for her Left DBS
procedure under local/MAC anesthesia. She had some headache and
nausea in the PACU. Her post-op CT showed left lateral, 3rd and
4th IVH. She was transferred to the ICU for close observation
and Q1hr neuro checks. She was neurologically intact and her CT
head was stable on [**10-21**]. Transfer orders for the floor were
written. She was tolerating a regular diet and ambulating. Her
Foley was discontinued.  She had mild confusion overnight but
was oriented and her CT was stable. She was discharged to home.

Medications on Admission:
Primidone 50 mg one tablet three times daily, levothyroxine,
pravastatin, Lovenox, zoledronic acid, calcium supplementation,
vitamin B12, multivitamin, and MiraLax as needed. Lovenox bridge
40mg SC QD


Discharge Medications:
.
1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
2. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
3. levothyroxine 100 mcg Tablet Sig: 1.5 Tablets PO DAILY
(Daily).
4. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
5. primidone 50 mg Tablet Sig: One (1) Tablet PO 5 TIMES DAILY
().
6. propranolol 40 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
7. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12
hours).


Discharge Disposition:
Home

Discharge Diagnosis:
Essential Tremor
Intraventricular Hemorrhage


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


Discharge Instructions:
General 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.
??????	Do not take any Coumadin or Lovenox
??????	Make sure to continue to use your incentive spirometer while
at home, unless you have been instructed not to.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of 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 for Stage 2 as directed.
You must have a CT of the head the day of the surgery before the
procedure. Please call Paresa at [**Telephone/Fax (1) 1669**] to schedule this.

                             [**Name6 (MD) 742**] [**Name8 (MD) **] MD [**MD Number(2) 1273**]

Completed by:[**2172-10-22**]
{'Essential and other specified forms of tremor,Hemorrhage complicating a procedure,Primary hypercoagulable state,Other and unspecified hyperlipidemia,Other B-complex deficiencies,Osteoporosis, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Knee joint replacement,Acquired absence of both cervix and uterus,History of fall,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}


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: Essential Tremor

PRESENT ILLNESS: This is a very pleasant 76 year old female with essential tremor
diagnosed many years ago. Every attempt with medical management
has failed. Her tremor is significant, especially when she is
anxious and among public people. She
states that alcohol makes the tremor better. She has significant
intentional tremor as well as postural tremor with both upper
extremities, may be left more
than right. She has also moderate resting head tremor.

MEDICAL HISTORY: Hyperlipidemia, depression, pulmonary embolus in [**2166**], protein S
deficiency on anticoagulation with Coumadin, status post left
retinal detachment surgery, status post cataract surgery, status
post right knee replacement surgery, osteoporosis, chol,
hypothyroid, H pylori, B12 def, PE x 5 yrs

MEDICATION ON ADMISSION: Primidone 50 mg one tablet three times daily, levothyroxine,
pravastatin, Lovenox, zoledronic acid, calcium supplementation,
vitamin B12, multivitamin, and MiraLax as needed. Lovenox bridge
40mg SC QD

ALLERGIES: Penicillins / Demerol / Morphine / Shellfish Derived / Sulfa
(Sulfonamide Antibiotics)

PHYSICAL EXAM: Pre-op: She has significant intentional tremor as well as
postural tremor with both upper extremities, may be left more
than right. She has also moderate resting head tremor

FAMILY HISTORY: NC

SOCIAL HISTORY: She is a retired [**Male First Name (un) 1573**] high guidance counselor. She does not
smoke. She has 2 ETOH beverages per day. 

### Response:
{'Essential and other specified forms of tremor,Hemorrhage complicating a procedure,Primary hypercoagulable state,Other and unspecified hyperlipidemia,Other B-complex deficiencies,Osteoporosis, unspecified,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation,Knee joint replacement,Acquired absence of both cervix and uterus,History of fall,Personal history of venous thrombosis and embolism,Long-term (current) use of anticoagulants'}
