CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 67-year-old right
handed man from [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**] with a history of glioblastoma
multiforme who was seen by Dr. [**Last Name (STitle) 724**] in clinic on the day of
admission.  Current medical history began in [**2196-5-10**] when he
experienced generalized tonic clonic seizure.  He was found to
have a left frontal mass.  At that time, he also developed a DVT
and had an IVC filter placed.  The mass was eventually resected
on [**2196-6-20**] with pathology consistent for glioblastoma multiforme.
The patient came from [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**] to [**Location (un) 86**] for phase I boron
neutron capture therapy at [**Hospital1 69**].
The patient was lasted treated on [**2196-7-26**] with this procedure.
In the week prior to admission, the patient was noted to be
increasingly somnolent.  He also developed a shuffling gait and
some unsteadiness on his feet and urinary incontinence.  He had
been started on Ditropan XL with improvement of his urinary
incontinence and urinary urgency.  The patient denied headaches,
nausea, vomiting or tonic clonic seizures.  He also denied any
falls.

MEDICAL HISTORY: 1.  Glioblastoma multiforme, status post resection, status
post boron neutron capture therapy on [**2196-7-26**].
2.  DVT, status post [**Location (un) 260**] IVC filter.
3.  Status post right frontal craniotomy for glioblastoma
multiforme on [**2196-6-20**] in [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**].

MEDICATION ON ADMISSION: Dilantin 300 mg q a.m., 200 mg
q p.m., Protonix 40 mg q day, Decadron 8 mg b.i.d., Cozaar 50
mg q day, metoprolol 50 mg q day, hydrochlorothiazide 25 mg
q day, Ditropan XL 10 mg q day and Aquaphor p.r.n.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a physician, [**Name10 (NameIs) **] denies alcohol or
tobacco use.
Other pulmonary embolism and infarction,Malignant neoplasm of brain, unspecified,Hyposmolality and/or hyponatremia,Other convulsions,Abnormality of gait,Anticoagulants causing adverse effects in therapeutic use
Pulm embol/infarct NEC,Malig neo brain NOS,Hyposmolality,Convulsions NEC,Abnormality of gait,Adv eff anticoagulants
Admission Date:  [**2196-9-13**]     Discharge Date:  [**2196-9-18**]

Date of Birth:   [**2129-4-10**]     Sex:  M

Service:  Oncology Medicine

Discharge for the dates the patient was on the oncology medicine
service.  The patient was discharged to the CCU for further care.

HISTORY OF PRESENT ILLNESS:  The patient is a 67-year-old right
handed man from [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**] with a history of glioblastoma
multiforme who was seen by Dr. [**Last Name (STitle) 724**] in clinic on the day of
admission.  Current medical history began in [**2196-5-10**] when he
experienced generalized tonic clonic seizure.  He was found to
have a left frontal mass.  At that time, he also developed a DVT
and had an IVC filter placed.  The mass was eventually resected
on [**2196-6-20**] with pathology consistent for glioblastoma multiforme.
The patient came from [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**] to [**Location (un) 86**] for phase I boron
neutron capture therapy at [**Hospital1 69**].
The patient was lasted treated on [**2196-7-26**] with this procedure.
In the week prior to admission, the patient was noted to be
increasingly somnolent.  He also developed a shuffling gait and
some unsteadiness on his feet and urinary incontinence.  He had
been started on Ditropan XL with improvement of his urinary
incontinence and urinary urgency.  The patient denied headaches,
nausea, vomiting or tonic clonic seizures.  He also denied any
falls.

PAST MEDICAL HISTORY:
1.  Glioblastoma multiforme, status post resection, status
post boron neutron capture therapy on [**2196-7-26**].
2.  DVT, status post [**Location (un) 260**] IVC filter.
3.  Status post right frontal craniotomy for glioblastoma
multiforme on [**2196-6-20**] in [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**].

SOCIAL HISTORY:  The patient is a physician, [**Name10 (NameIs) **] denies alcohol or
tobacco use.

MEDICATIONS ON ADMISSION:  Dilantin 300 mg q a.m., 200 mg
q p.m., Protonix 40 mg q day, Decadron 8 mg b.i.d., Cozaar 50
mg q day, metoprolol 50 mg q day, hydrochlorothiazide 25 mg
q day, Ditropan XL 10 mg q day and Aquaphor p.r.n.

ALLERGIES:  The patient has no known drug allergies.

SUMMARY OF HOSPITAL COURSE:
(1) Encephalopathy:  Multiple possible explanations for
encephalopathy were pursued.  First of all, for question of
dehydration the patient was given IV fluids.  The patient was
also given a bowel regimen to have a bowel movement, which the
patient did on the day after admission.  The patient underwent an
EEG which showed generalized slowing, but no seizure activity.
The patient also had a lumbar puncture performed to rule out any
infectious etiology or neoplastic meningitis.  The lumbar
puncture was unremarkable.  The patient underwent an MRI of his
head on [**2196-9-17**], which showed no bleed and no significant
swelling.  An infectious etiology was also considered.  However,
chest x-ray, blood culture, and urine culture remained negative.
The patient's encephalopathy and also gait disturbance seemed
most likely to be consistent with radiation somnolence syndrome
especially given his experimental status for this therapy.
Possible treatment for his encephalopathy and gait disturbance
the patient was started on Sinemet.  The patient was also started
on Ritalin on [**2196-9-17**].

(2) Glioblastoma multiforme:  The patient was being followed by
the oncology service.  His MRI on [**2196-9-6**] and also on [**2196-9-16**],
did not show any significant findings that would be consistent
with the glioblastoma multiforme as the cause for the patient's
current symptoms.

(3) Cardiovascular:  On [**2196-9-18**], the patient became acutely
diaphoretic and had decreased oxygen saturations.  An EKG was
obtained, which showed a new right bundle branch block and also
some ST segment elevations.  The patient was treated for this
acute coronary syndrome with a sublingual nitroglycerin, aspirin
and additional doses of IV Lopressor.  Although the patient had
originally not experienced any chest pain with this event,
shortly afterwards the patient developed substernal chest pain,
which radiated to his arm.  He received sublingual nitroglycerin
with relief of pain after one sublingual nitroglycerin.  The
patient was also started on a nitroglycerin drip and also on a
heparin GTT.  The patient was transferred to the CCU for further
management.

(4) IV access:  The patient lost his peripheral IV access
during the acute coronary event.  A right internal jugular
line was placed for better venous access.  The line was placed
without complication.

The remainder of his hospital course will be dictated at a
later date.  The patient was transferred to the CCU from the
oncology medicine service for further care.  Upon discharge
from the hospital the patient will need physical therapy and
inpatient rehabilitation services.


                       [**Doctor Last Name 640**] [**Doctor First Name 747**] [**Name8 (MD) **], M.D.  [**MD Number(1) 748**]

Dictated By:[**Doctor Last Name 32868**]
MEDQUIST36

D:  [**2196-9-19**]  00:51
T:  [**2196-9-21**]  19:29
JOB#:  [**Job Number 48048**]





Name:  [**Known lastname 8873**], [**First Name3 (LF) 499**]                     Unit No:  [**Numeric Identifier 8874**]

Admission Date:  [**2196-9-13**]     Discharge Date:  [**2196-9-30**]

Date of Birth:   [**2129-4-10**]     Sex:  M

Service:  [**Hospital1 248**]

ADDENDUM:  This is an addendum to the Discharge Summary dated
[**2196-9-18**].  This addendum contains events already described
in that Discharge Summary and the subsequent hospital course.

SUMMARY OF SUBSEQUENT HOSPITAL COURSE:
1.  ENCEPHALOPATHY:  Multiple possible explanations for
encephalopathy were pursued; first of all for a question of
dehydration the patient was given intravenous fluids.  The
patient was also given a bowel regimen to help bowel movement
which the patient did on the day after admission.  The
patient underwent an EEG which showed generalized slowing,
however, no seizure activity.

The patient also had a lumbar puncture performed to rule out
any infectious etiology or central nervous system involvement
with cancer.  The lumbar puncture was unremarkable.

The patient underwent an MRI of his head on [**9-17**], which
showed no bleed and no significant swelling and an infectious
etiology was also considered; however, chest x-ray, blood and
urine cultures remained negative.

The patient's encephalopathy and gait disturbance seemed most
likely consistent with irradiation somnolence syndrome,
especially given his terminal status for his Boron neutron
capture therapy.  As possible treatment for encephalopathy
and gait disturbance, the patient was started on Sinemet.
The patient was also started on Ritalin on [**9-17**] and the
patient was continued on Sinemet for the duration of his
admission.  The Ritalin was increased from 5 mg twice a day
to 10 mg twice a day on [**9-21**] with little improvement in
his alertness.

At discharge the patient was oriented to person, place and
time; he could answer some questions and respond to some
commands.

2.  GLIOBLASTOMA MULTIFORME:  The patient was followed by the
Oncology Service.  His MRI on [**9-6**], and also on [**9-16**],
did not show any findings that would be consistent with a GBM
as the cause for the patient's symptoms of change in mental
status and gait disturbance.  The patient complained of
headache on [**9-23**] and a head CT scan was done which
showed no intracranial hemorrhage and little change from
prior MRI.

The patient also underwent an MRI of his spine on [**9-26**]
to evaluate his lower extremity weakness and search for a
possible metastases.  This MRI showed no evidence for marrow
edema, pathologic compression or extrinsic cord compression.
The patient had continued lower extremity weakness throughout
the rest of his admission and continues to require maximum
assistance with all transfers.

3.  PULMONARY EMBOLISM / ANTICOAGULATION:  The patient had
been transferred to the Cardiac Care Unit after an event
consistent with myocardial infarction by symptoms, however,
in the Cardiac Care Unit the patient was sent for a CT
angiogram of the chest to rule out pulmonary embolism and
multiple large bilateral pulmonary emboli were found.  In the
end, the patient was felt not to have had a myocardial
infarction.  The patient was continued on heparin and then
transitioned to warfarin for long-term anti-coagulation for
pulmonary embolism.

After three days of warfarin 5 mg q. day and three days of
warfarin 2.5 mg p.o. q. day, the patient's INR was 2.9 on the
morning of [**9-29**] and patient was continued on warfarin 2.5 mg
q. day.

4.  ENDOCRINE:  The patient had increased serum glucose while
on dexamethasone 8 mg twice a day; this was treated with NPH
insulin in the morning and at bed time and a Regular insulin
sliding scale based on fingerstick glucoses four times a day
at breakfast, lunch and dinner, and at bed time.  At
discharge, the patient was receiving 30 units NPH q. a.m.; 20
units NPH q. p.m., as well as a sliding scale coverage.  This
regimen resulted in glucoses in the 150 range.

5.  ANEMIA:  The patient experienced a drop in hematocrit
from 37 to 30 while on heparin therapy.  Imaging was negative
for a head bleed and for abdominal or retroperitoneal bleed.
No source of bleeding was found.  The patient's hematocrit
was subsequently increased to 36.

6.  HEPARIN INDUCED THROMBOCYTOPENIA:  The patient also
experienced a drop in platelets from 162 to 95.  The patient
was found to be heparin antibody positive.  The patient was
continued on heparin and the platelet count increased during
this therapy and was above 200 at discharge.

7.  SEIZURE PROPHYLAXIS:  The patient was maintained on
phenytoin for seizure prophylaxis.  The patient was
subtherapeutic on phenytoin 200 mg twice a day and this dose
was increased to 300 mg twice a day on [**9-28**].  The
phenytoin level was 7.0 on the morning of [**9-29**].  The patient
received 300 mg of phenytoin p.o. two times on [**9-29**] in an
attempt to make his level therapeutic and will be continued
on phenytoin 300 mg twice a day.

8.  HYPERTENSION:  The patient's blood pressure was well
controlled on Losartan 100 mg p.o. q. day.

9.  INTRAVENOUS ACCESS:  The patient had a right internal
jugular central venous catheter that was removed on [**9-26**].  The patient will be transferred to the airport with a
right midline intravenous in place as well as a peripheral
intravenous.

10.  DISPOSITION:  The patient is to be transferred on the
morning of [**9-30**] by ambulance to [**Location (un) **] Airport from
which the patient will fly through [**Location (un) **] to [**Last Name (LF) 8875**], [**First Name3 (LF) 8876**],
where the patient will be met by ambulance and taken directly
to [**Hospital 8875**] Hospital.

The patient's physicians can be contact[**Name (NI) **] as follows:

1.  Dr.[**Name (NI) 8877**] email is EWNG@CareGroup@[**University/College 249**] IDDU.
2.  Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 8878**] email is CGORDON2@Caregroup@[**University/College 249**]
IDDU.

DISCHARGE DISPOSITION:   To a hospital in [**Location (un) 8875**] [**Country 8876**].

DISCHARGE INSTRUCTIONS:  The instructions are as laid out in
the Discharge Summary and in conversations between the
accepting physician in [**Name9 (PRE) 8876**] and Dr. [**First Name (STitle) **] here at [**Hospital1 1294**].

DISCHARGE MEDICATIONS:
1.  Protonix 40 mg once a day.
2.  Colace 100 mg twice a day.
3.  Nystatin Oral suspension 5 mg four times a day.
4.  Sinemet 0.5 tablets twice a day.
5.  Tylenol 325 to 650 mg p.o. q. four to six hours p.r.n.
6.  Bisacodyl 10 mg p.o., p.r. q. day p.r.n.
7.  Losartan 100 mg q. day.
8.  Ritalin 10 mg twice a day.
9.  Senna one tablet twice a day.
10. Dexamethasone 8 mg p.o. q. 12.
11. NPH insulin 30 units in the morning and 20 units in the
evening per Regular insulin sliding scale.
12. Dilantin 300 mg twice a day.
13. Warfarin 2.5 mg q. h.s.

CONDITION AT DISCHARGE:   Fair.

DISCHARGE DIAGNOSES:
1.  Glioblastoma multiforme.
2.  Hypertension.
3.  Hyperglycemia.
4.  Change in mental status.
5.  Lower extremity weakness.
6.  Pulmonary embolism.
7.  Hyponatremia.
8.  History of seizure.
9.  Heparin induced thrombocytopenia.





                          [**First Name11 (Name Pattern1) 520**] [**Last Name (NamePattern4) 521**], M.D.  [**MD Number(1) 522**]

Dictated By:[**Last Name (NamePattern1) 2223**]

MEDQUIST36

D:  [**2196-9-29**]  15:38
T:  [**2196-9-29**]  15:51
JOB#:  [**Job Number 8879**]
{'Other pulmonary embolism and infarction,Malignant neoplasm of brain, unspecified,Hyposmolality and/or hyponatremia,Other convulsions,Abnormality of gait,Anticoagulants causing adverse effects in therapeutic use'}


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 a 67-year-old right
handed man from [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**] with a history of glioblastoma
multiforme who was seen by Dr. [**Last Name (STitle) 724**] in clinic on the day of
admission.  Current medical history began in [**2196-5-10**] when he
experienced generalized tonic clonic seizure.  He was found to
have a left frontal mass.  At that time, he also developed a DVT
and had an IVC filter placed.  The mass was eventually resected
on [**2196-6-20**] with pathology consistent for glioblastoma multiforme.
The patient came from [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**] to [**Location (un) 86**] for phase I boron
neutron capture therapy at [**Hospital1 69**].
The patient was lasted treated on [**2196-7-26**] with this procedure.
In the week prior to admission, the patient was noted to be
increasingly somnolent.  He also developed a shuffling gait and
some unsteadiness on his feet and urinary incontinence.  He had
been started on Ditropan XL with improvement of his urinary
incontinence and urinary urgency.  The patient denied headaches,
nausea, vomiting or tonic clonic seizures.  He also denied any
falls.

MEDICAL HISTORY: 1.  Glioblastoma multiforme, status post resection, status
post boron neutron capture therapy on [**2196-7-26**].
2.  DVT, status post [**Location (un) 260**] IVC filter.
3.  Status post right frontal craniotomy for glioblastoma
multiforme on [**2196-6-20**] in [**Last Name (LF) 48047**], [**First Name3 (LF) 16465**].

MEDICATION ON ADMISSION: Dilantin 300 mg q a.m., 200 mg
q p.m., Protonix 40 mg q day, Decadron 8 mg b.i.d., Cozaar 50
mg q day, metoprolol 50 mg q day, hydrochlorothiazide 25 mg
q day, Ditropan XL 10 mg q day and Aquaphor p.r.n.

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient is a physician, [**Name10 (NameIs) **] denies alcohol or
tobacco use. 

### Response:
{'Other pulmonary embolism and infarction,Malignant neoplasm of brain, unspecified,Hyposmolality and/or hyponatremia,Other convulsions,Abnormality of gait,Anticoagulants causing adverse effects in therapeutic use'}
