CHIEF COMPLAINT: Seizure

PRESENT ILLNESS: 55 yo woman with PMH sig for intracranial "aneurysm" diagnosed
in [**Country 532**] 1-2 years ago who has history of episodes suspicious
for seizures which occur every 7-10 days. She has abnormal
sensation of smell that no one else can smell and last up to
several minutes usually per her husband. She had 7 episodes
overnight and complained of a headache at 3AM. Her family gave
her cognac this morning as it is "custom in [**Country 532**]" for these
type of situations. Her daughter and husband deny that she
drinks ETOH. EMS was called and noticed that she had left upward
eye deviation yet intermittently turned to voice and she
intermittently responded to daughter in [**Name (NI) 595**]. She was brought
by EMS and in ambulance vomited x 1 and then had GTC seizure. In
the ED she was noticed to have flaccid LUE and rigid RUE with
twitching of her right arm and right chin. She was given ativan
2 mg x 1 and then intubated and sedated with propofol at 9:30AM.

MEDICAL HISTORY: As above

MEDICATION ON ADMISSION: Tegretol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile   108   148/84   18   intubated
Gen: intubated and sedated
Head: NC/AT, non-icteric, MMM
Neck: no LAD, no carotid bruits
CV: nl S1, S2  regular  (-)MRG
Pulm: CTA bilaterally
Abd: S,NT,ND
Ext: no edema nor rashes

FAMILY HISTORY: 

SOCIAL HISTORY: Visiting from [**Country 532**]
Subarachnoid hemorrhage,Other convulsions
Subarachnoid hemorrhage,Convulsions NEC
Admission Date:  [**2119-1-5**]              Discharge Date:   [**2119-1-7**]

Date of Birth:  [**2063-12-3**]             Sex:   F

Service: NEUROLOGY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Seizure

Major Surgical or Invasive Procedure:
MRI


History of Present Illness:
55 yo woman with PMH sig for intracranial "aneurysm" diagnosed
in [**Country 532**] 1-2 years ago who has history of episodes suspicious
for seizures which occur every 7-10 days. She has abnormal
sensation of smell that no one else can smell and last up to
several minutes usually per her husband. She had 7 episodes
overnight and complained of a headache at 3AM. Her family gave
her cognac this morning as it is "custom in [**Country 532**]" for these
type of situations. Her daughter and husband deny that she
drinks ETOH. EMS was called and noticed that she had left upward
eye deviation yet intermittently turned to voice and she
intermittently responded to daughter in [**Name (NI) 595**]. She was brought
by EMS and in ambulance vomited x 1 and then had GTC seizure. In
the ED she was noticed to have flaccid LUE and rigid RUE with
twitching of her right arm and right chin. She was given ativan
2 mg x 1 and then intubated and sedated with propofol at 9:30AM.

Past Medical History:
As above

Social History:
Visiting from [**Country 532**]

Physical Exam:
Afebrile   108   148/84   18   intubated
Gen: intubated and sedated
Head: NC/AT, non-icteric, MMM
Neck: no LAD, no carotid bruits
CV: nl S1, S2  regular  (-)MRG
Pulm: CTA bilaterally
Abd: S,NT,ND
Ext: no edema nor rashes

Neuro: no commands; coughs spontaneously; grimaces to pain in
all 4 extrmities.
Pupils 2mm and reactive to 1.5mm b/l; EOMI with Doll's eye b/l
with no nystagmus; + corneals (right stronger than left)l face
symmetric with no droop;

Tone decreased in UE b/l; moves right leg spontaneously after
manipulation
Grimaces to noxious stim in all 4 extremities
Coordination and gait deferred

Pertinent Results:
CBC, coags normal. UA negative
Chem7 normal.  CK 357 but MB and troponin negative
Serum and urine tox negative

MRI head: Chronic blood products in the medial right occipital
lobe, and in the left cerebellar hemisphere inferiorly. No
abnormal vascular strictures are seen to indicated underlying
vascular malformation. No abnormal enhancement is seen to
indicate associated enhanced mass lesion. Normal MRA. Compared
with MRI from ~1 1/2 years ago in [**Country 532**], there is less edema.

Brief Hospital Course:
55F with history of intracranial "aneurysm" dx'd ~1 [**1-14**] yrs ago
in [**Country 532**] presents with episodes suspicious for seizures every
~1-2 weeks and now with generalized tonic-clonic seizure.

1. Neuro: Was loaded with phenytoin and did well, with no
further seizures. Was intubated in ED for airway protection, and
was rapidly extubated once in the ICU. MRI showed evidence of
old bleed in occipital lobe, likely from a cavernous angioma,
with less edema than in the previous film done in [**Country 532**]. This
is likely the cause of her seizures and since this is a
structural lesion she will likely need anti-convulsant
medication for the rest of her life.

2. Atypical chest pain: Pt reports intermittent chest pain,
mostly with exertion. Cardiac enzymes showed no evidence of
myocardial infarction. Her chest pain needs to be evaluated by
her primary care physician, [**Name10 (NameIs) **] she will likely need exercise
stress testing to further characterize.

Medications on Admission:
Tegretol prn

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Phenytoin Sodium Extended 100 mg Capsule Sig: varies Capsule
PO twice a day: Take 1 capsule (100mg) in the mornig and take 2
capsules (200mg) at night.

Discharge Disposition:
Home

Discharge Diagnosis:
Seizure disorder, likely secondary to cavernous angioma
Atypical chest pain
Hypertension


Discharge Condition:
Improved, with no neurological deficits.

Discharge Instructions:
Take all medications as prescribed. You will likely need to be
on anti-seizure medications for the rest of your life.

Follow-up with your neurologist and primary care doctor when you
get back to [**Country 532**].

Followup Instructions:
Follow-up with your neurologist in [**Country 532**]. You will likely need
to be on anti-seizure medication for the rest of your life. You
may continue phenytoin or change to something else as your
neurologist decides.

Follow-up with your primary care doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) 532**]. You likely
need an exercise stress test to further evaluate your atypical
chest pain. Continue taking metoprolol.

                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]
{'Subarachnoid hemorrhage,Other convulsions'}


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: 55 yo woman with PMH sig for intracranial "aneurysm" diagnosed
in [**Country 532**] 1-2 years ago who has history of episodes suspicious
for seizures which occur every 7-10 days. She has abnormal
sensation of smell that no one else can smell and last up to
several minutes usually per her husband. She had 7 episodes
overnight and complained of a headache at 3AM. Her family gave
her cognac this morning as it is "custom in [**Country 532**]" for these
type of situations. Her daughter and husband deny that she
drinks ETOH. EMS was called and noticed that she had left upward
eye deviation yet intermittently turned to voice and she
intermittently responded to daughter in [**Name (NI) 595**]. She was brought
by EMS and in ambulance vomited x 1 and then had GTC seizure. In
the ED she was noticed to have flaccid LUE and rigid RUE with
twitching of her right arm and right chin. She was given ativan
2 mg x 1 and then intubated and sedated with propofol at 9:30AM.

MEDICAL HISTORY: As above

MEDICATION ON ADMISSION: Tegretol prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Afebrile   108   148/84   18   intubated
Gen: intubated and sedated
Head: NC/AT, non-icteric, MMM
Neck: no LAD, no carotid bruits
CV: nl S1, S2  regular  (-)MRG
Pulm: CTA bilaterally
Abd: S,NT,ND
Ext: no edema nor rashes

FAMILY HISTORY: 

SOCIAL HISTORY: Visiting from [**Country 532**] 

### Response:
{'Subarachnoid hemorrhage,Other convulsions'}
