CHIEF COMPLAINT: seizures

PRESENT ILLNESS: Ms. [**Known lastname 13712**] is a 53 yo F from Bermuda with no PMHx transferred
from [**Hospital1 18**] [**Location (un) 620**] for new-onset seizure. Patient arrived to US
today; was grocery shopping with her husband this morning when
she suddenly became limp from the waist up and developed
right-sided facial twitch. Per husband she had altered mental
status during episode but never fell or struck head. No urinary
incontinence or tongue biting. EMS was called and she was
transported to [**Hospital1 18**] [**Location (un) 620**] by ambulance. She had two more of
the same seizures in the ambulance.

MEDICAL HISTORY: GERD
Hypercholesterolemia (total 231, trig 111 HDL 70 LDL 139)

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from Patient.
1. Multivitamins 1 TAB PO DAILY
2. Magnesium Citrate Dose is Unknown  PO Frequency is Unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: 98.7 68 145/83 16 100%

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Works as a minister at her church, lives with her husband and
has four children. Social drinker, no tobacco or illicits.
Anomalies of cerebrovascular system,Epilepsia partialis continua, with intractable epilepsy,Hemiplegia, unspecified, affecting nondominant side,Esophageal reflux,Pure hypercholesterolemia,Lipoma of skin and subcutaneous tissue of face,Postprocedural fever,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Constipation, unspecified,Anemia, unspecified
Cerebrovascular anomaly,Epil par cont w intr epi,Unsp hmiplga nondmnt sde,Esophageal reflux,Pure hypercholesterolem,Lipoma skin face,Postprocedural fever,Abn react-surg proc NEC,Constipation NOS,Anemia NOS
Admission Date:  [**2176-7-26**]              Discharge Date:   [**2176-8-9**]

Date of Birth:  [**2122-10-2**]             Sex:   F

Service: NEUROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 7575**]
Chief Complaint:
seizures

Major Surgical or Invasive Procedure:
Right frontal cavernoma resection with Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) **] on
[**2176-7-31**]
Forehead lipoma resection with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1022**] on [**2176-7-31**]


History of Present Illness:
Ms. [**Known lastname 13712**] is a 53 yo F from Bermuda with no PMHx transferred
from [**Hospital1 18**] [**Location (un) 620**] for new-onset seizure. Patient arrived to US
today; was grocery shopping with her husband this morning when
she suddenly became limp from the waist up and developed
right-sided facial twitch. Per husband she had altered mental
status during episode but never fell or struck head. No urinary
incontinence or tongue biting. EMS was called and she was
transported to [**Hospital1 18**] [**Location (un) 620**] by ambulance. She had two more of
the same seizures in the ambulance.

At [**Location (un) 620**], she had two more of these seizures. She received
Ativan in [**Hospital1 **] [**Location (un) 620**] ED and was loaded with 1200mg of Dilantin.
Noncontrast head CT revealed 1x1cm right frontal mass without
associated vasogenic edema. She was transferred to [**Hospital1 18**] [**Location (un) 86**]
for further evaluation.

For the past 2 days, patient has had severe bifrontal headache
that is worse when bending down; not worse at any time of day or
when lying flat. Has taken ASA which is unhelpful for headache.
Has never had headaches like this before. Denies vision change,
blurred vision, tinnitus, weakness/numbness, ataxia, falls.
Endorses social EtOH but no abuse. Denies illicit drugs, h/o
cancer, h/o animal/insect bites.

On arrival to ED, vitals were: 98.7 145/83 68 16 100% RA.
Patient sleepy but opens eyes to voice and answers questions
appropriately. Complains of [**8-23**] frontal headache.

Past Medical History:
GERD
Hypercholesterolemia (total 231, trig 111 HDL 70 LDL 139)

Social History:
Works as a minister at her church, lives with her husband and
has four children. Social drinker, no tobacco or illicits.

Family History:
Noncontributory.

Physical Exam:
Admission Physical Exam:
Vitals: 98.7 68 145/83 16 100%

General: Awake and alert, somewhat anxious.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: Alert and oriented x 3. Able to relate history
without difficulty. Language is fluent with intact repetition
and comprehension. Normal prosody. There were no paraphasic
errors. Speech was not dysarthric. Able to follow both midline
and appendicular commands. The pt had good knowledge of current
events. There was no evidence of apraxia or neglect.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk. Funduscopic exam revealed no
papilledema, exudates, or hemorrhages.
III, IV, VI: EOMI with end-gaze nystagmus b/l. Normal saccades.
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
  Delt Bic Tri WrE FFl FE IO IP Quad Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**]
L  5    5   5   5   5  5  5  5   5    5  5     5     5
R  5    5   5   5   5  5  5  5   5    5  5     5     5

-Sensory: No deficits to light touch throughout.

-Coordination: No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF bilaterally.

-Gait: Deferred

*****
Discharge Physical Exam:
AFVSS
GEN exam: patient with well healing surgical scar across her
head, staples removed. Otherwise unchanged.

Neurological exam:
cranial nerves, strength and sensation intact.
ambulating with cane, gait is cautious but steady.

Pertinent Results:
ADMISSION LABS:
[**2176-7-25**] 10:30PM BLOOD WBC-9.4 RBC-4.25 Hgb-11.8* Hct-36.3
MCV-86 MCH-27.7 MCHC-32.4 RDW-13.0 Plt Ct-317
[**2176-7-26**] 08:54AM BLOOD PT-12.0 PTT-28.5 INR(PT)-1.1
[**2176-7-25**] 10:30PM BLOOD Glucose-92 UreaN-9 Creat-0.7 Na-140 K-4.1
Cl-106 HCO3-28 AnGap-10
[**2176-7-26**] 08:54AM BLOOD Albumin-4.3 Calcium-9.4 Phos-3.4 Mg-2.1
[**2176-7-25**] 10:30PM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG

RELEVANT LABS:
[**2176-7-25**] 10:30PM BLOOD Phenyto-10.2
[**2176-7-26**] 10:00PM BLOOD Phenyto-20.7*
[**2176-7-27**] 05:45AM BLOOD Phenyto-19.8
[**2176-7-28**] 07:40AM BLOOD Phenyto-18.9
[**2176-7-29**] 10:25AM BLOOD Phenyto-23.0*
[**2176-7-29**] 03:45PM BLOOD Phenyto-19.8
[**2176-7-31**] 01:00PM BLOOD Phenyto-22.4*
[**2176-8-1**] 05:11AM BLOOD Phenyto-17.2

IMAGING:
EEG [**2176-7-26**]: This is an abnormal continuous video EEG given the
presence of brief subclinical electrographic seizures over the
right greater than left frontal leads. The seizures were
predominantly appreciated with the onset of the recording at
18:00 hours until midnight. There is a significant reduction
during the morning hours. There was one pushbutton activation
without a clear electrographic correlate. On video, there is
some trembling in the patient's left cheek. The patient however
is able to respond to command. Automated sampling captured some
of the sharper alpha which correlated with the patient's
electrographic events.

EEG [**2176-7-27**]: This is an abnormal continuous video EEG given the
presence of brief subclinical electrographic seizures over the
right greater than left frontal leads. The seizures were
predominantly appreciated in the early portion of the recording.
There is a significant reduction to no seizures appreciated
after the morning hours. There was one pushbutton activation
without a clear electrographic correlate. On video, the patient
is moaning with her family around. Automated sampling captured a
couple of the sharper alpha which correlated with the patient's
electrographic events. The telemetry is significantly improved
from the prior day's recording.

EEG [**2176-7-29**]: This is an abnormal continuous video EEG given the
presence of burst of bilateral frontal and temporal generalized
slowing. This may represents her subcortical dysfunction. There
were no electrographic seizures detected.

MRI BRAIN [**2176-7-26**]: 1.  10 x 6 mm enhancing lesion in the right
frontal lobe, with central intrinsic T1-hyperintensity,
"blooming" susceptibility and adjacent filamentous vascular
structures extending to the nearby dura.  Taken together, these
findings suggest hemorrhage related to underlying cavernous
angioma with possible associated developmental venous anomaly. A
more remote possibility is dural AV fistula, with cortical
venous drainage.  Further evaluation via consultation with
Interventional Neuroradiology service has been recommended.
2.  Expanded sella turcica, with an appearance suggestive of an
"empty sella," a common variant, or possibly, arachnoid cyst of
the suprasellar cistern.
3.  Large frontal subcutaneous lipoma.

CXR [**2176-7-26**]: Normal radiographic study of the chest.

CEREBRAL ANGIOGRAM [**2176-7-29**]: [**Known firstname **] [**Known lastname 13712**] underwent a
diagnostic cerebral angiogram which was grossly normal,
specifically with no evidence of a dural arteriovenous fistula.
Given the pre-procedural imaging, this favours an occult
vascular malformation (ie. cavernoma) as the underlying cause
for the findings on those studies.

MRI [**2176-7-31**]: 1.  Limited pre-operative study redemonstrating the
7 x 7 mm enhancing lesion in the right frontal region consistent
with the previously-characterized cavernous angioma, unchanged
in appearance since [**2176-7-26**].
2.  Large left frontal subcutaneous lipoma.

HEAD CT [**2176-7-31**]: No evidence of postoperative hemorrhage.
HEAD CT [**2176-8-4**]: No evidence of interval hemorrhage from
[**2176-7-31**].
HEAD CT [**2176-8-8**]: Expected evolution of postoperative bed in the
right frontal lobe.  No evidence of new hemorrhage.

Brief Hospital Course:
53 yo RH F who p/w new onset seizure, found to have R frontal
cavernoma. Her seizure was controlled with Keppra and Dilantin,
and patient underwent cavernoma resection for better control of
her seizures. She was monitored in the ICU in immediate post op
setting, but was called out to the floor. She was managed on the
floor and stabilized prior to her discharge.

# Neuro: Patient presented with seizure and found to have right
frontal cavernoma, which was the likely cause of her seizures.
Patient's seizures were typified by leftward gaze, crying spells
and confusion. On admission, patient was noted to be confused
and lethargic, and EEG revealed that she was still having
seizures while on Dilantin. She was loaded with Keppra and her
confusion resolved. Given that her seizures were difficult to
control, discussion was had with neurosurgery and patient
decided to undergo cavernoma resection. Lipoma resection was
done at the same time. Post op course was complicated by
continued headache, but repeat head CTs only showed expected
post op changes and no hemorrhages. Her dilantin was adjusted to
450 mg daily, and her seizures were under control. She was seen
by PT/OT and was discharged home with home PT and home safety
evaluation.

# CV: She was continued on telemetry without events, and her
lipid panel showed slightly elevated LDL, but given no other
risk, she was recommended lifestyle changes for now.

# ID: Patient developed fevers during her post op period, and
was started on IV vancomycin for a few days. However, her blood
cultures were negative and her fevers resolved, so vancomycin
was stopped without further issues. Patient never developed
leukocytosis.

# GI: patient suffered from constipation, likely from decreased
mobility and narcotics during her post op period. Her bowel
regimen was increased, and she was given magnesium citrate,
which has helped her in the past. Her constipation improved with
increased bowel regimen.

# HEME: patient developed progressive anemia after her surgery
for unclear reason. Hemolysis labs were checked and were
negative, and her guaiac was also negative. She was not
transfused RBCs as her HCT remained in high 20s. Her HCT
improved to low 30s without any intervention. Iron studies were
done and did not show iron deficiency.

Medications on Admission:
Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from Patient.
1. Multivitamins 1 TAB PO DAILY
2. Magnesium Citrate Dose is Unknown  PO Frequency is Unknown


Discharge Medications:
1. LeVETiracetam 1500 mg PO BID
RX *Keppra 750 mg 2 tablet(s) by mouth twice a day Disp #*60
Tablet Refills:*2
2. Multivitamins 1 TAB PO DAILY
3. Docusate Sodium 100 mg PO BID
RX *Colace 100 mg 1 capsule(s) by mouth twice a day Disp #*60
Tablet Refills:*0
4. Senna 1 TAB PO BID constipation
RX *senna 8.6 mg 1 tablet(s) by mouth twice a day Disp #*60
Tablet Refills:*0
5. Polyethylene Glycol 17 g PO DAILY
RX *Miralax 17 gram 1 packet(s) by mouth daily Disp #*30 Packet
Refills:*0
6. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation
RX *bisacodyl 5 mg [**1-15**] tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
7. Magnesium Citrate 300 mL PO PRN constipation
8. Acetaminophen 1000 mg PO Q 8H
RX *acetaminophen 500 mg 2 tablet(s) by mouth every 8 hours Disp
#*50 Tablet Refills:*0
9. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain
hold if sedated or RR<12
RX *hydromorphone 2 mg 1 tablet(s) by mouth every 6 hours Disp
#*30 Tablet Refills:*0
10. Ibuprofen 600 mg PO Q8H pain
RX *ibuprofen 600 mg 1 tablet(s) by mouth every 8 hours Disp
#*42 Tablet Refills:*0
11. Phenytoin Infatab 150 mg PO TID
RX *Dilantin Infatabs 50 mg 3 tablet(s) by mouth every 8 hours
Disp #*90 Tablet Refills:*2

Discharge Disposition:
Home With Service

Facility:
Steward Home Care and Hospice

Discharge Diagnosis:
Primary Diagnosis: Right frontal cavernoma s/p resection, lipoma
s/p resection, seizures


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).
Neurologic Status: alert and oriented to self, [**Hospital1 18**] and date.
Strength intact throughout, sensation intact.


Discharge Instructions:
Dear Mrs. [**Known lastname 13712**],
It was a pleasure to take care of you at [**Hospital1 827**]. You were admitted to the hospital because you
had a seizure and then in the ED, you were found to have a
cavernoma in your brain.

Your seizures were controlled with medications, and upon
consultation with neurosurgery, you decided to undergo resection
of the cavernoma as well as the lipoma on your forehead.

Please follow up with Dr. [**First Name (STitle) **] as scheduled below. You will
need a repeat CT of your head prior to your appointment.

Followup Instructions:
Department: RADIOLOGY
When: THURSDAY [**2176-9-5**] at 10:15 AM
With: CAT SCAN [**Telephone/Fax (1) 590**]
Building: CC [**Location (un) 591**] [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Department: NEUROSURGERY
When: THURSDAY [**2176-9-5**] at 11:15 AM
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

Department: NEUROLOGY
When: MONDAY [**2176-9-30**] at 4:00 PM
With: DRS. [**Last Name (STitle) 43**] AND [**Telephone/Fax (1) 112098**]
Building: [**Hospital6 29**] [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Anomalies of cerebrovascular system,Epilepsia partialis continua, with intractable epilepsy,Hemiplegia, unspecified, affecting nondominant side,Esophageal reflux,Pure hypercholesterolemia,Lipoma of skin and subcutaneous tissue of face,Postprocedural fever,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Constipation, unspecified,Anemia, 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: seizures

PRESENT ILLNESS: Ms. [**Known lastname 13712**] is a 53 yo F from Bermuda with no PMHx transferred
from [**Hospital1 18**] [**Location (un) 620**] for new-onset seizure. Patient arrived to US
today; was grocery shopping with her husband this morning when
she suddenly became limp from the waist up and developed
right-sided facial twitch. Per husband she had altered mental
status during episode but never fell or struck head. No urinary
incontinence or tongue biting. EMS was called and she was
transported to [**Hospital1 18**] [**Location (un) 620**] by ambulance. She had two more of
the same seizures in the ambulance.

MEDICAL HISTORY: GERD
Hypercholesterolemia (total 231, trig 111 HDL 70 LDL 139)

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from Patient.
1. Multivitamins 1 TAB PO DAILY
2. Magnesium Citrate Dose is Unknown  PO Frequency is Unknown

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Admission Physical Exam:
Vitals: 98.7 68 145/83 16 100%

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Works as a minister at her church, lives with her husband and
has four children. Social drinker, no tobacco or illicits. 

### Response:
{'Anomalies of cerebrovascular system,Epilepsia partialis continua, with intractable epilepsy,Hemiplegia, unspecified, affecting nondominant side,Esophageal reflux,Pure hypercholesterolemia,Lipoma of skin and subcutaneous tissue of face,Postprocedural fever,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Constipation, unspecified,Anemia, unspecified'}
